The following guide is provided to patients of Dr. Gregory Raab, an orthopedic surgeon in Nashville, TN that specializes in total joint replacement and revisions in the knee and hip. If you are suffering from knee pain, schedule an appointment with a knee replacement doctor near you to find out if you are a candidate for total knee replacement surgery.
90-95% of total knee replacements should last 15 years or longer. Some of the most important factors in maintaining your knee replacement are the type and level of your activity, keeping your weight under control and maintaining regular follow-up visits.
Most people are in the hospital from 1-2 days. Most patients return directly home after discharge from the hospital. However, there are some patients who live alone, have no available caregivers or who require some additional recovery. These patients may qualify for a short-term rehab stay at an outside facility for further physical therapy.
Patients heal from surgery at different rates. In most cases, you will be limited to the use of a walker or crutches for approximately 2-4 weeks. As you continue to improve you will transition to using a cane when out of the house and no supportive device around the house for several weeks. You will gradually return to normal function without any assistive devices. This usually takes approximately 3 months but may take more or less time depending on your preoperative level of health and function.
After the first initial bandage change in the hospital, typically on post-op day #1 or 2, you will only need a minimal bandage. Should there be any drainage, dry, clean gauze should be applied to protect the wound and keep your sheets and clothing clean.
You may shower beginning on the 2nd day after your operation. You will typically have steri-strips (white pieces of tape) over your incision line. These may get wet and just need to be gently patted dry after your shower. The steri-strips will gradually begin to loosen and curl around the edges 10-14 days after surgery. At your 2-week post-operative visit these strips will be removed. Underneath will be a healed incision line. Also, you may notice a clear piece of thread coming from the top and/or bottom of your incision line. These are absorbable sutures and will often fall off on their own, or they will be trimmed at the skin level at your first post-op visit.
Your knee can be totally immersed once your incision is completely healed. This generally occurs around 2-3 weeks and will be verified at your first post-op visit.
Total joint replacement is a big surgery. It is not unusual to require some form of pain medication for approximately 6-8 weeks. Initially, the medication will be a strong oral narcotic such as oxycodone or hydrocodone. Most people begin to wean off their strong pain medication 3-4 weeks after surgery, requiring it mostly around times of therapy. Moderate strength medication, like Celebrex, Meloxicam or Ibuprofen and/or Tylenol may be needed for an additional 3-4 weeks.
You will be placed on low-dose Aspirin twice a day during your recovery in the hospital. You will go home with a prescription for low-dose Aspirin that will be taken twice a day for 2 weeks.
If you are on Coumadin or Xarelto prior to surgery, it is important to let your knee replacement doctor and the anesthesia staff know prior to surgery so the necessary adjustment can be made. Most patients will stop their Coumadin 7 days prior to surgery and switch to an injectable blood thinner up until the night before surgery. Once the surgery is over, you will continue the injectable and Coumadin until your Coumadin levels have returned to their pre-operative levels. If you have had a history of blood clots or pulmonary embolism, additional arrangements may also be made.
While in the hospital and for several weeks after surgery, ice is most helpful to keep down swelling. In the hospital you should have ice applied to your knee at least 2-3 times daily. At home the most convenient ice bag is a bag of frozen peas that will conform easily to your knee and can be frozen. A warm towel placed around your knee prior to therapy sessions may help loosen up your knee, and ice may be used after therapy to cool the joint down.
If you had surgery on your right or left knee and drive an automatic transmission, you should not drive for at least 4-6 weeks. After 4-6 weeks you may return to driving as soon as you feel comfortable, are not taking narcotic pain medications, and can safely and quickly move the leg from the accelerator to the brake petal. For a stick shift, or standard transmission, it will be at least 4-6 weeks regardless of which leg you had surgery. Again, you should not drive if you are taking narcotics.
Yes. You should avoid dental cleaning and dental work for several weeks prior to surgery and at least 12 weeks following surgery. After that point, antibiotics are recommended prior to all dental visits, including regular cleanings.
This depends greatly on your profession and your obligations at work. Typically, if your work is primarily sedentary, you may return after 3-4 weeks. If your work is more rigorous, you may require up to 3 months before you can return to full, unrestricted duty.
Most patients may travel as soon as they are comfortable after an initial 2-week visit with their knee replacement doctor. It is recommended that you get up to stretch or walk at least once an hour when taking long trips. This is important to help prevent stiffness and lessen the risk of blood clots.
