INPATIENT TOTAL KNEE REPLACEMENT - THE PATIENT'S GUIDE TO Tailored for patients of Jason P. Norcross, MD
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THE PATIENT’S GUIDE TO INPATIENT TOTAL KNEE REPLACEMENT Tailored for patients of Jason P. Norcross, MD
Reclaiming Table of
Contents
Your Quality INTRODUCTION
of Life
Welcome....................................................... 4
Partnering for Success.................................... 4
About the Provider: Jason Norcross, MD.......... 5
Inpatient Total Knee Replacement.................. 6
PREPARING FOR SURGERY
Scheduling and Medications........................... 8
Medical History and Presurgical Testing........... 8
Presurgical Orientation................................... 9
Presurgical Exercises...................................... 10
Preparing Your Home For Your Return..............11
One Day Prior to Surgery................................11
DAY OF SURGERY
At Home...................................................... 12
Arrival at Hilton Head Hospital...................... 12
Post-op/Recovery......................................... 13
AFTER SURGERY: AT HOME
Managing Swelling ....................................... 14
Managing Pain............................................. 14
Home Healthcare......................................... 15
Precautions.................................................. 16
Handwashing............................................... 16
Stall Shower................................................. 16
Toilet............................................................ 16
POST-OP TIMELINE
Night of Surgery: Day 1.................................. 17
Post-op: Day 2.............................................. 18
Post-op: Day 3.............................................. 19
Post-op: Day 4..............................................20
Post-op: Two Weeks......................................20
Post-op: Six Weeks........................................ 21
Post-op: Three Months.................................. 21
Post-op: Six Months...................................... 22
Post-op: One Year......................................... 22
Troubleshooting Problems After Surgery.........23
Post-op Physical Therapy Program.................24
Living with Your Resurfaced Knee................... 27
Introduction
Welcome
Arthritis affects about 40 million to combat the effects of arthritis, and Partnering for Success
Americans, one in eight people. As we have worked tirelessly to develop and You and your surgeon have agreed
age, doing the things we love to do master advanced surgical techniques to that you are a good candidate
without arthritis pain often becomes help you revitalize your life. for knee replacement: a unique
challenging. Sometimes, even the treatment model that begins at
The purpose of this brochure is to
simplest of life’s tasks, like walking or diagnosis, continues with surgery,
introduce you to our comprehensive
getting out of a chair, can become and is completed at home, with you
partial and total knee replacement
difficult and painful. as an active participant.
program. Knee replacement, or
The physicians and the staff of arthroplasty, is the surgical resurfacing Understanding what is happening
Orthopedic Associates of the Lowcountry of the damaged surfaces of your knee, will make your time spent with us
and Hilton Head Regional Healthcare and one of the most effective ways – and the time spent throughout
are working to restore the quality of life to reduce pain and restore mobility. your entire journey to a better
of people with arthritis throughout the Our program is designed to optimize quality of life – smoother and more
area... one joint at a time. your health care experience, typically comfortable.
accompanied by a one-, or occasionally,
For many, a great quality of life means We ask you to arrange for a
two-night stay in the hospital.
spending time with family, enjoying responsible adult to be your JOINT
a round of golf, a bicycle ride or the With our extensive patient education PARTNER, or “JP.” This should be Jason Norcross, MD
pleasure of a simple walk. No matter and comprehensive care program, someone who can attend pre- Orthopedic Surgeon
what your definition, being able to walk we are confident that you will have surgical visits, take you home after
and move without pain is an important the information, care and support to hospital discharge, and help you
part of living well. succeed on this journey to restore a once you’ve returned home.
Our physicians and staff have spent
more active lifestyle. About the Provider EDUCATION
We encourage you to share
their professional lives studying how Dr. Jason Norcross is a fellowship-trained adult reconstruction surgeon specializing Fellowship: Concord Repatriation
information with your JP and all
in hip and knee replacement surgery. He has become one of the nation’s top General Hospital, Sydney, Australia
the other important people in
your life who will assist you. Your experts in the field of robotic-assisted surgery, and provides training to other Residency: University of Texas
understanding, participation and orthopaedic surgeons learning this technology. Dr. Norcross spent the first 14 years Medical Branch, Galveston, TX
commitment – and that of your of his practice in Hickory, North Carolina, developing a 5-star rating and achieving
Internship: University of Texas
JP – are important to the success one of the highest patient-satisfaction scores in the region. He has developed
Medical Branch, Galveston, TX
of your procedure. Both you and a reputation for being compassionate, humble, personable, and completely
dedicated to serving his patients. Medical School: University of
your JP should read and complete
North Carolina School of Medicine,
everything given to you. When
Dr. Norcross completed Medical School at the University of North Carolina, Chapel Hill, NC
everyone is on the same page and
Chapel Hill, NC. This was followed by an internship and residency program at The
fully informed, the journey to a
University of Texas Medical Branch in Galveston,Texas. During his residency, Dr. SPECIAL INTERESTS
successful recovery is smoother and
Norcross was awarded the OITE Master Academic Certificate of Recognition four Less invasive hip replacement surgery
less scary.
times. This award represents the highest academic score earned by a resident. He Outpatient joint replacement surgery
OUR GOAL IS TO HELP YOU completed an accredited fellowship program at Concord Repatriation Hospital in Robotic-assisted partial and total
ACHIEVE A GREAT RESULT. Sydney, Australia. This comprehensive program prepared Dr. Norcross to perform knee replacement
IMPORTANT some of the latest treatment options for arthritis of the hip and knee, including Knee arthroscopy
As soon as you get this booklet, begin doing the presurgical exercises to build We are committed to helping you minimally invasive surgery, hip resurfacing, computer-assisted surgery and General Orthopaedic procedures
strength and stamina. Don’t do specific exercises if they cause excessive pain. reclaim your quality of life. revisions of hip and knee replacements. Fracture Care
4 Reclaiming Your Quality of Life hhiorthopedics.com 5
KNEE REPLACEMENT (CONTINUED)
What are the risks of surgery? help prevent blood clots. Compression nerves heal, you may experience a tingling
Your surgeon has performed many stockings and a systemic compression sensation. You may experience permanent
inpatient and outpatient knee procedures device (calf pumps) are typically used to numbness in a small area around your
safely and successfully. However, there are further reduce risk. A short walk every 2 incision. This will not affect the function
potential complications associated with or 3 hours is also helpful. If your medical of your knee. It is extremely rare to have
any surgery. Below, we have listed some history suggests higher than average risk permanent neurologic damage that alters
of the possible complications associated for blood clots, additional medications the function of your leg from the surgery.
with knee replacement surgery and may be required.
