Instructions following Total Knee Replacement

Weight Bearing Status

Put as much weight as you can on your operated leg with the help of the walking aid provided by the physical therapist. Initially you start with a walker, with time you will progress on to crutches and then on to a cane. If using a cane, use it on the same side as your knee replacement. Use the appropriate walking aid (as prescribed by your physical therapist) until 4-6 weeks. This prevents you from tripping and falling over while your muscles around the knee recover.

Anticoagulation (Blood Thinners)

Blood thinners help to prevent inflammation of the veins, blood clots and migration of the blood clots to the lungs known as pulmonary embolism. Please be sure you understand the type of anticoagulation recommended to you. This has been started while you were in the hospital. The medication sheet given to you when you are discharged will list the name of the blood thinner medicine which you are taking. Coumadin is prescribed for 3 weeks after the surgery.

If you are on Coumadin, the dose will be ordered by your surgeon if you are going home and your rehab doctor if you are going to a rehab place.

Make sure that once you are home from a rehab centre, and if you are on Coumadin, you have arrangements made for blood drawn twice a week to know the level of the blood thinner following which the doctor would prescribe you further doses of Coumadin.

If you are on Aspirin, you need to take 325 mg of Aspirin twice a day for a total period of 6 weeks (This is of utmost importance). You do not have to have blood drawn on a regular basis for this. You can buy Aspirin over the counter as prescription is not required for this.

If you are on Lovenox, you need to have an injection as directed by your physician

Diet

You need to eat to gain back your strength. You should resume your pre-hospitalization diet unless otherwise instructed.

Exercise and Activity

The exercises consist of the following and should be done by performing five sets of 10 through the course of the day if possible

• Ankle punch.
• Quad sets (pressing the knee down).
• Heel slide; this is the most difficult and will take time to recover, do not be discouraged.
• Straight leg raises, do not do this with any weights.

I recommend that you walk as much as you feel comfortable at least two to three times a day, trying to walk a little further each time. You may walk inside or outside the house as you feel comfortable. My best advice to you during the recovery is to listen to your body. That is, if you feel pain during the exercises or afterwards you have probably overdone it. I also recommend that you ride a stationary bicycle without any resistance as soon as you can comfortably get on the bicycle. After two and a half weeks if the incisions are clean and dry, you may begin to swim

Dressing and Incision care

Have sponge baths until the stitches come out in 2 weeks. If the central pad of the dressing appears soaked from underneath then inform us and come and see us in the office immediately. Make sure you do not immerse the incision in a bath tub. If for any reason the water runs into the incision site, remove the dressing and apply a fresh one. The dressing applied in the hospital (if not soaked by leakage from the wound) can be left on until removed by us in the office.

Pain Medicine: You have been given a prescription for pain medication. Please remember the following:

• Take only what is prescribed by your doctor.
• Take your pain medicine 45 minutes prior to exercise.
• Try to take the medicine before it becomes severe.
• If the medicine does not reduce your pain, call your surgeon.
• If you are taking pain medicine, you MUST avoid alcohol, illicit or illegal drugs.

Frequently Asked Questions:

How long should I use the pain medication?

This is different for each patient. Some are able to use Tylenol or Advil after you leave the hospital and others require narcotic pain medications for two to three weeks. Generally, you should try to decrease the use of medications as time passes.

When should I go to outpatient therapy?

If you are going home then a physical therapist (PT) would come to your home. If you are going to a rehab centre then you would have PT at the rehab place. In either case, you should have physical therapy within a few days following your release from them. If you do not have a prescription for PT, please call your surgeons office and they will provide a prescription and list of places.

When can I go to the dentist?

Not for three months after surgery. As the knee is gently healing and there is increased blood flow to this area, there is a higher risk of infection.

You must take prophylactic antibiotics if any of the following things pertain to you for the next two years.

• Another operation anywhere on your body
• Any dental procedure
• Lung, bladder, or colon endoscopy or any surgical procedure
• If you develop an infection anywhere in your body

Patient with low body defense mechanism (e.g.; Rheumatoid Arthritis, Lupus, Insulin Dependent Diabetes, chemical or radiation induced immuno-supression) need to take prophylactic antibiotics for life.

When can I drive?

You should not drive as long as you are taking narcotic pain medications. If it is your left knee, you can resume driving when you feel a bit more normal ( usually in about three weeks or so as long as vehicle is an automatic). If it is your right knee, I would like to evaluate you at 6 weeks-hence no driving before 6 weeks in cases of surgery to the right knee.

My knee clicks after surgery. Clicking after surgery is normal. The clicking is a result of the metal and the plastic part coming in contact during motion. With time you will get used to it.

I am experiencing a lot of swelling, is it normal?

Fluid can accumulate in the legs due to the effects of gravity. Usually it is not a problem in the hospital, but it gets worse when you go home or rehab because you are doing more. To reduce this you should elevate your legs at night. Lie on your back and place pillows underneath the legs so that they are above the heart. Never place a pillow under your knee at night time as it prevents the knee from becoming straight. However if your ankle and leg swelling does not get better after keeping your leg elevated at night then phone your surgeons office. To reduce swelling in the knee, use an ice pack if your knee swells. Apply for 20 minutes, three times per day.

How long do I have to wear the stockings?

You should wear the stockings on both legs. Have someone help you with them in the morning, wear then throughout the day and then take them off at night. If you did not get the stockings from the hospital you can purchase knee height, medium, compression, surgical stockings from any pharmacy shop. Try to wear them for 6 weeks if possible. This helps to reduce leg swelling and prevent blood clot formation in your legs.

When can I return to work?

It depends on your occupation. It’s never a mistake to take more time off in the beginning of the recovery. That way you can focus on your knee. I recommend taking at least three weeks off following your surgery.

Can I travel?

In general, I would like to see you before you fly. If you are traveling by car you should be sure to take frequent breaks so that you do not feel too stiff in getting up. In an airplane, wear compression stockings and take couple of walks during the flight. Having aisle and bulk head seat will help you get more space.

You must call your physician if you experience any of the following problems

• Drainage from the incision
• Increasing redness of the suture line.
• Temperature over 101 degrees
• Sudden shortness of breath or chest pain or difficulty in breathing.
• Increasing tenderness of thigh or calf or increasing pain.
• Swelling of the knee, calf, or ankle that does not respond to elevation for few hours. The leg and ankle must be elevated above the level of the heart.

Sanjay Gupta, M.D.
Office Tel number: 203 775 6205