You may return to many activities as soon as tolerated including walking, gardening, golf, and doubles tennis. Some of the best activities to help with motion and strengthening are swimming and the use of a stationary bicycle. You should avoid high impact stresses to the knee such as running and jumping and vigorous sports such as singles tennis, basketball, water skiing, and downhill snow skiing.
You should avoid alcohol as long as you are requiring narcotic pain medication. Otherwise, you may use alcohol in moderation at your own discretion.
You should spend some time each day working on flexion and extension of the knee. Although it may be more comfortable, you should NOT use a pillow.
Early on after surgery it is important to keep the knee as straight as possible except when specifically working on bending. Flexion will continue to improve over the first several weeks post-operatively, but extension is often maximized after the first couple of weeks.
In general, no. However, depending on the circumstances of your surgery, you may benefit from a CPM. If so, most patients will be started on the CPM on the first post-operative day.
The amount of bend will gradually increase while you are in the hospital. Typically, patients will use the machine for 1-2 hours at a time, 2-3 times a day. Except under rare circumstances, you will not need a CPM when you go home.
Yes. Initially, you will lead with your non-operated leg when going up stairs, and lead with your operated leg when coming down. As your muscles get stronger and your motion improves, you will be able to perform stairs in a more normal fashion, usually after 4 weeks.
Yes. Physical therapy plays a very important role in your recovery. You will be seen by a physical therapist soon after your surgery and throughout your hospital stay. Once you are discharged from the hospital you will continue to go to a therapy center close to home 2-3 times a week for about a month. If your in-hospital recovery is somewhat slower than typical you may need to spend some time building up your strength at an inpatient rehabilitation facility. The hospital case managers will assist in making those arrangements if necessary.
As soon as you are comfortable.
It is very common to have some constipation after surgery. This is due to a number of factors and is aggravated by the need to take narcotic pain medications. Regular physical activity and the return to a healthy, balanced diet with adequate hydration will assist with this. In addition, a simple over the counter stool softener/ laxative may help with the prevention of this problem. In rare cases, you may require a suppository or an enema.
You may set off the alarm at some airport security checkpoints. Be proactive and inform the personnel that you have a total knee replacement and will most likely set off the alarm. Wear clothing that allows you to show the knee incision without difficulty. A letter from your surgeon or a wallet card is no longer of any help when passing through security.
It is not uncommon to have feelings of depression after surgery. This may be due to a variety of factors, such as limited mobility, discomfort, temporary increased dependency on other and medication side effects. Feelings of depression will typically fade as you begin to return to more regular activities and social functions.
This is a common complaint after surgery. Nonprescription remedies such as Benadryl or melatonin may be effective. If this continues to be a problem, prescription medication from your primary care physician may be necessary.
After several months you may certainly try to kneel. It may be painful at first but will not be harmful or damaging to your total knee. Much of the discomfort often comes from kneeling on your recent incision and the surrounding tissues that are healing.
Range of motion varies and depends on many individual factors. The single greatest determinant is your initial range of motion just prior to surgery. The average patient achieves approximately 110-130 degrees of flexion by one year post-operatively. Some patients achieve less and others much more.
Any condition which is new or out of the ordinary for your total knee is worth at least a phone call, an office visit, or possibly a trip to the Emergency Room. Prolonged fever greater than 102 degrees, increasing or worsening pain in your knee, increasing or worsening redness in your knee, increasing or smelly drainage from your incision, worsening calf pain and swelling, chest pain and shortness of breath are all conditions which warrant immediate medical advice.
While you are in the hospital, it’s possible your knee replacement doctor will follow up with you each day. Under rare circumstances, another orthopedic surgeon or physician assistant may check on you your knee replacement doctor’s absence. Once discharged from the hospital, follow up appointments are usually made at 2 weeks, 6 weeks, 12 weeks, and 1 year. After the one-year anniversary, appointments should be made to check your knee at least every 1-2 years or if new or concerning symptoms develop.
Having a Total Knee Replacement is a team effort, and YOU are the most important team member. If you have other questions or concerns, please do not hesitate to reach out to your knee replacement doctor.
Elite's Dr. Raab is one of the best knee replacement specialists in Nashville, TN and a several time recipient of Castle Conolly's Top Doctor award. You can schedule your consultation today.
