What is the recovery time?
Everyone heals from his or her surgery at a different pace. In most cases, however, you will be restricted to using a walker or crutches for one month after your operation. You will then be allowed to advance to a cane outdoors and no support around the house for several weeks. You will gradually return to normal function without any assistive devices. You will use an assistive device until you can walk without a limp. This usually takes about three months but can take longer.
When will my stitches be removed?
Approximately 10 to 14 days postoperatively. This may be done by a visiting nurse (if you are at home) or rehabilitation staff (if you are at a rehab facility). Some surgeons use stitches that dissolve and do not need to be removed. Your surgeon and nurse will instruct you in this. If your surgeon used nonabsorbable sutures, they are usually removed by a visiting nurse, at your surgeon's office or by a local physician 10 to 14 days after surgery.
How long do I need to keep a bandage on my incision?
Approximately one week or until there is no drainage from the incision. This should be changed daily to a new, dry sterile gauze. If desired, you may continue to wear a bandage to protect the incision from irritation (clothing, compression stockings, etc.).
When should I wear a knee immobilizer? When can I discontinue it?
If your physician orders a knee immobilizer, it should be worn when sleeping and walking, until you are able to independently perform a straight leg raise. Most patients only use this for about one week postoperatively. However, if you wish to wear it for comfort, you may also use it at night for several weeks.
When can I shower (get the incision wet)?
Five days after your operation, if no drainage is present at the incision. (Initially, try to keep the incision dry with plastic wrap.) If it gets wet, pat it dry.
When can I immerse my knee in water (e.g., bath, swimming pool, ocean, hot tub)?
Typically, you should not swim or get in a hot tub for six weeks. However, some surgeons allow their patients to do so after two weeks if there is no drainage. Check with your surgeon.
How long will I be on pain medication?
You will likely require some form of pain medication for about three months. Initially, you will be on a strong oral pain medication (such as a narcotic). Most people are able to wean off their strong pain medication after one month and are able to switch to an over-the-counter pain medication (such as Tylenol or ibuprofen). If you are on Coumadin (warfarin), avoid taking any NSAIDs (e.g., aspirin, ibuprofen, Anvil, Motrin, Aleve, Naprosyn) without first consulting with your internist.
Will I go to a rehabilitation facility or home?
It depends. Most people are able to go home after their operation. However, you may go to a rehabilitation facility in order to gain the skills you need to return home safely. Many factors will be considered in this decision. These include availability of family or friends to assist with daily activities, home environment, safety considerations, postoperative functional status as evaluated by a physical therapist in the hospital and overall evaluation by our hospital team.
Do I need a physical therapist?
Yes! The physical therapist plays a very important role in recovery. You will see a physical therapist soon after your operation and throughout your stay at the hospital. If you go home, you will likely have a therapist come to visit you (usually two to three times a week). Sometimes you will be referred to an outpatient physical therapist. If you go to a rehabilitation facility, you will receive therapy there. Your therapist will keep your surgeon informed of your progress.
How often should I use a CPM (continuous passive motion) machine? What settings should I use?
If you have been given a CPM, you will use it about six hours per day. This may be divided any way you wish. For example, you can use it three times a day for two hours. The setting for flexion (bending the knee) can be increased daily as tolerated. Your surgeon and therapist will inform you how to set the machine upon your discharge from the hospital.
What exercises should I do?
You will be instructed by your physical therapist on appropriate exercises and given a list to follow. In general, swimming and stationary bicycles are good exercise options. These should be continued indefinitely even after your recovery is complete. Do not begin using a stationary bike or swimming until four weeks after your surgery or until you have been seen by your surgeon.
What are good positions for my knee? what positions should I avoid?
You should spend some time each day working on strengthening your knee (extension) as well as bending your knee (flexion). A good way to work on extension is to place a towel roll underneath your ankle when you're lying down. A good way to work on flexion is to sit on a chair or stationary bicycle and bend your knee. Avoid using a pillow or a towel roll behind the knee for any length of time.
Can I use weights?
Generally not for the first two months. However, as everyone's strength varies, consult with your physical therapist before using weights. Use light weights to begin with and gradually progress from 1 pound to a minimum of 5 pounds.
How long will I be on a blood thinner?
Typically, you will be on Coumadin (warfarin) as a blood thinner. This medication is used to help prevent blood clots. Some surgeons may order a dose of Coumadin the night before surgery and continue you on Coumadin while in the hospital. You might stay on Coumadin for four to six weeks or switch over to aspirin. This will be decided prior to your discharge from the hospital. If you are on aspirin, you will be on this for 12 weeks. You may want to consider talking to your internist about the benefits of continuing aspirin after 12 weeks.
How long should I take iron supplements?
Four weeks is usually sufficient. These supplements help your body replenish its iron stores, which may be depleted postoperatively.