SCAR TISSUE
precautions to help prevent them:
PNEUMONIA The surgical “injury” inevitably causes
INFECTION Breathing deeply after surgery and some scar tissue formation due to the
There is a risk of infection with all frequent coughing are important ways body’s normal healing response. This
surgeries. Your pre-admission evaluation to prevent congestion from building up in rarely impacts the ultimate function and
and test results will confirm you have your lungs, which can lead to pneumonia. performance of the knee. However, some
no active infections before surgery. popping and clicking is very common. Scar
BLADDER INFECTIONS
Antibiotics are administered before and tissue formation can become problematic
Bladder infections may also occur, so it
after surgery. Many other precautions when physical therapy progress is
is particularly important to drink plenty
– before, during and after your surgery unusually slow.
of fluids to help prevent this type of
– are taken to further reduce your risk of
infection. A urinary catheter is typically SEVERE COMPLICATIONS
infection, which occurs in less than 1 out
not used to further reduce this risk. You As with all major surgeries, there is a
of 100 knee surgeries.
will be getting up shortly after surgery to possibility that complications from any of
BLOOD CLOTS use the bathroom and begin walking. the above, or from the anesthesia, could
To reduce the risk of blood clots and be severe enough to result in major events
NUMBNESS
like heart attack, stroke or even death. If
Knee Replacement promote circulation, you will be asked to
You will experience some numbness
you have specific concerns regarding any
pump your feet and exercise your ankles
around your knee incision following
to increase circulation following surgery major medical issue that could impact
surgery. This is normal and expected.
How long will surgery take? ultrasound guidance. It numbs the leg and during recovery. After surgery, aspirin the success of the surgery, please notify
What is it? During surgery, the microscopic nerves
Your surgery will take 60 to 80 minutes from the hip down without altering is usually taken twice daily to further your surgeon and anesthesiologist.
Knee replacement surgery, also called around the joint are disturbed. As these
on average. muscle function. This often eliminates
arthroplasty, is an ever-evolving technique
the majority of your pain for 24 hours.
designed to resurface the damaged
How is the knee resurfaced?
compartments of your knee. During Light general anesthesia is then
An incision is made on the front of the
surgery, the damaged surfaces of the administered with intravenous (IV) Healthy Knee Arthritic Knee Total Knee Replacement
knee utilizing less invasive techniques.
bone as well as deteriorated soft-tissues sedatives and a unique breathing
The damaged bone and tissue are
surrounding the joint are removed, being mask called laryngeal mask airway
removed, and the bone surfaces are
replaced by metal (typically titanium) (LMA).
prepped and shaped to hold modern
and wear-resistant plastic. This can be Medications for pain, relaxation
titanium implants. Robotic technology
done on one-half of the knee, or partial and nausea prevention will be given
with precise computer algorithms
knee replacement, if the disease process to promote a smooth recovery
is utilized to align and balance the
is limited to one area, or compartment. If experience.
implants, which are secured to the bone
the disease process is more widespread,
utilizing bone cement. A special “cocktail” of pain-relieving
which is more common, the entire knee
medications will be injected into the
(total knee) will require resurfacing. What kind of anesthetic soft tissues around the knee during
The surgery can eliminate knee pain will I have?
surgery to further reduce immediate
and allows for a complete recovery and An adductor canal block (ACB)
post-op pain.
restoration of an active lifestyle. is performed by anesthesia using
6 Reclaiming Your Quality of Life hhiorthopedics.com 7
Preparing for Surgery
PREPARING FOR SURGERY (CONTINUED)
Presurgical Orientation
1. MEDICAL CLEARANCE: The surgery 5. DURABLE MEDICAL EQUIPMENT O
ndansetron (for nausea)
Scheduling Medications coordinator will ensure proper clearance (DME) VISIT: Usually the same day Aspirin 325 mg (for blood
Most insurance companies Once your surgery is scheduled, please inform our office if you are currently taking documents, and blood work are obtained as the pre-op visit, you will see a clot prevention)
require pre-authorization prior any of these medications, as they need to be stopped prior to your surgery: from your medical providers. This may or DME specialist who will provide some
K
eflex 500 mg (antibiotic for
to scheduling surgery. Our staff may not require a separate visit to your equipment options for purchase or rent
Coumadin 5 days infection prevention)
will call your insurance company 7 days medical provider before surgery. to facilitate your recovery at home,
Aspirin
to check eligibility and get Varies (notify your surgeon of these) including the following: S
copolamine transdermal
Rheumatoid arthritis drugs
pre-authorization as needed. St. John’s wort 2 weeks 2.PRE-OP VISIT: Approximately one patch (placed behind the ear
2 weeks Calf sequential compression device
This may take several days, Prescription diet pills week before the surgery, you will see to prevent nausea)
All vitamins and supplements 7 days (SCD) – for blood clot prevention
depending on the insurance your surgeon’s PA to perform necessary Tylenol is encouraged liberally during
Anti-inflammatory medications (Advil, Cold therapy unit – an ice machine
company. Once we have received paperwork, review the pre-op and the recovery process to reduce the
ibuprofen; Aleve, Naprosyn; Relafen, 7 days for swelling reduction
approval from your insurance, post-op plans, ensure all questions dependence on stronger narcotics.
nabumetone; diclofenac; meloxicam)
you will be contacted to discuss are answered and ensure all details Walker This should be taken thrice daily or
Hormone replacement therapy 7 days
available surgery dates and other are complete. every 8 hours. Tylenol max dose:
Cane
important appointments. Note: Celebrex can be taken until surgery. 3,000 mg (1,000 mg thrice daily)
3. ANESTHESIA PRE-OP VISIT: Bedside commode/shower chair
If you take other BLOOD-THINNING MEDICATIONS (i.e., Eliquis, Xarelto, Plavix, etc.),
Approximately one week before the Note: Notify your surgeon if you are
notify your surgeon, as you may not be a candidate for outpatient knee replacement.
