Total Knee Replacement is a resurfacing of the knee with metal and plastic components which are inserted through a knee incision to resurface the exposed bone; designed to relieve weight bearing pain, rebalance the knee, and improve knee function. The procedure is performed on an inpatient basis (discharged 1-3 days after surgery). You will require someone at home to assist you initially after discharge.
The incision will be 6-8 inches in length, is sutured with absorbable suture and skin glue and covered with a gauze dressing. Schedule an office appointment for about 7-10 days from your surgery so the wound can be checked. Usually, the nurses will send you home with extra dressings. You may change the dressing every 3 days until the wound is healing well about 5-7 days. (Remove dressings carefully to avoid skin abrasions). By 5-7 days after surgery if the wound is dry without drainage you may get the incision wet and leave the wound open to air. Any wound drainage should be reported to our office. You may shower with the waterproof dressing. Some swelling, bruising and warmth is expected after surgery. If you develop increased redness, drainage, or a fever, CALL THE OFFICE. Bruising around the thigh/knee area is not uncommon. This may even extend down the leg to the shin and ankle/heel area and will resolve in over 3-4 weeks.
You will be provided with a prescription for a pain medication when you are ready to leave the hospital. Usually, we will prescribe hydrocodone, hydromorphone, or oxycodone. These are generic names for three different narcotic pain relievers. If you are aware of a certain pain medication that you have previously had problems with or one that you normally respond favorably to, please inform us so that we can give you the appropriate prescription. You may have the prescription prior to surgery to avoid filling it the day of surgery.
You might also be given a prescription for an anti-inflammatory medication Toradol (ketorolac) that will help lessen pain and swelling. If not, you are welcome to use an over-the-counter anti-inflammatory such as Ibuprofen (Advil, Nuprin, etc.). These come in 200-mg tablets. The usual maximum adult prescription dosage is 400-600 mg 3-4 times per day, usually taken with food. This would amount to taking 9-12 store tabs per day. The anti-inflammatory medicine can be taken on a regular basis along with the prescription pain medication, which is utilized on an as needed basis. You will find that the combination will lessen your need for the prescription pain pill. If you have a history of ulcers or of stomach irritation with aspirin or anti-inflammatory drugs, then you should avoid taking these medications. If you have high blood pressure you should check your blood pressure to be sure these medications do not cause an elevation in your pressure. If you have kidney problems you should avoid these medications.
Plain Tylenol is OK if you have no liver disease. Remember, the short acting pain pills often have acetaminophen (Tylenol) in them. The maximum daily dose of Tylenol if you have a normal liver is 3500-4000 mg. If your narcotic pain medicine is not lasting long enough you can use a little more or use if less often as long as you do not overuse the maximum daily acetaminophen dose.
If you have a history of nausea with surgery we can prescribe an anti-nausea medication (Phenergan or Zofran). Try to take this medication regularly at first and prior to taking the narcotic pain pills to allow it to be most effective.
Please try to anticipate the need for any refills on your pain medication, and contact our office early in the day the day before running out completely. I cannot provide prescription refills after business hours or on weekends.
Swelling around the knee and down the leg to the foot and ankle region is NORMAL. Reducing the swelling as much as possible will improve comfort and mobility. The following will help to reduce swelling. Wear the TED stockings (white) for 2-4 weeks after surgery. For the first couple weeks when you go to bed, elevate your leg on 1-2 pillows (so that the knee is above the level of your heart). Also, 3 or 4 times during the day, lie flat on your back with your leg above the level of your heart (on 1-2 pillows) for 1/2 hour. The ice should be replaced every 2-3 hours for the first 24 hours. Protect the skin from direct contact with the ice pack. (Not necessary to change as often during sleep hours.) After the first 24 hours apply refreshed ice pack on the knee, 3 or 4 times a day for 20-30 minutes. The ice and elevation may be helpful up to 2-3 weeks after surgery. If you feel the swelling is excessive you should call the office.
Upon discharge from the hospital, you will be walking with the assistance of a walker or crutches. Generally walking and bending the knee is good, pain or discomfort will limit your activity. You may discontinue using the walker or crutches when you feel comfortable and walk without a limp, on the average within 3-4 weeks (may use a cane or single crutch if desired). You may go up and down stairs as needed and physical therapy will help with some tricks until flexibility allows normal stairs. After 2 weeks enough flexibility should be established to bend the knee while going up or down stairs.
In order to reduce stiffness and obtain maximum function of your knee, it is important to maintain a good balance of rest and exercise. Listen to your body; too much activity will produce increased swelling and/or pain; too little activity could prolong your recovery and/or limit your knee mobility. The physical therapist should provide you with leg and knee exercises. To promote circulation, remember to do your ankle/foot stretching exercises regularly.
Sitting in a chair so that your foot is off the floor, (may use a phone book) cross your legs at the ankles (good one over operated one)- push back leg with front leg until a stretch is felt and hold for 15 seconds. Relax. Raise foot of operated leg, straightening it out and hold for 15 seconds. Repeat 15 times. Do this 3-4 times a day. Continue these exercises until you return to your normal activities.
Note: Walking and normal activities will NOT harm the implants, they are stable.
These are averages, remember that each case is individualized, depending on your general health, age, and attitude. For 3-4 weeks after surgery, your activity level is usually limited, however you will be able to walk independently and use bathroom and kitchen facilities. Within 6 weeks you will have resumed more of your normal activities. Squatting and kneeling come with time. You should never kneel with your weight completely on the kneecap due to the resurfacing of the kneecap and potential to break it, and the discomfort it seems to cause. Complete surgical wound healing takes 6-8 weeks. During this time some swelling, itching and discomfort is normal and should be manageable with the prescribed medications. After this time the knee tissues begin to soften and become more natural. Some patients may require an injection of cortisone (after 5-6 weeks) to relieve tissue soreness due to inflammation from surgery and readjustment of the knee. Many patients will notice an area of numbness on the lateral aspect (outside area) of the knee incision. This usually resolves to some degree over time.
Important Notice: You will require an antibiotic prophylaxis prior to having any dental work or invasive procedures done for the first 6 months after surgery. If you have no diabetes or other immune suppressing medications or conditions you may discontinue these after 6 months. This includes routine cleaning. Please let your dentist know you have a knee implant at the time you make the appointment with him/her.
If you then still have any questions or concerns please notify me, my nurse, or physician assistant.
Bryan Bomberg, MD