Knee Replacement: Post-Operative Instructions

These instructions cover the first several weeks after total knee replacement. Your surgeon’s team will tell you if any of them are different for you.

When You Go Home

1. Keep the operative leg elevated above your heart as much as possible. Avoid putting a pillow behind your knee, as this makes it harder to regain full extension (getting your knee straight) after surgery.
2. Your weight-bearing status (how much weight you may put on your leg) will be given to you at the time of surgery. Follow it carefully. Most patients use a walker at first and progress to a cane as their strength and balance improve.
3. Ice your knee with a cold therapy unit, a bag of ice, or a bag of frozen peas. For the first few days you may ice for 30–45 minutes at a time because the dressings are thick. After that, do not ice for more than 20 minutes at a time, to avoid frostbite.
4. Swelling and bruising of the thigh, knee, calf, and ankle are common after surgery. Swelling is usually greatest in the first few weeks, and mild swelling can last several months. Elevation, ice, and your exercises help reduce it.
5. Do not drive until you have stopped narcotic pain medication, have the strength and reaction time to brake safely, and have been approved by your surgeon.
6. Return to work will depend on your type of employment.

Make Your Home Safe

• Remove loose rugs and secure electrical cords so you don’t trip.
• Use a firm chair with a higher seat, which is easier to get in and out of.
• A shower chair, grab bar, and raised toilet seat can make bathing and toileting safer in the first weeks.

Exercises: Start Right Away

Your therapist will start these exercises with you in the hospital. Continue them at home several times a day unless your physical therapist tells you otherwise. Getting your knee fully straight and regaining bend early are important parts of recovery. Walk several times a day as well, but walking does not replace these exercises.

Quad Sets

Tighten your thigh muscles and hold for 5 seconds. It will feel like your knee is being pushed into the ground. Do at least 3 sets of 10 repetitions.

Straight Leg Raises

Once you can complete a set of 10 quad sets, begin straight leg raises. Tighten your thigh muscle as in a quad set, lift your leg about 12 inches off the ground, hold for 5 seconds, then lower. Do at least 3 sets of 10 repetitions.

Heel Slides (Bending the Knee)

Slide your heel toward your buttock, hold for 5 seconds, then straighten the knee. You can use a towel around your foot to assist. Do 3 sets of 10 repetitions.

Heel Props (Straightening the Knee)

Keeping your knee fully straight is important early after surgery. Place a rolled towel or pillow under your heel with nothing under your knee or thigh, and hold this position for 5–10 minutes. Gravity will slowly help straighten your knee. You can also sit in a chair with your foot resting on another chair or ottoman, and rest your hand on your thigh near the knee to assist.

Calf Pumps

Move both feet up and down at the ankle at least 10 times an hour, every 1–2 hours, until you are up and around regularly. This encourages blood flow in the lower legs and helps reduce the risk of a blood clot (DVT).

Incision Care

• Expect a small amount of bloody drainage on your dressing. Contact our office if the bandage becomes saturated or is leaking.
• About 1 week after surgery, change your dressing and replace it with a clean bandage over the incision. Your dressing will be removed for good at your first post-op visit.
• Your dressing is watertight, so you may shower with it in place. When showering, let water run over the area without scrubbing, then pat dry.
• Do not remove the skin glue (Dermabond) or any white strips over the incision.
• Do not put ointment on or touch your incision until your surgeon says it is OK.
• Do not soak the knee (no bathtub, hot tub, pool, lake, or ocean) until your surgeon says it is OK.
• Some redness right around the incision and a small amount of drainage in the first few days are common. Contact our office if drainage continues after 5 days or redness spreads away from the incision.

Diet

After surgery, begin with liquids and light foods such as gelatin and soup. Progress to your normal diet if you are not nauseated. Digestion can be slow after anesthesia and narcotic pain medication; a stool softener or mild laxative may help with constipation.