surgery, you will see an anesthesiologist 6. H
OME HEALTH PLANNING: allergic or unusually sensitive to any
to review the anesthesia plans, ensure Confirm that home health has been of the recommended medications as
you are an appropriate candidate for approved, which will consist of physical there are often alternatives.
knee replacement in the outpatient therapy to start the day after you
are discharged from the hospital. The 8. CUTS AND SCRATCHES: The operative
Medical History and Health Status Presurgical Testing setting and go over medications.
frequency of home therapy will be leg cannot have any open or healing
Before your surgery, we will ask questions Are you taking any medications [this Depending upon your age and
4. P
HYSICAL THERAPY PRE-OP determined by your surgeon, but is wounds at the time of your knee
regarding your medical history and health includes over-the-counter (OTC) products medical status, we may ask
EVALUATION: Approximately one to typically twice per week for 2 weeks. replacement due to infection risk. Notify
status for insurance verification. These are such as aspirin, ibuprofen, vitamins, herbs you to go to a local laboratory
two weeks before surgery, you may be your surgeon immediately if this occurs
some of the questions frequently asked: and teas]? Please have your medication or diagnostic center for pre-
asked to see a physical therapist for 7. PRESCRIPTION MEDICATIONS as surgery will need to be postponed.
bottles or a complete list available for your operative testing. These tests
Do you have health problems such the purpose of presurgical orientation. (POST-OP MEDS): Post-op medication
physician to review. may include the following:
as diabetes, heart disease or high At this visit, you will learn in great prescriptions will be provided at the pre- 9. STOP MEDICATIONS AND
blood pressure? Have you had previous surgeries Chest X-ray detail about the procedure, including op visit, including a sheet of instructions SUPPLEMENTS THAT CAUSE BLOOD
or illnesses? Blood work (CBC, BMP, PT/PTT) the following: on how to take them and a chart THINNING: See the list covered
Do you use tobacco, alcohol or
to help you keep track of usage. The previously.
recreational drugs? Are you or could you be pregnant? Urine test How to prepare your home medications may include the following:
Do you have allergies? Have you or any blood relatives had Electrocardiogram (EKG) What to bring to the surgery center 10. STOP SMOKING AND CHEWING
previous problems with anesthesia? Tramadol (for moderate pain)
Do you currently have a fever, cold, rash or Nasal MRSA culture TOBACCO: Nicotine impairs bone and
What equipment you’ll need
history of recurring infection? Have you or any blood relatives had a Oxycodone (for severe pain) wound healing and can directly lead
history of blood clots? What to expect during and
Celebrex (for inflammation – to infection. You must quit 1 month
after surgery
ibuprofen can be substituted) before surgery and continue avoiding
Exercises to prepare for surgery nicotine for 2 weeks after surgery or
Dexamethasone (for inflammation
until the wound is fully healed.
and swelling)
IMPORTANT
If you get a fever, cold, serious medical illness, rash or a CUT/SCRATCH ON YOUR SURGICAL LEG, call our office regarding your
change of health. Your surgery may need to be postponed.
8 Reclaiming Your Quality of Life hhiorthopedics.com 9
PREPARING FOR SURGERY (CONTINUED) PREPARING FOR SURGERY (CONTINUED)
Presurgical Exercises Preparing Your Home For Your Return
Perform this list of exercises twice daily. They should take about 15-20 minutes to complete. Don’t do any exercises that are too Please review and complete the following list of items prior to surgery. This will ensure a smooth transition from the surgery center to
painful. In addition, the use of a stationary bike for 15-20 minutes per day is highly recommended to begin preconditioning for your home on the day of surgery.
success after surgery. These are the same exercises used AFTER surgery.
Prepare meals ahead of time and put fresh linens on your bed. Arrange for pet care if needed. Keep pets away from the
surgical leg.
Presurgical Exercises (See pages 28-29 for pictures of each exercise.) Make sure you have an armchair with a firm cushion that you
can sit on. Prepare a comfortable rest area with tissues, phone, TV, remote
Ankle Pumps Flex foot. Point toes. Repeat 20 times. control, etc., nearby. You don’t want to rush for the phone.
Water beds are not recommended after your surgery. A flat,
Quad Sets (knee push Lie on back, press surgical knee into mat tightening muscles on front of Repeat 20 times. firm mattress should be in place. If you are going to be alone on some parts of the day, carry
downs) thigh. Do NOT hold breath. a portable phone and/or personal alarm with you to call for
Have an ample supply of your prescription medications available.
Gluteal Sets (Bottom Squeezes) Squeeze bottom together. Do NOT hold breath. Repeat 20 times. help in case of an emergency.
Pick up throw rugs and make sure long phone and electrical
Knee Abduction and Lie on back, slide legs out to side. Keep toes pointed up and knees straight. Repeat 20 times. Have footwear available with nonskid soles.
cords are out of the way.
Adduction Bring legs back to starting point. Arrange transportation for follow-up visits.
Put night-lights in bathrooms and dark areas.
Heel Slides (Slide Heels Up Lie on couch or bed. Slide heel toward your bottom. Repeat 50 times.
Have nonskid surfaces (strips, etc.) in place in tubs and showers.
and Down)
Short Arc Quads Lie on back, place towel roll under thigh. Lift foot, straightening knee. Repeat 20 times.
Do not raise thigh off roll.
Armchair Push-ups This exercise will help strengthen your arms for walking with crutches or a Repeat 20 times.
walker. Sit in an armchair. Place hands on armrests. Straighten arms, raising
bottom up off chair seat, if possible. Feet should be flat on the floor.
Seated Hamstring Stretch Sit on couch or bed with leg extended. Lean forward and pull ankle up. Repeat 5 times.
Stretch until pull is felt. Hold for 20-30 seconds. Keep back straight. Relax.
Straight Leg Raises Lie on back, unaffected knee bent and foot flat. Lift opposite leg up to 12 Repeat 20 times.
inches. Keep knee straight and toes pointed up. Relax.
