ARTHRITIS OF THE KNEE JOINT

You will be able to go home in a regular sized car. It is better if someone can be at home with you for at least portions of each day to assist you with shopping, meal preparation, etc. Constant nursing care is rarely needed at home. We will arrange for a home physical therapist as well as for a visiting nurse to see you at home, if your insurance will cover these services (Medicare does).

Most patients who have had a knee replacement need instruction and visits with a physical therapist for several weeks after they go home. Usually this is done 3 times a week for 3 to 4 weeks. It is very important that exercises be done vigorously for the first weeks after surgery so that the knee flexibility can be maximized.

Please do the exercises demonstrated in Home Exercises for the First Eight Weeks After Surgery. Continue all these exercises for two months and do numbers 8, 9 and 10 for at least six more months.

You must call the office after you get home to set a date for an office visit. The first office visit after you leave the hospital is usually 6 weeks following the day of surgery. Until then continue all the restrictions which you were taught in the hospital. If any problem develops you will need to come in sooner.

You may be provided with a CPM machine at home. You should use it for about four hours a day the same way you used it in the hospital.

It is not uncommon to develop some swelling of the knee, foot and ankle in the weeks after surgery. If this occurs, you should elevate your leg on pillows when you are not up and about.

Wound sutures or staples are usually removed on the fourteenth day after surgery. If you are discharged before that time, they may be removed by a visiting nurse at your home, or you may be asked to come to the office for removal. One day after staple removal you may take a shower. Up to that point the wound should be kept dry. It is best to shower rather than get into a tub. We recommend avoiding a tub for at least two months after surgery. A shower stool is helpful so as to avoid slipping while taking a shower.

Once you get home you are not expected to stay in bed. You should be up and about on your walker or crutches most of the time, but rest as much as you need to. You should also do the exercises illustrated in Home Exercises for the First Eight Weeks After Surgery.

You should get off the walker and go to a cane as soon as you can. You should then get off the cane as soon as you can.

Most patients are walking without a walker or cane by the end of two weeks. Many are off all walking aids by the third day after surgery.

DRIVING AFTER KNEE REPLACEMENT SURGERY

Driving is best to avoid until about 6 weeks after the surgery, but avoidance is not essential if the left knee has been operated on and you drive an automatic and are not taking strong pain medications that might cloud your judgment. Driving is not likely to injure the knee replacement, but you may not be able to operate the car as well as needed to prevent an accident. Dr. Huddleston can not judge whether you are safe to drive from a legal standpoint but can simply tell you if you are safe to drive from a standpoint on injuring your knee replacement.

RETURNING TO WORK AFTER KNEE REPLACEMENT SURGERY

You will probably not return to work for 6 to 8 weeks after the operation. Quite a few patients do return earlier, depending on the nature of their work, and depending on how important it is for them to be back at work. Some patients with strong motivation and a suitable job return to work in as little as a week. Discuss this with Dr. Huddleston if you need to be back at work sooner.

PROBLEMS YOU MAY ENCOUNTER AT HOME

1. Excessive swelling of your leg and foot: It is not uncommon to develop some swelling in the first few weeks after surgery. If this occurs, you should elevate your leg whenever you are not up to walking. However, excessive swelling of the foot and lower leg can be due to thrombosis (blood clots) in the veins in the leg.

   We should be notified if swelling is associated with pain or tenderness in the calf muscles, or if the swelling just seems over-excessive, and doesn’t respond to elevation.

2. Chest pain, a cough or shortness of breath may be signs of embolism. Please do not ignore these symptoms. Call us right away.

3. Drainage from the wound, or increasing redness around the wound, could signify impending infection. Our office should be notified, and in most instances you will need to come in and let Dr. Huddleston take a look at it.

4. High fever could also be a sign of impending infection. You need to take your temperature twice a day for a month after surgery. Take it three times a day if it is elevated over 99 degrees. If you get two readings, at least three hours apart, of over 100 degrees, you need to notify us immediately.

5. Increasing knee pain. Pain should be decreasing from day to day. If it seems to be steadily increasing, let us know.

6. The knee loses motion. If Dr. Huddleston feels that your knee flexibility is not satisfactory (because of developing scar tissue, see Complications of Total Knee Replacement Surgery) he may recommend manipulation of the knee under general anesthetic. This procedure may be performed before you leave the hospital, or, after you leave the hospital it may be performed at the Surgery Center as an out-patient. It involves putting you to sleep for at least 5 minutes during which time Dr. Huddleston will gently manipulate the knee while you are asleep to break down the devloping scar tissue. It is possible for the femur to fracture during this procedure if you have osteoporosis, but the chances of this happening are extremely small.