Post Operative Instructions
Total Knee Replacement
SURGERY AND ANESTHESIA
A total knee replacement is a safe and effective way to reduce pain due to arthritis when medications, exercises, and modification of activities are no longer helpful. The surgical procedure takes approximately 120 minutes and is done under general anesthesia. A vertical incision is made in the front of the knee to access the joint. The knee joint is comprised of the distal end of the femur, upper portion of the tibia, and the patella. During the procedure, the arthritic parts of the femur, tibia, and kneecap are removed and replaced with artificial components called a prosthesis. This procedure is performed in the hospital and requires a two night stay for pain control and monitoring.
In most cases, anesthesia will offer to perform a nerve block prior to surgery. The purpose of the block is to help control the acute pain in the first two to three days following surgery. The block is administered by the anesthesiologist in the pre-operative bay. It takes about 10 minutes and numbs the nerves of the operative leg. The nerve block not only helps with post-operative pain, but also helps to decrease the amount of anesthesia needed during the surgical procedure.
DRESSING AND COMPRESSION STOCKINGS
Following surgery, the leg will be wrapped in a dressing from mid-thigh down to the foot. A small amount of bloody drainage on the dressing is not unusual in the first day or two. If this occurs, the dressing will be reinforced by the nurse. The dressing is to remain in place for 48 hours and must stay completely dry. It will be changed by my physician assistant prior to discharge from the hospital. After leaving the hospital, you may shower; however, the knee must be covered with plastic wrap before doing so. If the Steri-strips fall off before your first post-operative appointment, place Band-Aids over the incision sites. No baths, hot tubs, or swimming for 3 weeks following surgery to allow the incisions to fully close. The compression stockings must be worn on both legs for the first 3-4 weeks following surgery to help decrease the risk of blood clots.
REST, ICE AND ELEVATION
Elevate your leg under the heel, not the knee, to prevent a flexion contracture or stiffness in the knee.The Cold Therapy unit is helpful in reducing swelling which minimizes the requirements for narcotics. Follow the instructions given at the time of discharge and use the cooling system a minimum of 12 hours/day for the first few days. Continuous use is allowed and encouraged as long as it is not uncomfortable. Do not let the cooling pad touch the skin. There should always be a dressing or cloth between the skin and the cooling pad.
Full weight bearing on the operative leg is allowed and encouraged. Crutches, cane, or a walker may be helpful for the first several days to weeks for stability and help with getting around.
POST-OP APPOINTMENT AND PHYSICAL THERAPY
Your first post-operative appointment will be approximately 14 days following surgery. At this appointment, we will check your incision site to be sure it is healing properly as well as your range of motion and your overall post-operative progress.
You will receive one-on-one and group physical therapy while in the hospital. Following discharge from the hospital, home physical therapy will be set up for you twice a week for 2 weeks. You will be given a prescription for outpatient physical therapy at your first post-operative appointment to begin once the home physical therapy is complete. Appointments for physical therapy should be twice a week for 2-3 months. We recommend that you call to schedule those appointments prior to surgery since physical therapy offices fill quickly.
You will be prescribed three medications following surgery: A pain medication, an anti-nausea medication, and Xarelto.
- Do not drive or drink alcohol beverages while taking pain medications.
- Pain medication should be taken with food to help prevent any stomach upset. You may also take the prescribed anti-nausea medication.
- Often pain medications will cause constipation. Eat high fiber foods and increase your water intake. You may also purchase a stool softener at any pharmacy and follow the recommended directions on the bottle.
- You should resume taking your normally prescribed medications unless otherwise directed.
- Xarelto 10 mg has been prescribed to help prevent a blood clot in your lower leg. This medication should be taken once daily for 2 weeks following surgery.
You may resume driving a vehicle when you have stopped your narcotic pain medication and you are cleared by Dr. Novak.
Please contact the office by calling 703-810-5223 for any of the following symptoms:
- Fever greater than 101.5 degrees F for 24 hours.
- Severe pain unresponsive to narcotic medication.
- Excessive bleeding or vomiting.
- Numbness, loss of color, or coolness to touch in hand.
- Redness or swelling in the calf that does not resolve overnight.
- Difficulty breathing or shortness of breath, CALL 911.