I am constipated. What should I do?
It is very common to have constipation postoperatively. This may be due to a variety of factors, but is especially common when taking narcotic pain medication. A simple over-the-counter stool softener (such as Colace) is the best prevention for this problem. In rare instances, you may require a suppository or enema.
When can I drive?
If you had surgery on your right knee, you should not drive for at least one month. After one month, you may return to driving as soon as you feel comfortable. If you had surgery on your left knee, you may return to driving as soon as you feel comfortable as long as you have an automatic transmission. DO NOT DRIVE IF TAKING NARCOTICS! Some surgeons do not allow their patients to drive until they have seen them back in their office four to six weeks after surgery. Check with your surgeon.
When can I return to work?
This depends on your profession. Typically, if your work is primarily sedentary, you may return after approximately one month. If your work is more rigorous, you may require up to three months before you can return to full duty. In some cases, more time may be necessary.
When can I travel?
You may travel as soon as you feel comfortable. It is recommended that you get up to stretch or walk at least once an hour when taking long trips. This is important to help prevent blood clots.
Will I set off machines at airport security? Do I need a doctor's note about my surgery?
You may set off the machines at airport security depending on the type of knee implant you have and the sensitivity of the security checkpoint equipment. At your follow up visit, you may ask to have a wallet card to carry with you for travel.
What activities are permitted following surgery?
You may return to most activities as tolerated, including walking, gardening, golf and doubles tennis. Some of the best activities to help with motion and strengthening are swimming and a stationary bicycle.
What activities should I avoid?
You should avoid impact activities such as running, downhill skiing on expert slopes and vigorous racquet sports, such as singles tennis or squash. Some surgeons allow more vigorous activities. Check with your surgeon.
Can I have sex?
Yes, as soon as you feel comfortable.
Can I drink alcohol?
If you are on Coumadin, avoid alcohol intake. Otherwise, use in moderation at your own discretion. You should avoid taking narcotics or other medications.
How long should I use compression stockings (TEDs)?
These should be used for the first several days, particularly if you have a lot of swelling or discomfort. Some surgeons allow the use of heat. Once the initial swelling has decreased, you may use ice or heat. Check with your surgeon.
Can I go up and down stairs?
Initially during your recovery period, leading up with the good (non operated) leg and down with the bad (operative side) is the preferred method for negotiating steps. After a few months, alternating steps will help strengthen both sides.
Can I kneel?
After about two months, you may try to kneel. Although this may be uncomfortable initially, you will not injure your knee replacement by kneeling. Most people find the more you kneel, the easier it gets. You may find it more comfortable to use a kneeling pad.
Should I use ice or heat?
Ice should be used for the first several days, particularly if you have a lot of swelling or discomfort. Some surgeons allow the use of heat once the initial swelling has decreased. Check with your surgeon.
What should I expect for my range of motion at six weeks? At one year?
Everyone's range of motion varies and depends on individual factors. Your potential will be determined at the time of your surgery. In most cases, you will have at least 90 degrees of flexion and full extension by six weeks. At one year, you may have up to 125 degrees of flexion, but 105 to 110 degrees is usually satisfactory.
How much range of motion do I need?
Most people require 70 degrees of flexion (bending the knee) to walk on level ground, 90 degrees to ascend stairs, 100 degrees to descend stairs and 105 degrees to get out of a low chair. You should also come to within 10 degrees of being fully straight to function well.
I think my leg feels longer now. Is this possible?
For the large majority of cases, your leg length will be essentially unchanged. In rare cases, however, you may notice a change in leg length. This is more common when a severe deformity of the knee exists before surgery. At first, this may feel awkward. However, you will gradually become accustomed to your new knee and length. Occasionally, a shoe may be prescribed for you.
Do I need antibiotics before dental work or an invasive procedure?
Yes. You will be given a letter explaining this in detail at your first follow-up visit. Avoid any dental cleaning or non urgent procedures for six weeks postoperatively.
I feel depressed. Is this normal?
It is not uncommon to have feelings of depression after your knee replacement. This may be due to a variety of factors, such as limited mobility, discomfort, increased dependency on others and medication side effects. Feelings of depression will typically fade as you begin to return to your regular activities. If your feelings of depression persist, consult your internist.
I have insomnia. Is this normal? What can I do about it?
This is a very common complaint following knee replacement surgery. Nonprescription remedies such as Benadryl or melatonin may be effective. If this continues to be a problem, medication may be prescribed to you.
How long will my total knee replacement last?
This varies from patient to patient. For each year following your knee replacement, you have a 1 percent chance of requiring additional surgery. For example, at 10 years postoperatively, there is a 90 percent success rate.
When do I need to follow up with my surgeon?