Ankle Dorsiflexion Standing, hold onto firm surface. Raise up on toes. Go back on heels.
(Plantar Flexion)
Hip Flexion Standing, march in place.
One Day Prior to Surgery
REMEMBER Shower with Hibiclens antiseptic skin cleanser (if available). Eat a “regular-sized” dinner the day before surgery. Do not
The use of a stationary bike is one feast on large quantities of heavy or rich foods.
Use antimicrobial wipes over surgical site.
of the best pre-op and post-op
Take all routine medications except those already stopped. If
exercises for knee replacement Have nothing to eat after midnight. This includes gum,
there is any question about which medications to take, please
success. Having access to this candy and mints. Your surgery may be cancelled or delayed if
contact your surgeon.
device could dramatically impact you don’t follow this guideline.
your results. Avoid heavy labor. Avoid activities that could result in cuts and
You are expected to drink 16 oz of water or an electrolyte
scratches. Avoid activities that could result in dehydration.
drink between midnight and 2 hours before your arrival time
at the surgery center.
10 Reclaiming Your Quality of Life hhiorthopedics.com 11
Day of Surgery
DAY OF SURGERY (CONTINUED)
Post-op / Recovery
At Home At the end of the surgery, anesthesia medications. Physical therapy will begin
IMPORTANT REMINDER will be reversed and you will be brought shortly after you arrive in your hospital DISCHARGE CHECKLIST
Use the last set of antimicrobial wipes over the surgical site – DO NOT SHOWER. Completely drink 16 oz of water to your recovery suite. You’ll wake up room, and the goal is to ambulate All home medication
Wear comfortable, loose clothing. OR an electrolyte drink (Propel, with minimal discomfort. Your leg will be short distances on the same day of your prescriptions filled
Do not use lotions, talcum, perfume, make-up or nail polish. Gatorade, etc.) 2 hours before wrapped for compression, elevated on surgery. The morning after surgery, the
Take heart and blood pressure medications with a sip of water. Do not take insulin P
ick up Tylenol 500mg and
arrival to the surgery center. pillows, and a drain in place to minimize surgical bandage will be removed and
or diabetes medications unless instructed to do so. Aspirin 325mg in addition to
pain and swelling. drain discontinued. Physical therapy
prescription meds
sessions will be continued until you can
In the recovery area, the nurses will
successfully ambulate 100 feet, climb H
ome health agency contacted
monitor your vital signs and keep
stairs, and stand/sit safely. Once your pain – visit by physical therapist
you comfortable. Medications will be
is controlled, physical therapy tests are confirmed for day after home
administered as necessary for pain or
passed, and you are successfully eating, discharge
nausea. IV fluids and oral liquids will be
drinking, and voiding appropriately, you
utilized for hydration. All necessary home equipment
will be discharged home. That is typically
achieved the day after surgery, but some has been acquired – walker, cane,
You will be monitored in the recovery area
more deconditioned patients may require cold-therapy device, home SCDs,
for approximately one hour, and then be
a second night in the hospital. bedside commode/shower chair
transported to your hospital room on the
orthopedic floor. For the next 24 hours, P
ost-op appointment scheduled
Prior to discharge, you will be given a brief
you will be monitored by the nursing (2 weeks after surgery day)
home instruction sheet – detailed home
staff, receiving protocol medications,
instructions are on the next several pages
like IV antibiotics, steroids, and pain O
K to shower if the waterproof
of this booklet.
dressing is properly sealed
A second waterproof dressing will
be provided for dressing change
at 7 days post-op
J P or family member will be
with you for 24 hours after
discharge and be present with
you most of the time for the
first week at home
Arrival at Hilton Head Hospital
At Hilton Head Hospital Same-Day Surgery: In the pre-op area
Bring walker. Y
ou will sign the surgical and anesthesia consent forms.
Bring photo ID, bag for dentures, cases for contact lenses IV will be started, and pre-op medications and antibiotics
or glasses. will be administered.
Bring a book, iPad, laptop or headphones for your stay in A
nerve block will be performed by the anesthesiologist.
the recovery suite. T he knee will be shaved and prepped with Hibiclens.
A family member or significant other must accompany Y
our surgeon will meet you and your family in the pre-op
you to the hospital. area, confirm and mark the surgical site and answer any
Your JP should also accompany you to the hospital (if the question you may have.
JP isn’t your family member or significant other). Y
ou will then be transferred to the OR.
Family members will be brought to the waiting lounge.
12 Reclaiming Your Quality of Life hhiorthopedics.com 13
After Surgery: At Home
AFTER SURGERY: AT HOME (CONTINUED)
Managing Swelling
GOALS FOR THE FIRST 2 WEEKS
Manage swelling. The success and degree of pain during the Swelling will typically peak on Day 4 or 5
Manage your pain (by managing first 2 weeks hinges on swelling control. after surgery.
the swelling).
YOUR KNEE WILL SWELL. YOUR KNEE Keep the leg elevated continuously, knee
T ake short, brief walks and
WILL HURT AS A RESULT. straight, toes at eye level or higher. The
transition to a cane.
only time the leg should not be elevated
A
chieve 90 degrees or more of A good rule of thumb is to ice the knee for
is during therapy, walking, using the
knee motion as soon as possible. 20-30 min every hour when awake.
bathroom or when eating.
CAUTION
Using a recliner may not elevate
your leg high enough or keep your
knee straight enough. Toes should
be at or near eye level.
Elevate high. Knee straight.
