General Post-Operative Instructions
Following total knee arthroplasty, you will be involved with several care providers. Our office will coordinate physical therapy and home health to make sure that your surgery has been a success and you obtain maximum benefit from this procedure. I routinely use a rotating platform knee (knees that bend and rotate).
To learn more about your knee, click on the following link: http://orthoinfo.aaos.org/topic.cfm?topic=A00221
Home health personnel will follow up with you after you have arrived home. These nurses will help you with wound care and follow up laboratory work. Wounds will typically turn a little red around your staples or sutures. Some swelling is expected. Bruising may extend down the leg into the calf. These things are common after such a major surgery. Home health nurses are trained to look for excessive swelling, redness and drainage, which could indicate an infection.
Computer-navigated total knee patients will notice two small incisions on the front part of their leg. Pins are placed in the tibia during the surgery to allow the computer to "see". These should be treated like any other wounds and should heal uneventfully. Many therapists are not familiar with this technique and may ask you why they are there. Simply smile and say that your knee was done with computer navigation to ensure that the position of the knee is as precise as possible.
Physical Therapy And Exercise
Physical therapy will have begun in the hospital, and your therapy at home is essential to improving the motion and function of your new knee. It is my experience that concentrating on full extension in the early period is very important. The knee feels better bent, and this is normal. Extension or straightening of the knee is painful at first, but it is necessary for you to do this in order to reach maximum benefit. Work on this by resting the heel on a stool while sitting in a chair or on the side of the bed. You will feel the stretch in the back of the knee, and it will become more comfortable after a few days. Good extension will allow good flexion or bending as time progresses.
Your preoperative class introduced you to other exercises you will be doing now that surgery has been completed. These exercises are not only to be done with the therapist, but also on your own at home.
Total knee physical therapy link: http://orthoinfo.aaos.org/booklet/view_report.cfm?Thread_ID=16&topcategory=Knee
Gentle exercise is also important. Walking is done initially with a walker for balance, and the transition to walking with a cane is made as soon as possible. Your physical therapist will help you with this transition. Before long, you will be walking again on your own without aids. These transitions should be done when you feel comfortable and balanced. It is especially important that you avoid falling and injuring yourself during this time.
CPM machines or continuous passive motion machines are not routinely needed after total knee replacements. They are expensive to rent, and there is no documented long term benefit on motion of your new knee with these devices.
Any questions should be directed to your physical therapist. Many questions can be answered with physical therapy link listed above. Of course, any concerns you may still have should be directed directly to the office.
Joint arthroplasty patients are given antibiotics before surgery and for twenty-four hours after the surgery. In rare cases, antibiotics may be given for a longer time period after the surgery while you are in the hospital. This is usually done for patients who are obese or have diminished wound healing properties because of chronic medical problems. Very rarely, short courses of antibiotics by mouth may be administered after the surgery for continued wound drainage.
You will receive a prescription for pain medication during the postoperative period. Narcotics are used for the first three weeks, if needed. Please direct all medication needs to me during office hours or during our first post op visit. Some medicines cannot be "called in" to the pharmacy and require a prescription from me to be filled by your pharmacist.
Special Instructions And Concerns
You will be taking blood thinners after your surgery. Compression stockings on each leg should remain in place until your blood thinning medication is discontinued. Lab work is done to ensure that the medicines given to thin the blood are adjusted to the correct dose. I will monitor these values and adjust your dose accordingly during the post-operative period. You will begin taking the blood thinner immediately after your surgery and continue for a period of twenty-one days. Some patients will be given injections to take. These may be administered by a home health nurse or a family member. These medicines help prevent the development of blood clots, but do not eliminate this potential complication.
Swelling of the Calf
Calf swelling may indicate a blood clot, and you should contact me immediately if you notice this. I may order an ultrasound to look for this. Again, our office should be called if you have any questions or concerns.
Any infection of the sinuses, urinary tract, skin, teeth or other area requires prompt medical attention to avoid the complication of a late joint infection. Contact your primary care provider immediately if you suspect you are suffering from one of the above conditions.
You will need antibiotics prior to dental cleanings or any other invasive procedures for the first two years after your surgery. Communicate to your dentist that you have a new joint and you require antibiotics prior to your visit. A protocol of antibiotic coverage for dental procedures is listed on the following link: http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=364&topcategory=Patient%20Safety