Physical Therapy

Physical therapy starts right away in the hospital and continues as an outpatient as soon as you get home. Set up your outpatient physical therapy before surgery so there is no gap, and bring your physical therapy prescription to your first visit. Continue the exercises your therapist gives you for at least 2 months after surgery.

Medications After Surgery

You will receive several prescriptions before or at the time of surgery. Take each exactly as prescribed. They typically include:

1. Narcotic (such as oxycodone): a strong pain medication that makes pain tolerable but does not eliminate it. Use it only as directed, and stop once your pain decreases, as it can be addictive. Side effects include drowsiness, constipation, nausea, and itching. Drink plenty of water to reduce constipation.
2. Tylenol (acetaminophen): very effective at reducing pain after surgery. Take as prescribed. Talk with your doctor if you have a history of liver disease.
3. Anti-nausea medication (such as Zofran or Compazine): anesthesia and narcotics can cause significant nausea in the first 24–48 hours. Take as needed during this period.
4. Anti-constipation medication (such as docusate, senna, or Miralax): the combination of anesthesia and narcotics often causes constipation. Use over-the-counter medications as directed and drink plenty of water.
5. Anti-inflammatory (meloxicam or Celebrex): reduces pain and inflammation. Take as prescribed. While taking it, do not take other anti-inflammatory medications such as ibuprofen (Advil, Motrin) or naproxen (Aleve).
6. Aspirin: to help prevent blood clots (see Preventing Blood Clots below).

Pain Control After Surgery

Many patients receive a nerve block for pain control during and immediately after surgery. It temporarily causes numbness and difficulty moving the leg, and there will be some pain once it wears off. Pain is typically worst in the first few days.

• Starting after surgery and before your nerve block wears off, follow this regimen for the first 24–48 hours:
  • Take Tylenol as prescribed. It is your first-line pain medication.
  • Take your narcotic pain medication as prescribed, on a regular schedule, during this period.
• Take your prescribed anti-inflammatory (meloxicam or Celebrex) as prescribed. Do not add ibuprofen, naproxen, or other anti-inflammatory medications.
• Wean off narcotics as your pain improves. You should aim to wean off narcotics by 2–4 weeks after surgery. Continue the Tylenol and your anti-inflammatory as prescribed.

Preventing Blood Clots

Knee replacement surgery increases your risk of a blood clot in the leg (deep vein thrombosis, or DVT), which can travel to the lungs (pulmonary embolism).

• Take aspirin as prescribed, and continue it for 30 days after surgery. If you already take a blood thinner, you will be told how to manage it instead.
• Do your calf pumps (at least 10 times every 1–2 hours) and walk several times a day.
• Avoid sitting for long periods. On long car rides, stop to walk every 1–2 hours.
• Contact our office right away for pain, tenderness, or new swelling in your calf, thigh, ankle, or foot.

Follow-Up Care

Your first post-op visit should already be scheduled, generally 10–14 days after surgery. If it is not, contact our office.

Call the Office If You Have Any of the Following

• Fever greater than 101.5°F (38.5°C), or chills
• Increasing redness, warmth, swelling, or tenderness around the incision
• Continuous drainage or bleeding from the dressing, or drainage from the incision lasting longer than 5 days
• Unrelenting pain, or pain that is getting worse instead of better
• Pain, tenderness, or new swelling in the calf
• Excessive nausea or vomiting from pain medication
• Increasing numbness or color change in the toes (your toes should be pink and warm)
• Any other worrisome condition

Call 911 for severe symptoms, including severe pain in the back of the calf, shortness of breath, or chest pain (especially with breathing), which may be warning signs of a blood clot or pulmonary embolism.

Protecting Your Knee Replacement Long-Term

• Tell your dentist and all of your doctors that you have a knee replacement. Before dental work or other procedures, ask whether you need antibiotics beforehand.
• Infections elsewhere in the body, such as a urinary tract or skin infection, should be treated promptly. Contact your doctor if you develop one.
• Ask your surgeon before air travel in the first weeks after surgery. Let airport security know you have a joint replacement, as it may set off metal detectors.