Managing Pain
Our primary goal is to keep you as around the clock for the first 2 weeks to Remember, pain will NOT be an obstacle Home Health Care
comfortable as possible following your keep your baseline level of pain lower, in the first 2 days. And you have all the
A physical therapist will visit you at home order to more effectively exercise on your
surgery, and this starts with swelling so the spikes of increased pain are more tools to manage your pain when it hits: ice
the day after surgery. The therapist will own and achieve your range or motion goal REMINDERS
management. It is equally important to easily managed by stronger narcotic and a three-level medication strategy:
evaluate the safety of your home and ensure for the 2 week post-op visit: 0 degrees (or Wear the compression stockings regularly
understand our philosophy of multimodal medication. If you manage the swelling Mild pain – Tylenol, Celebrex (or ibuprofen)
proper icing and elevation is performed. fully straight) and OVER 90 degrees of flexion for the first 2 weeks.
pain management. well, you will manage the pain well. And Moderate pain – Tramadol
The therapist will assist you in your exercise (bending).
don’t forget: ICE is a great pain killer. Severe pain – Oxycodone Use the home SCD machine most of the
It is important to realize that your knee program, and encourage walking with
The physical therapist will also check your time, including sleep, for the first 2 weeks.
will hurt, often bad at times, but it is very Your pain will be assessed from the time *If you are allergic or unusually proper technique utilizing your walker or
vital signs, like blood pressure, and evaluate
manageable if you follow our protocols. you leave the operating room until the sensitive (with nausea, itching) to any cane. Walking will be encouraged every Remove the SCDs during ambulation and
whether it is safe to restart your blood
time you leave the surgery center. You will medications in the protocol, notify your 2-3 hours, for short distances. Excessive PT sessions.
The pain is relatively minor for the first 24- pressure medications. The therapist will
frequently be asked to rate your discomfort surgeon as there are often substitutes. standing or walking are discouraged to
48 hours after surgery. It will rapidly escalate assess your surgical dressing and perform
on a pain scale that will help us determine Celebrex – If you have gastrointestinal avoid developing too much swelling. The
and peak somewhere between Days 3 to 5, the necessary dressing change in 7 days or
if your current method of pain control is (GI) sensitivity or sulfa allergy, ibuprofen therapist will evaluate your knee range of your compression stockings are worn
and then begin to slowly subside. if your dressing becomes excessively soiled.
adequate or if changes need to be made. can be substituted. motion, and assist you in improving your correctly and that home SCD machine (calf
The therapist will encourage hydration,
Oral or injected pain medications may be Oxycodone – If you have itching knee motion daily. It is also very important compression device) is being utilized properly.
Our philosophy: use Tylenol, ibuprofen and review your medications, and evaluate
used to relieve discomfort. or GI sensitivity, hydrocodone or to continue taking your pain medication The will make sure all DME devices are
tramadol (all nonaddictive medications) your pain. The therapist will make sure
hydromorphone can be substituted. consistently according to the protocol, in working and being utilized properly.
14 Reclaiming Your Quality of Life hhiorthopedics.com 15
Post-op Timeline
AFTER SURGERY: AT HOME (CONTINUED)
Precautions
Use your walker or cane when walking Allow for adequate room at the side of Avoid reaching far overhead or
and weight-bearing (as tolerated). your bed to walk. Avoid pivoting on your down low. Discharge Home: Day 1
Do not lift or carry things while walking. affected leg. It’s easier to take out the trash if you Keep the surgical dressing dry and intact. Take at least two short walks, which can be done during
Avoid slippery or unstable surfaces. use small plastic grocery bags and tie Don’t forget to use your medicine tracking chart to help keep bathroom breaks. Don’t walk too much.
Avoid small pets, remove throw rugs
and secure electrical and phone cords Do not allow yourself to get exhausted. them to your walker. track of things. Keep leg continuously elevated otherwise with home SCDs on
on the floor where you may walk. Do Slide bowls, containers, pots and pans We recommend staggering the doses of the pain medications most of the time.
Use a cart to move items.
not let pets near your surgical leg. along the counter. Don’t carry them. to optimize pain relief, and to always have a medication Begin aggressive ice and elevation strategy. Remember:
Wear an apron or light jacket with
Do not drive for two weeks or working for you. elevate toes to the nose and ice 20-30 minutes every hour.
several pockets to keep your hands free.
as instructed. Drink lots of fluids.
Medication Checklist: Night of Hospital Discharge
Handwashing Helps Medication Dose First Dose Additional Doses
Prevent Infection
Around 8 p.m. or upon Every 6 hours,
A serious form of bacteria known as Keflex1 500 mg
arrival at home for four doses
MRSA frequently inhabits the skin
Aspirin 325 mg Around 8 p.m. ––
or nose of healthy people. When
introduced into the home setting Dexamethasone 4 mg Around 8 p.m. ––
during recovery, it can be harmful to
Tylenol 1,000 mg Around 10 p.m. or before bed Every 8 hours
patients. Hand hygiene is the single
most important method of controlling Celebrex2 200 mg Around 10 p.m. or before bed Every 12 hours
the spread of bacteria. We ask all 50 mg
Tramadol3 As needed for pain Every 6 hours
visitors and caregivers to wash their (2 tabs)
hands before and after contact with
5 mg
patients and their surroundings. This Oxycodone4 As needed for pain Every 4 hours
(1 or 2 tabs)
simple act can provide for a safer
environment for all. Zofran (ondansetron) 1 dose As needed for nausea ––
OTC laxative 1 dose As needed to prevent constipation ––
1 Clindamycin may be substituted for Keflex if allergic to penicillin.
2 OTC Ibuprofen may be substituted for Celebrex if GI sensitive or allergic to sulfa. Ibuprofen dose is 800 mg every 8 hours.
Stall Shower Toilet 3 Tramadol is AS NEEDED. Max 4 doses in a 24hr period.
Do not attempt to use your walker to pull
4 Oxycodone is AS NEEDED. Max 6 doses in a 24hr period. This medicine is highly constipating, so use sparingly when the other
If your cane fits into the shower stall, step Put a bar of soap in the foot end. Tie the
protocol drugs are not effective enough. If oxycodone causes excessive sedation/drowsiness, try taking half a tablet.
in with the affected leg first. If you are two top ends together. Hand around yourself up to stand. Push up from the
unable to fit the cane into the stall, step in your neck. seat, reaching forward with one hand at a
backwards with your strong leg first. time to your walker.
Use a long-handled sponge or brush to
Make sure surfaces inside and outside the wash and dry legs. When out in the community, use the
shower are nonskid to decrease your risk of bathrooms that accommodate people
Make sure the dressing is fully sealed so the
slipping. with disabilities. They will have grab bars.
incision stays dry.
You can make a soap holder from the cut Use a shower bench/chair if available
off legs of pantyhose. Cut them down the as needed.
center leaving the foot end mostly intact.
