In this section, we will discuss a few things you need to know in regard to surgery and recovery. We will cover some common hospital protocols as well as precautions your doctor and staff will be taking to avoid complications which can result from surgery.
Surgery and recovery
Once your surgery is complete, you will be taken to a recovery room for a period of close observation. Your blood pressure, heart rate, respiration and temperature will be closely monitored with special attention given to the circulation and sensation in your feet and legs. Once you awaken and your condition is stabilized, you will be transferred to your room.
While protocols differ from hospital to hospital, here is a list of things you may see when you wake up:
- A large dressing applied to the surgical area
- A drain tube leading into the surgical area
- An IV will continue to be used to provide adequate fluids and administer antibiotics and other medication
- A catheter may have been inserted into your bladder as the side effects of medication often make it difficult to urinate
- A continuous passive motion (CPM) unit may be placed on your leg to slowly and gently bend and straighten your knee, to help more quickly regain your knee range of motion
- A patient-controlled analgesia (PCA) device connected to your IV for pain relief
Post-operative care and precautions
As with any major surgical procedure, knee complications can occur following knee replacement surgery. The following is a list of some of the complications with a brief description of each.
Deep vein thrombosis
Deep vein thrombosis occurs when blood clots are formed in the larger veins of the legs. In some cases, these clots may dislodge from the veins, travel through the circulatory system and become stuck in critical arteries of the lungs. The following precautionary steps may be taken by you and your physician to prevent deep vein thrombosis:
- Blood thinning medication, such as aspirin or anticoagulants
- Support stockings (TED hose)
- Foot elevation to prevent swelling
- Pneumatic devices placed on the feet to improve circulation
In a small percentage of patients undergoing knee replacement surgery infection can occur. Your physician will be able to minimize the risk of infection by closely monitoring the incision and looking for any signs of redness, swelling or other indications. Always remember to wash your hands after any contact to the incision site, especially when the sutures are still in place.
A possible side effect of surgery is the development of pneumonia. The following steps may help minimize the risk.
Deep breathing exercises: A simple analogy to illustrate proper deep breathing is to “Smell a Rose and Blow Out the Candles.” In other words, inhale slowly and deeply through your nose and exhale slowly through your mouth at a slow and controlled rate. A simple rule of thumb may be to perform these deep breathing exercises eight to 10 times every hour.
Coughing: This activity helps to loosen the secretions in your lungs and excrete them from your pulmonary system.
Incentive spirometer: This simple device provides visual feedback while performing deep breathing exercises. Your nurse or respiratory therapist will demonstrate the proper technique.
In some cases the mobility of your knee following surgery may be significantly restricted. You may develop scar tissue in your knee that will cause stiffness during walking and other activities. The following steps may be taken to maximize your range of motion following surgery.
- Strict adherence to a continuous passive motion (CPM) protocol as prescribed by your orthopaedic surgeon
- Early physical therapy to begin range of motion exercises and walking program
- Edema control to reduce swelling using ice, support stockings (TED hose) and elevation
- Adequate pain control so you can tolerate the rehabilitation treatment
Rehabilitation after total knee surgery
Perhaps the most critical factor in achieving successful knee replacement surgery depends on your approach and diligence in physical rehabilitation. It is important that you actively participate in every aspect of this process, working on your own and with your physical therapists to achieve the best results.
The physical therapists will begin working with you as early as one to two days after surgery. They will teach you simple exercises that can even be performed in bed to strengthen muscles in the knee and lower extremity. These exercises may include:
- Ankle pumps: Flex and extend the ankles
- Quadricep sets: Tighten and relax the thigh muscles
- Heel slides: Flex your hip and knee. Return knee to the straight position
- Leg lifts: Raise leg six inches above mat, keep knee straight
- Knee extension: Place a pillow under your knee. Lift your foot off the mat
Your physical therapists will also teach you the following proper techniques for performing daily activities. Although these activities may seem simple, you must learn to do them safely so you do not suffer other injury.
- Get in and out of bed
- Walk down the hall using your walker or crutches
- Manage steps at home
- Bend your knee 90 degrees and straighten your knee
An occupational therapist will teach you how to safely perform activities needed in daily life and will also provide you with a list of knee precautions that are designed to protect your new knee during the first eight to 12 weeks following knee surgery. The occupational therapist will also instruct you in the proper use of various long-handled devices that will assist you in your daily life activities. These devices may include the following:
- A reacher to dress and pick things up off the floor
- A sock-aid to assist in putting on socks
- A long-handled sponge to wash your legs and feet
- A leg-lifting device to move the operated leg in and out of the car or bed
- An elevated toilet seat for when using the bathroom
- An elevated bathtub chair to fit in the shower or tub
Hospital discharge and home instructions
Before leaving the hospital, your doctor and staff will help you adjust to recovery in every way possible. They will show you safe techniques of simple activities like getting in and out of bed, going to the bathroom, managing steps at home and getting in and out of a car.
Progress varies from patient to patient, so discharge instructions may also vary. You will receive specific precautions from your orthopaedic surgeon, nurse and physical therapist.
- You will be using a walker or crutches to assist with walking. Ask you surgeon how much weight you can put on your operated leg
- Wear your TED hose
- Your surgeon will talk to you about when you can drive; generally it is six to eight weeks after surgery
- Continue the exercise program you learned while in the hospital
Once you have completed the post-operative knee rehabilitation process, you should have near-normal range of movement and adequate strength in your knee to perform most activities of daily living. Patients having knee replacement surgery have successfully returned to walking, driving, swimming, golf, doubles tennis, cycling and gardening. However, special precautions should be taken. Avoid high-impact activities like running, vigorous walking and downhill skiing. Remember to listen to your body. If you have pain or swelling, contact your healthcare professional for advice.