Follow-up appointments should be made postoperatively at four to six weeks, one year, two years, five years, seven years and 10 years.
Normal things about your new knee:
- Clicking noise with knee motion
- Skin numbness on the outer (lateral) part of your knee
- Swelling around knee or lower leg
- Warmth around knee
- "Pins and needles" feeling at or near your incision
- Dark or red incision line
- Increased bruising if on Coumadin
- Bumps under the skin along the incision. Occasionally, the sutures used to close the wound can be felt.
Abnormal things about your new knee (call the surgeon if you experience any of these):
- Increasing redness, particularly spreading from incision
- Increasing pain and swelling
- Fevers (above 101 degrees)
- Persistent drainage from your wound
- Calf swelling or pain, particularly associated with ankle motion
- Ankle swelling that does not resolve or decrease overnight
- Bleeding gums or blood in urine/stool
What is arthritis and why does my knee hurt?
The knee joint consists of three layers of smooth cartilage. The layers are on the lower end of the thighbone (femur), the upper end of the shinbone (tibia), and the undersurface of the knee cap (patella). This cartilage serves as a cushion. It allows for smooth motion of the knee. Arthritis is a wearing away at this smooth cartilage. This cushion can wear down to bone. Rubbing of bone against bone causes discomfort, swelling, and stiffness.
What is a total knee replacement?
A total knee replacement is a cartilage replacement with an artificial surface. The knee itself is not replaced. However, an artificial substitute for the cartilage is inserted on the end of the bones. This is done with a metal alloy on the femur and plastic spacer on the tibia and kneecap (patella). This creates a new smooth cushion and a functioning joint that does not hurt.
What are the results of a total knee replacement?
Ninety to ninety-five percent of patients have good to excellent results with relief of discomfort after the surgery. Most patients can significantly increase activity and mobility.
When should I have this type of surgery?
Your orthopedic surgeon will decide if you are a candidate for the surgery. This will be based on your medical history, exam, X-rays, and response to conservative treatment. The decision will then be yours.
Am I too old for this surgery?
Age is not a problem if you are in good health and have the desire to continue living a productive, active life. You may be asked to see your personal physician regarding your general health and readiness for surgery. We have performed total knee replacement surgery on patients ages 18 to 100.
How long will my new knee last and can a second replacement be done?
We expect most knees to last more than 10 to 15 years. However, there is no guarantee. A second replacement or revision may be needed.
Will I notice anything different about my knee?
Yes. You may have a small area of numbness to the outside of the scar. This may last a year or more. It is not serious. Kneeling may be uncomfortable for a year or more. Some patients notice some clicking when they move their knee. This is the result of the artificial surfaces coming together. It also is not serious, or any cause for concern.
More than 600,000 people go through total joint replacement surgery every year. Candidates are those with chronic joint pain from arthritis. The pain interrupts daily activities, walking, exercise, recreation, and work. The surgery helps to relieve pain, and helps restore your independence and gets you back to work and other daily activities.
Total joint replacement patients recover quickly. Patients will be able to walk the day of surgery. Generally, patients are able to return to driving in two to four weeks, dance in four to six weeks, and golf in six to 12 weeks.
What are the major risks?
Most surgeries go well, without any complications. However, infection and blood clots are two serious complications that can occur. To avoid these complications, you will be prescribed antibiotics while in the hospital and medications to thin the blood. Special precautions are taken in the operating room to reduce the risk of a surgical infection. The chances of this happening in your lifetime are one percent or less. A more common risk is dislocation of your surgical hip. Hip dislocation is more common with posterior hip replacements. Your doctor will discuss ways to reduce this risk.
Should I exercise before the surgery?
Yes. You should either consult an outpatient physical therapist or follow the exercises listed in your notebook. Exercises should begin as soon as possible (avoid the affected extremity if it is causing more pain or swelling).
How long am I incapacitated?
In most cases, patients will ambulate within a few hours after leaving the recovery room. We encourage sitting up post-operative day one in a chair or recliner for all meals. In addition, you will be encouraged to ambulate with a walker or crutches a couple of times a day on postoperative day one.
How long will I be in the hospital?
Most total joint patients will be hospitalized for one to two days after surgery. There are several goals that you must meet before you can be discharged.
What if I live alone?
In most cases, you will be able to go home directly from the hospital and safely get around your house without help. An outpatient physical therapy appointment or home physical therapy appointment will be made depending on your needs. On the rare occasion that you are unable to manage at home safely, a Nurse Case Manager will discuss your options with you.
How do I arrange for surgery?
In most cases a referral will be sent from your surgeon’s office to your primary care physician’s office notifying them that you will be having total joint replacement. If you have questions or concerns, feel free to speak with the scheduler at your surgeon’s office and they will be able to further direct you.
How long does the surgery take?