16 Reclaiming Your Quality of Life hhiorthopedics.com 17
POST-OP TIMELINE (CONTINUED) POST-OP TIMELINE (CONTINUED)
Post-op: Day 2 Post-op: Day 3
Drink lots of fluids today. Drain site will ooze for a few days. Keep Home SCDs should be worn most of the Pain will get worse today and will Use SCDs and TED hose as previously Take short, brief walks every 2-3 hours.
Continue aggressive ice and elevation covered with gauze and tape until time, except during walking. likely peak in a few more days. instructed on both legs. Do the exercise program at least twice
strategy. Remember: elevate toes to the leakage stops. Leakage on surgical T ED hose should be worn most of the Continue the tramadol, Tylenol and Continue aggressive ice and elevation daily. Focus on extension (straight
nose and ice 20-30 minutes every hour. dressing should be minor. A few spots time on BOTH legs. Celebrex. Pain is directly linked to the strategy. Remember: elevate toes to the knee) and flexion (bend as much as
(quarter-size) are expected and normal. swelling. nose and ice 20-30 min every hour. pain permits).
May shower today if pain is controlled Home health physical therapy visit:
Pain will begin escalating today. This Continue drinking fluids and using a
and dressing is properly sealed. PT will start today, reinforcing the Ambulate with a walker. Transition to Antibiotics are NOT necessary
is because the nerve block is wearing laxative to prevent constipation.
T ake short, brief walks every 2-3 hours. exercise program, measuring range cane if safe and stable. starting today.
off. Don’t panic. Our pain “recipe”
Don’t walk or stand too much to avoid of motion, ensuring proper ice and
works. Continue the tramadol, Tylenol
swelling. elevation, checking home for safety and
and ibuprofen. If you manage the
assistance with walking. Medication Checklist: Day 3
swelling well, you manage the pain well.
Medication Dose 1st Dose 2nd Dose 3rd Dose 4th Dose 5th Dose 6th Dose
Aspirin1 325 mg 8 a.m. 8 p.m. –– –– –– ––
Medication Checklist: Day 2 Dexamethasone 4 mg 8 a.m. 8 p.m. –– –– –– ––
Medication Dose 1st Dose 2nd Dose 3rd Dose 4th Dose 5th Dose 6th Dose
Tylenol 1,000 mg 10 a.m. 6 p.m. 2 a.m. –– –– ––
Keflex 500 mg 6 a.m. Noon 6 p.m. –– –– ––
Celebrex2 200 mg 10 a.m. 10 p.m. –– –– –– ––
Aspirin1 325 mg 8 a.m. 8 p.m. –– –– –– ––
50-100 mg
Tramadol3 –– ––
Dexamethasone 4 mg 8 a.m. 8 p.m. –– –– –– –– (2 tabs)
Tylenol 1,000 mg 10 a.m. 6 p.m. 2 a.m. –– –– –– 5-10 mg
Oxycodone4
(1 or 2 tabs)
Celebrex2 200 mg 10 a.m. 10 p.m. –– –– –– ––
50-100 mg Zofran5
1 dose
Tramadol3 –– –– (ondansetron)
(2 tabs)
Oxycodone4 5 mg (1 tab) OTC laxative6 1 dose
Zofran
1 dose 1 Take aspirin 325 mg twice a day to help prevent blood clots.
(ondansetron)
2 If you substitute Ibuprofen for Celebrex, it should be taken only thrice daily.
OTC laxative5 1 dose 3 Tramadol is AS NEEDED. Max of 4 doses in a 24-hr period. Write in the times taken.
4 Oxycodone (or alternative, if allergic) can be taken every 4 hours. Use one or two 10-mg tabs as needed. If overly sedated, try
1 Take aspirin 325 mg twice a day to help prevent blood clots and finish last dose of Keflex (antibiotic). taking half a tablet (5 mg dose).
2 If you substitute Ibuprofen for Celebrex, it should be taken only thrice daily. 5 For nausea or an upset stomach, take Zofran (ondansetron) as needed. You may take an antacid (Pepcid or Prilosec OTC)
3 Tramadol is AS NEEDED. Max of 4 doses in a 24-hr period. Write in the times taken. for heartburn. If this persists, Celebrex can be changed to once daily or switched to OTC ibuprofen. NSAIDs may need to be
4 Oxycodone (or alternative, if allergic) is AS NEEDED and should be started every 4 hours. Max of 6 doses in a 24-hr period. discontinued completely. Call your surgeon if this is necessary. If this still doesn’t fix the problem, the aspirin dose may need to be
Use one 5mg tab at first. Take 2 tabs as pain ramps up. For extreme pain, you may on occasion take 3 tabs (15mg) at one time, lowered to 81 mg twice daily.
although this will likely cause sedation. Write in the times taken. 6 Bowel management – Take an OTC laxative – pain medications are constipating.
5 Bowel management – Take an OTC laxative – pain medications are constipating.
18 Reclaiming Your Quality of Life hhiorthopedics.com 19POST-OP TIMELINE (CONTINUED) POST-OP TIMELINE (CONTINUED)
Post-op: Day 4 Post-op: Six Weeks
Not much changes from here on. – Oxycodone every 4 hours for moderate Continue aggressive ice and elevation Post-op visit with your surgeon. Xrays Expect significant weakness and
Post-op:
pain. Begin spacing oxycodone dose out strategy. Remember: elevate toes to the are not usually necessary. difficulty with stairs at this stage.
Three Months
Pain and swelling should slowly
begin improving. and weaning slowly, as pain permits. nose and ice 20-30 min every hour. Post-op visit with your surgeon.
Target ROM is 0-120 degrees. OK to resume swimming if wound fully
Xrays are not usually necessary.
Continue taking short walks and do the Unlikely to require cane at this point. healed (includes the ocean, hot tubs,
Continue current medication regimen:
physical therapy program twice daily. pools, etc) Return to normal level activity
– Tylenol, Celebrex and tramadol to If ROM is NOT beyond 90 degrees, an
is expected at this point in the
lower baseline pain. Last day of dexamethasone. additional procedure (knee manipulation Anticipate return to work now (or recovery process. Most hobbies
under sedation) may be required. soon) for sedentary jobs. can be resumed, including golf,
Medication Checklist: Day 4 Sleep disturbances, swelling, heat, Aspirin 81mg twice daily is stopped,
doubles tennis, hiking, cycling,
and exercise.
