If you are a candidate for knee replacement surgery, you probably anticipate that life after the surgery will be much like life before it, only without the pain. In many ways, you are correct. But change doesn’t happen overnight and your active participation in the healing process is necessary to ensure a successful outcome.
Although you will be able to resume most activities, you should avoid activities that place excessive stress on the new knee. The following suggestions will help you adapt to your new joint and resume your daily activities safely.
Activities in the hospital
The knee is the largest joint in the body and replacing it is major surgery. Although you’ll probably want to take it easy at first, early mobilization is important. If you had considerable pain in your knee, you probably cut back on your activities before surgery and your leg muscles may be weak. You’ll need to build up strength in your quadriceps muscles to develop control of your new joint. Early activity is also important to counteract the effects of the anesthesia and to encourage healing. Your doctor and a physical therapist will give you specific instructions on wound care, pain management, diet and exercise. Ask specifically about how much weight you can put on your operated leg.
Proper pain management is important to your early recovery. Although pain after surgery is quite variable and not entirely predictable, it can be controlled with medication. Initially, you will probably receive pain control medication through an intravenous (IV) connection so that you can regulate the amount of medication you need. Remember that it is easier to prevent pain than to control it. You don’t have to worry about becoming dependent on the medication; after a day or two, injections or pills will replace the IV.
In addition to pain medication, you will also have to take antibiotics and blood thinning medication to help prevent blood clots from forming in the veins of your thigh and calves.
You may lose your appetite and feel nauseous or constipated for a couple of days. These are normal reactions. You may be fitted with a urinary catheter during surgery and be given stool softeners or laxatives to ease the constipation caused by the pain medication after surgery. You will be taught to do breathing exercises to prevent congestion from developing in your chest and lungs.
Initially, you will have a bulky dressing around the knee and a drain to remove any fluid build-up around the knee. The drain will be removed in a day or two. You may also be wearing elastic hose and, possibly, compression stocking sleeves. These plastic sleeves are connected to a machine that circulates air around your legs to help keep blood flowing normally.
Usually, a physical therapist will visit you on the day after your surgery and begin teaching you how to use your new knee. You may be fitted with a continuous passive motion (CPM) machine that will slowly and smoothly straighten and bend your knee. Even as you lie in bed, you can “pedal” your feet and “pump” your ankles on a regular basis to promote blood flow in your legs.
Your hospital stay may last from 3 to 7 days, depending on how well you heal after surgery. Before you go home, you will need to meet several goals:
- Get in and out of bed by yourself.
- Bend your knee approximately 90 degrees, or show good progress in bending your knee.
- Extend (straighten) your knee fully.
- Walk with crutches or a walker on a level surface and to climb up and down 2 or 3 stairs.
- Do the prescribed home exercises.
You may experience mild swelling in your leg after you are discharged. Elevating the leg, wearing compression hose and applying an ice pack for 15 to 20 minutes at a time will help reduce the swelling. You may be permitted to take the CPM machine home with you for a few weeks, but this is not a substitute for the prescribed exercises.
You will probably need some help at home for several weeks. If you do not have sufficient help at home, you may be temporarily transferred to a rehabilitation center. The following tips can make homecoming more comfortable:
- Rearrange furniture so you can maneuver with a walker or crutches. You may temporarily change rooms (make the living room your bedroom, for example) to avoid using the stairs.
- Remove any throw or area rugs that could cause you to slip. Securely fasten electrical cords around the perimeter of the room.
- Install a shower chair, gripping bar and raised toilet seat in the bathroom.
- Use assistive devices such as long-handled mops, brooms, dustpans or reachers to do simple chores that would involve bending, stooping, or twisting. Do not run the vacuum cleaner or sweeper.
- Use a rolling cart to transport items.
- A footstool is useful for keeping your operated leg straight out in front of you when you sit. Wear a big-pocket shirt or soft shoulder bag for carrying things around.
- Set up a “recovery center” in your home, with phone, television remote control, radio, facial tissue, wastebasket, pitcher and glass, reading materials and medications within reach.
Care at Home
- Keep the area clean and dry. A dressing will be applied in the hospital and should be changed as necessary. Ask for instructions on how to change the dressing if you are not sure.
- Sutures will be removed in two to three weeks and X-rays will be taken to ensure that the joint is healing properly. Until then, do not shower or bathe; instead, do a simple sponge bath.
- Notify your doctor if the wound appears red or begins to drain.
- Take your temperature twice daily and notify your doctor if it exceeds 100.5ºF.
- Swelling is normal for the first three to six months after surgery. Elevate your leg slightly and apply an ice pack for 15 to 20 minutes at a time.
- Warning signs – calf pain, chest pain or shortness of breath are signs of a possible blood clot. Notify your doctor immediately if you notice any of these symptoms.
Take all medications as directed. You will probably be given a blood thinner to prevent clots from forming in the veins of your calf and thigh because these clots can be life-threatening. If a blood clot forms and then breaks free, it could travel to your lungs, resulting in a pulmonary embolism, a potentially fatal condition.
Because you have an artificial joint, it is especially important to prevent any bacterial infection from settling into your joint implant. You should get a medical alert card and take antibiotics whenever there is a possibility of a bacterial infection, such as when you have dental work. Be sure to notify your dentist that you have a joint implant and let your doctor know if your dentist schedules an extraction, periodontal work, dental implant or root canal work.
By the time you go home from the hospital, you should be eating a normal diet. Your physician may recommend that you take iron and Vitamin C supplements. Continue to drink plenty of fluids and avoid excessive intake of Vitamin K while you are taking blood thinner medication. Foods rich in Vitamin K include:
- Garbanzo beans
- Soybean oil
- Turnip greens
Try to limit your coffee intake and avoid alcohol. You should continue to watch your weight to avoid putting more stress on the joint.
Resuming Normal Activities
Once you get home, you should continue to stay active. The key is not to overdo it! While you can expect some good days and some bad days, you should notice a gradual improvement over time. Generally, the following guidelines will apply:
- Driving: Do not drive until your doctor says you may. Do not enter a car while standing on a curb or step. Avoid long car rides. Avoid cars with deep bucket seats or low seats. Sit on a pillow to raise the seat height.
- Exercise: Your knee is designed for low impact exercises like walking and bike riding. Talk to your physician before beginning high impact activities like jogging. Also, avoid excessive twisting at the knee as would be done with gardening.
- Sexual relations: Ask your doctor before resuming sexual relations.
- Sleeping positions: Lie on your back when resting in bed. Keep a pillow between your thighs to prevent your knees from touching. You must have a pillow between your thighs if you lie on your side.
- Sitting: For at least the first three months, sit only in chairs that have arms. Do not sit on sofas, soft chairs, stools, or rocking chairs. Do not cross your legs. The physical therapist will show you how to sit and stand from a chair, keeping your operated leg out in front of you. Get up and move around on a regular basis, at least once every hour. Sit while preparing food.
- Bathing: You may use a walk-in shower. Otherwise, take sponge baths or purchase a tub bench.
- Stairs: Stair climbing should be avoided, if possible, until healing is complete. If you must go up stairs:
- The unaffected leg should step up first
- Then bring the affected leg up.
- Then bring your crutches or cane up
- To go down stairs, reverse the process:
- Put your crutches or cane on the lower steps
- Next, bring the affected leg forward
- Finally, step down on the unaffected leg.
- Return to work: Depending on the type of activities you perform, it may be three to six months before you can return to work.