Post-Operative Instructions

Total Knee Replacement

(You will receive your customized post-op instructions after your surgery.)


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 90 minutes and is done with spinal or general anesthesia. Frequently a nerve block is also used to decrease pain and need for narcotics both during and after surgery. Numbness in the leg from this can often last greater than 24 hours. At the beginning of the procedure, a vertical incision is made in the front of the knee to access the joint. During the procedure, the arthritic parts of the femur, tibia, and kneecap are removed and replaced with artificial components called a prosthesis.


Following surgery, the knee will be wrapped in a dressing from mid-thigh down to the mid-calf. A small amount of bloody drainage on the dressing is not unusual in the first day or two. If this occurs, remove the Ace wrap and reinforce the dressing with another layer of gauze, then reapply the Ace wrap. Do not remove the deeper layers of the dressing!The dressing is to remain in place for 48 hours and must stay completely dry.After 48 hours, you may remove the dressing and shower; however, the knee must be covered with plastic wrap before doing so. A shower chair will likely be helpful. Change the dressing daily until there has been no drainage for 2 days. Then the incision can be left open to the air. No baths, hot tubs, or swimming for 3 weeks following surgery to allow the incisions to fully close. Compression stockings are worn for the first 3-4 weeks to decrease the risk of blood clots and help with swelling.


Elevate your leg with a pillow under the heel, not the knee, to prevent the knee getting stuck in a bent position.The Cold Therapy unit or ice are helpful in reducing swelling which minimizes the requirements for narcotics. 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. Start working on range of motion of the knee immediately, both on your own and with 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.

Home physical therapy may be set up for you 2-3 times a week for 1-2 weeks. Outpatient physical therapy is even more beneficial, so we try to start that as soon as possible. Many patients can go directly to outpatient physical therapy without needing home therapy. Appointments for physical therapy should be 2-3 times 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 several medications following surgery: pain medications and a blood thinner.

These may include:

  • Celebrex 200 mg twice a day—antiinflammatory and pain medication. Plan on taking this for about a month, but it can be stopped as pain diminishes.
  • Lyrica 75 mg twice a day—nerve pain medication. This should be taken as scheduled for a month.
  • Aspirin 81 mg twice a day for 6 weeks—blood thinner. Take for 6 full weeks. (Other blood thinners may be used in place of this in higher risk patients.)
  • Oxycontin (oxycodone sustained release)—narcotic pain medication. Take as scheduled twice a day. As pain diminishes, this can be tapered to once a day, either morning or evening.
  • Percocet (oxycodone/apap, oxycodone/acetaminophen) or Norco (hydrocodone/acetaminophen)—narcotic pain medication to be taken every 4 hours only as needed for pain. Keeping track of how many tablets are needed per day is a good way to keep track of how much pain you are having.

Medication Tips:

  • Do not drive or drink alcoholic beverages while taking pain medications.
  • Pain medication should be taken with food to help minimize stomach upset.
  • 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. Pericolace is my first choice, but Dulcolax, magnesium citrate, or Fleet’s enemas can be added as needed.
  • Pain medications can sometimes cause itching. This should be treated as needed with over-the-counter Benadryl or Claritin. If that doesn’t work, the pain medications may need to be changed.
  • You should resume taking your normally prescribed medications unless otherwise directed.


You may resume driving a vehicle when you have stopped your narcotic pain medication, feel comfortable with slamming on the brakes in a parked car, and you are cleared by Dr. Thompson. This typically is about 2 weeks for a left knee and 6 weeks for a right knee.


Please contact the office by calling 703-810-5209for 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.
  • Redness or swelling in the calf that does not improve overnight.
  • Difficulty breathing or shortness of breath, CALL 911.

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