Medication Dose 1st Dose 2nd Dose 3rd Dose 4th Dose 5th Dose 6th Dose soreness, aching, stiffness, and some unless recommended by your PCP.
Anticipate return to more
pain are all typical for this stage of Vitamins and supplements can now
Aspirin1 325 mg 8 a.m. 8 p.m. –– –– –– –– demanding jobs at this stage,
recovery. be resumed. including jobs that require
Dexamethasone 4 mg 8 a.m. 8 p.m. –– –– –– –– standing, climbing, and lifting.
Formal physical therapy is transitioned Scar creams and body lotion can now
Tylenol 1,000 mg 10 a.m. 6 p.m. 2 a.m. –– –– –– to a home gym and home exercise be applied on the surgical site. Please note that KNEELING
program around this point in the ON THE KNEE REPLACEMENT
Celebrex2 200 mg 10 a.m. 10 p.m. –– –– –– ––
recovery process. The stationary bike is is not recommended for long
50-100 mg the most useful rehab tool at this stage. durations. Kneeling may remain
Tramadol3 –– –– permanently uncomfortable due
(2 tabs)
to the scar sensitivity.
5-10 mg
Oxycodone4 Expect activity-related swelling
(1 or 2 tabs)
to still occur. This will typically
get a little worse as the day
1 Aspirin twice daily for blood clots. Remember, if you are having continued stomach upset or heartburn, lower the dose of Aspirin progresses. Occasional icing,
from 325mg to 81mg twice per day and stop taking Celebrex or Ibuprofen. Tylenol, and ibuprofen are helpful
2 If you substitute Ibuprofen for Celebrex, it should be taken only thrice daily. for these symptoms.
3 Tramadol is AS NEEDED. Max of 4 doses in a 24-hr period. Write in the times taken. May now resume routine dental
4 Oxycodone (or alternative, if allergic) can be taken every 4 hours. Use one or two 10-mg tabs as needed. If overly sedated, try visits. Antibiotics will be required
taking half a tablet (5 mg dose). 30 minutes before your visits.
Most dentists will prescribe the
Post-op: Two Weeks antibiotic for you.
Post-op: Day 7 Post-op office visit with your surgeon: Aspirin dose changed to 81mg twice daily.
Some activities may produce
discomfort in the front of your
Home health physical therapist Xray, incision check, review physical Resume driving when off narcotics knee, including rising from a
will change the waterproof therapy progress, evaluation of (oxycodone, or alternative) and reaction chair, getting out of the car,
functional status, level of discomfort. stair-climbing, and walking down
dressing today. time/control of driving leg returns to
a slope.
The dressing is good for 7 more Staples are removed. The incision no normal. You may require a driver for
Decrease the frequency of
days, and if sealed properly, will longer requires a dressing. physical therapy visits for a few more
exercise at this stage, to
allow normal showering. TED hose are discontinued. weeks, depending on your progress. Most
allow inflammation to reduce.
No soaking. people can drive while taking Tramadol, Recommend using gym
Home SCDs are only required at
as it usually does NOT cause sedation. equipment and the stationary
The second dressing was night now.
bike 3-4 days per week.
provided in your discharge Continue home exercise program.
Outpatient physical therapy should
packet from the surgery center. Range of motion goal: 120 degrees
begin. The frequency of visits will
by 6 weeks post-op. Begin using a
depend on your level of progress and
stationary bike as soon as your pain/
access to similar gym equipment.
motion permits.
20 Reclaiming Your Quality of Life hhiorthopedics.com 21After Surgery: Troubleshooting Problems
POST-OP TIMELINE (CONTINUED)
Post-op: Six Months
Post-op visit with your surgeon. Muscle atrophy in the quadriceps will Knee will still feel stiff occasionally, WATERPROOF BANDAGE LEAKS DIFFICULTY LIFTING LEG OR
Xrays obtained. still be present, but improving steadily. especially after long periods where no OR GETS WET HOLDING IT STRAIGHT IMPORTANT!
T endency for activity-related This persistent muscle weakness movement occurs. If the waterproof dressing loses the seal, This becomes more difficult as the
Please call our office or the on-call
causes a strain and discomfort along water can saturate the pad and cause knee swelling increases. Keep icing and
soreness mostly resolved. There will Recommend continued use of gym physician if you experience any of
the front of the knee during stair- problems with the incision, such as elevating. As the swelling diminishes, this
still be a small amount of swelling, equipment and the stationary bike for the following:
climbing (especially going down stairs), infection. If this occurs, do NOT shower. gets easier.
heat, inflammation in most knees at strengthening 3-4 days per week. Fever greater than 101°F
squatting, arising from a chair after Remove the dressing and cover with sterile
this stage. CONSTIPATION WHILE ON NARCOTICS S
udden rapid increase in knee pain
sitting for prolonged periods. gauze/tape. Call your physician and tell
Extremely common and directly related Increased drainage, redness or
your home health therapist. A second
to narcotic (oxycodone) use. Take an swelling to the incision
waterproof bandage will be provided on the
OTC laxative AND stool softener, and C
alf pain/tenderness or dramatic
day of surgery and can be applied early.
consider taking Miralax in addition. changes in leg or knee swelling
REDNESS NEAR THE INCISION Occasionally, suppositories and/or C
hest pain
This is typically related to bruising, enemas may be required. C
hest congestion or tightness
bleeding and inflammation just below the P
roblems with breathing or
DECREASE IN ROM shortness of breath
skin’s surface. This usually responds to ice
Progress with ROM is associated with the Difficulty urinating, burning with
and elevation and backing off the rehab
degree of SWELLING in the leg and knee urination or urinary frequency beyond
exercises for 24-48 hours. Your blood
joint. Swelling peaks in the first 5-7 days the first 2 or 3 days after surgery.
thinner may need to be held. If it persists,
at home, and during that period, ROM
especially when associated with a FEVER
may diminish. As swelling subsides (ice OFFICE PHONE NUMBER
over 101°F, call your physician immediately.
and elevate), ROM should begin improving 843-547-0183
THE KNEE FEELS WARM again. Goal: achieve over 90 degrees of
AFTER HOURS NUMBER
This is NORMAL for months after knee flexion by 2 weeks.