We reserve approximately two- to two-and-a-half hours for surgery. Some of this time is taken by the operating room staff to prepare for the surgery. Your surgeon is a great source for a more specific timeframe.
Do I need to be put to sleep for this surgery?
You may have a general anesthetic, which most people call “being put to sleep.” Some patients prefer a spinal or epidural anesthetic, which numbs your legs only and does not require you to be asleep. The choice is between you and your anesthesiologist. For more information: read “Anesthesia and You” in the appendix section of this guide.
Will the surgery be painful?
You will have discomfort following the surgery. We will keep you as comfortable as possible with the correct medication. Pain will slowly decrease and you will be able to wean off your pain medication. Please remember each patient responds to pain differently. If your pain is not tolerable once you are discharged to home, please call the surgeon’s office.
Who will be performing the surgery?
Your orthopedic surgeon will do the surgery. An assistant helps during the surgery.
Will I need a private nurse?
No. For about two to six weeks we do recommend that you use a walker, a cane or crutches. The total joint team can help arrange for them if necessary.
Will I need a walker or crutches?
In most cases, we do recommend that you use a walker, a cane, or crutches for the first several weeks. Your therapist and surgeon will help you decide if you need an assistive device. Case Management will help arrange for equipment if needed. Please do not purchase these items prior to your hospital stay, insurance may not reimburse you.
Where will I go after discharge from the hospital?
Most patients are able to go directly home after discharge. In the case that you are unable to go home safely, the surgeon and case management team will discuss options with you.
Will I need help at home?
Not necessarily. For the first several days, it can be helpful for someone to prepare meals, and handle other household tasks. If you go directly home from the hospital, the total joint team may arrange a home health nurse to come to your house if needed. Many patients discharge home with home health physical therapy only. Preparing ahead of time, before your surgery, can reduce the amount of help needed. Having the laundry done, house cleaned, yard work completed, clean linens put on the bed, and single portion frozen meals will reduce the need for extra help.
What physical/recreational activities may I participate in after my recovery?
You are encouraged to participate in low-impact activities such as walking, dancing, golf, hiking, swimming, bowling, doubles tennis, and gardening.
Will I need physical therapy when I go home?
Yes. You will have either outpatient or in-home physical therapy. Patients are encouraged to attend outpatient physical therapy. If you need in-home physical therapy, we will arrange for therapy and provide you with the contact information of the company. The length of time required for home therapy differs with each patient.
When will I be able to get back to work?
This is based on each individual’s job and progress. If your job is more sedentary such as office work, you may return as early as two to three weeks after surgery, with crutches. Individuals who have a much more strenuous job may require two to three months of rehab before returning to work. A physical therapist can make suggestions for joint protection and energy management on the job.
How often will I need to see my doctor following the surgery?
One to two weeks after discharge, you will be seen for your first postoperative office visit. The schedule of follow-up visits will depend on your progress. Many patients are seen at six weeks, 12 weeks, and then yearly. Your surgeon will let you know what is recommended as it can differ with each patient.
When can I have sexual intercourse?
There are no true restrictions with sexual activity; normally you may resume when your joint feels comfortable enough. Further discussion resuming sexual intercourse should be discussed with your doctor.
Will I need any other equipment?
Most patients are stable with a walker for the first few weeks after surgery. Purchase of a 3:1 commode or shower can be done prior to surgery if you feel it will be beneficial. This equipment can be purchased at a medical supply store or online. Most insurance companies do not cover this equipment. You may call your insurance for further information. With a knee replacement, you have the option to purchase an ice-cooling unit — again this is generally not covered by insurance. You may use gel ice packs in place of this unit — the purchase of four to six flexible ice packs should be sufficient to reduce pain and inflammation.
Will I receive a card stating that I had joint replacement surgery?
Yes, you may receive a card that states you had a joint replacement. You may carry the card with you. However, when you go to the airport you will still have to be scanned and you will set off the alarms. If you ask to go through the body scanner right away, it will help prevent any further delays.
How long until I can drive and get back to normal?
Driving depends on the type of surgery performed and whether it was the right or left extremity. The right side may require a longer delay in driving. The left side will depend on type of car. If you have an automatic, you could be driving again within two to four weeks. “Getting back to normal” will depend on your progress. Ask your doctor or therapist for their advice on your activity. However, you may never drive under the influence of narcotic pain medicine, if pulled over while under the influence of narcotics you can be charged with a DUI.
Will I be eligible for a temporary disabled placard?
Yes, you will be eligible for a temporary disabled placard for about six to eight weeks postoperatively.
What time should I arrive to the hospital?
You will be asked to come to the hospital one-and-a-half to two hours before the surgery time. Please arrive at the time provided. This gives the nursing staff time to start IVs, prep you for surgery, and answer any additional questions.