POST OP CARE AFTER TOTAL KNEE REPLACEMENT

OPERATION DAY
WOUND
When you came out from the operation theatre, your knee will be covered
with a bulky dressing (thick bandage) for at least 24 hours after the
operation. Your incisions were closed with a single long dissolving stitch,
which are covered with small white tapes called steri-strips. The steristrips should be left in place for about 4 weeks after the surgery. They can
be peeled off after 4 weeks. You will see a drain, which is to remove any
fluid build-up around the knee.
PAIN MANAGEMENT
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) canula so that you can regulate
the amount of medication you need. Remember that it is easier to prevent
pain than to control it.
EXERCISE
Although you will probably want to rest after surgery, early mobilization is
important. You will 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. 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.
OTHERS
Right after the operation you can take an occasional sip of water.
You can take alittle more fluid but only a small amount at a time.
Besides water, you should alsochoose clear liquids that have an
adequate number of calories. To prevent nausea andvomiting, do
not drink much. You may lose your appetite and feel nausea and
dizziness. These are normal reactions from the side effect from
anesthesia.
You may be fitted with a urinary catheter.
DAY 1
WOUND
Bulky dressing must be kept clean and dry. Drain will be remove, and a
pressure will applied on the drain site.
EXERCISE
Physical therapist will visit you and begin teaching you how to use your
new knee. He will work through some exercises with you in your room, and
help you take a few steps to sit in the chair. You will be given a walking
frame to help you balance and he will be advised how much weight you
can put through your operated leg.
DAY 2

WOUND
The bulky dressing will be changed into post-opsite which is a water-proof
dressing. You may shower after that, but do not submerge or soak your
knee in the water. You will be given compression stockings which called
as TED stocking to prevent blood clotting and excessive swelling. You
should wear them most of the time through the day and night for 4-6
weeks. Dressings must be kept clean and dry. A small amount of blood
stained is normal.
EXERCISE
Physical therapist will bring your down to physiotherapy department on
wheelchair. They help you with exercises such as knee bending, sit-standsit exercises, straight leg raises, and heel slides. You may also be asked to
do leg stretching, squatting, and ankle bending and stretching. You may
need to begin a walking program, or use an exercise bicycle. These
exercises help strengthen the bones and muscles around your knee joint.
These exercises may also help your knee heal.
OTHERS
You may constipated for a couple of days, these are normal reactions. You
may be given stool softeners or laxatives to ease the constipation caused
by the pain medication after surgery.
Urinary catheter will be remove.
BEFORE DISCHARGE
You will need to meet several goals:
Get in and out of bed by yourself
Bend your knee approximately 90 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
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 continuous passive motion
exercise machine home with you for a few weeks, but this is not a
substitute for the prescribed exercises.
AFTER DISCHARGE
WOUND

After you discharged from the hospital, you have to come back to
follow up with your doctor as scheduled. Bring along the postopsites which the hospital gave you upon your discharge. Your
doctor will change it for you as he will assess your wound healing.
For patients who scheduled to follow up after 4-6 weeks, you may
change the dressing at home by family members or to the nearest
clinic. The wound must be covered up for 3 weeks after you
discharge from the hospital. Therefore, you need to change it

weekly until the wound looks dry. Do not apply any medication or
oitment over your wound. Before placing a new post-opsite, you
must wash your hands thoroughly and do not touch the wound with
your hand as it might cause infection to it. Remember do not touch
the whitish area of the post-opsite before you place it over the
wound.
You do not have to change it if only small blood stained shown over
the dressing. You may change the dressing if it detaches from the
wound or moderate size of blood stained seen. If you notice the
dressing is fully soaked with blood, you need to contact the surgeon
immediately.
Warmth to touch around the wound is very normal within fist few
months post-operatively. You need to watch out for persistent high
grade fever, abnormal discharge, increasingly warmth, excessive
swelling, and severe pain at the operated site as these symptoms
indicate infection. You should contact surgeon immediately for
further interventions of you notice any symptoms as mentioned
above.
Keep the wound 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 before you leave the hospital.
Notify your doctor if the wound appears red or begins to drain.
Swelling is normal for the first 3 to 6 months after surgery. Elevate
your leg slightly and apply ice.
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.

MEDICATION
It is common to have pain and swelling in your knee however, you may be
overdoing it.Rehabilitation needs to take a smooth and structured path.
Continue to take regular pain relief as prescribed. If the pain and swelling
increase, please contact your doctor for further advice.
EXERCISE
Continue to do the exercises prescribed for at least two months after
surgery. Riding a stationary bicycle can start after 2 week of operation, it
can help maintain muscle tone and keep your knee flexible. Try to achieve
the maximum degree of bending and extension possible. Walk as much as
you like, but remember that walking is no substitute for the exercises your
doctor and physical therapist will prescribe. Swimming is also
recommended; you can begin as soon as the sutures have been removed
and the wound is healed, approximately 6 to 8 weeks after surgery.
Acceptable activities include dancing, golfing (with spikeless shoes and a
cart), and bicycling (on level surfaces). Avoid activities that put stress on
the knee. These activities include: tennis, badminton, contact sports (such
as football, baseball), squash or racquetball, jumping, squats, skiing, or
jogging. Do not do any heavy lifting (more than 40 lb) or weight lifting.
DIET
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 the blood thinner medication. Try to limit

coffee intake and avoid alcohol. You should continue to watch your weight
to avoid putting more stress on the joint.
OTHERS
Avoid driving for 6 to 8 weeks. Remember that your reflexes may
not be as sharp as before your surgery.
The sensitivity of metal detectors varies and it is unlikely that your
prosthesis will cause an alarm. You should carry a medic alert card
indicating you have an artificial joint, just in case.
You can safely sleep on your back, on either side, or on your
stomach.
Depending on the type of activities you perform, it may be 6 to 8
weeks before you return to work.
Because you have an artificial joint, it is especially important to
prevent any bacterial infections from settling in your joint implant.
You should get a medical alert card and take antibiotics whenever
there is the 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.