843-547-0183 (call service will notify
surgery. It is the result of swelling and
DRAINAGE ON THE SURGICAL BANDAGE the on-call physician)
inflammation in the knee. Ice and elevate
This is common and expected, especially over
to control the swelling and warmth. This
the navigation pin sites. A quarter-sized area
slowly improves with time. NAUSEA OR UPSET STOMACH
that does NOT continue to expand in one
Nausea, or even vomiting, can be a problem
INCREASED PAIN AND SWELLING or two spots is normal. If the entire dressing
related to side effects of anesthesia or some
AFTER THERAPY/ WALKING pad gets saturated, notify your doctor as
of the medications prescribed after surgery.
This is the main “battle” in the first 2 weeks. the bandage needs to be changed and the
It is common to have a sensitivity to NSAIDs
Ice and elevate for 20-30 min every hour incision needs to be assessed.
and Aspirin, especially if you have pre-existing
while awake. Elevate the leg as high as
DRAIN SITE LEAKAGE gastroesophageal reflux disease (GERD). The
possible for more effective swelling reduction.
This is a NORMAL problem that will resolve first step to troubleshoot this problem is to
Don’t overdo it. Doing a lot of walking is NOT
over the course of 3 to 4 days. Reinforce reduce the dosage of Aspirin from 325mg to
the fastest road to recovery. Blood thinning
drain site area with gauze and tape. 81mg. If this does NOT fix the nausea issue,
medications may need to be held.
Change as necessary. It is OK to continue then lower the frequency or eliminate the
BRUISING DOWN THE BACK OF THE to shower if the main waterproof dressing Celebrex (or Ibuprofen). Nausea is also a
Post-op: One Year THIGH, CALF AND ANKLE is sealed. common side effect of narcotics, especially
Post-op visit with your surgeon. Inflammation and swelling are typically Rapid pivoting movements and twisting This is from normal oozing and bleeding under oxycodone. Try avoiding the narcotics if
NUMBNESS NEAR THE INCISION
the skin from the surgery and will collect in the possible, unless the pain is unmanageable,
Xrays obtained. resolved, and most activities can be maneuvers can elicit fleeting sharp The outer (lateral) edge of the incision
back of the leg because of gravity. It usually and if that is the case, you may be forced to
T he average patient achieves peak done without soreness. pain, which usually does not result in often becomes numb for months following
peaks in the first 5-7 days at home, then take a Zofran (anti-nausea drug) 20 minutes
performance of the knee at this stage. Changes in the weather are often problems with routine daily activities. the surgery. There may even be tingling or
slowly resolves with ice and elevation. If there before taking a dose of oxycodone or
associated with minor aching in the burning in the skin. This is unavoidable and
Strength has returned to near-normal is excessive bruising in the front of the knee tramadol. If these steps do not resolve your
knee. This gets better with time. slowly improves with time.
levels, and quadriceps atrophy resolved. around the incision, notify your doctor. nausea, please call your doctor.
22 Reclaiming Your Quality of Life hhiorthopedics.com 23Post-op Physical Therapy
POST-OP PHYSICAL THERAPY (CONTINUED)
Exercise Program (Perform at least twice daily)
The following exercises will help you make a complete recovery from your outpatient knee replacement surgery. The exercises are
GETTING INTO THE CAR designed to improve your range of motion (ROM) and flexibility, as well as to restore your strength.
Front Seat
W
ith the passenger seat
pushed back, back up to the
Ankle Pumps Flex foot. Point toes. Repeat 20 times.
seat using your walker. Lower
yourself into the seat. Tip: a
plastic trash bag can help you
rotate side to front.
Sit with your surgical leg straight, other knee bent, and
Gently swing both legs into Quad Sets (Knee
press the backside of the surgical knee into the floor, Repeat 20 times.
the vehicle using your hands to Push-Downs)
tightening muscles in front of thigh. Do NOT hold breath.
assist you. Don’t be afraid to
bend the surgical leg to do this.
Do not spend too much time
Gluteal Sets
SAFE USE OF YOUR WALKER just enough pressure from the surgical in the passenger front seat
(Bottom Squeeze bottom together. Do NOT hold breath. Repeat 20 times.
Keep your hips straight and stand tall leg to lessen discomfort and reduce the with your leg down. Remember,
Squeezes)
when using the walker. Use your arms risk of falls. elevate the surgical leg as
to alleviate just enough pressure to much as possible to control
A single-prong cane with a “no slip” tip
minimize pain on the surgical leg. swelling in the first 2 weeks.
is recommended over a larger, heavier
Knee Abduction Lie on back, slide legs out to side. Keep toes pointed up
Use the walker until confidence in the multi-prong cane. Back Seat Repeat 20 times.
and Adduction and knees straight. Bring legs back to starting point.
surgical leg grows, tolerance to full Once you can walk without a noticeable If surgery was on your right leg,
weight-bearing improves and tendency limp and your quadriceps strength has enter on the passenger side.
for the knee to buckle diminishes. returned to allow you to manipulate your If surgery was on the left leg,
Do not use the walker as a support when leg easily, you may start transitioning enter on the driver’s side. Back
getting in or out of bed, up from a chair OFF the cane. Start at home, and use up to the open rear car door Heel Slides Lie on couch or bed. Slide heel toward your bottom. Repeat 30 times.
or off a toilet. It is not stable enough in the walls/furniture for balance until your with your walker or cane. Lower
that position. Back up to the chair until confidence grows. yourself carefully into the seat.
you feel the front of the chair on the back Scoot across the back seat and
GETTING IN AND OUT OF BED have pillows stacked so you
of your legs. Reach down for the arms and
Lie on back, place towel roll under thigh. Lift foot,
Sit on the edge of the bed in the same can semi-recline. Short Arc Quads Repeat 20 times.
lower yourself safely into the chair.
straightening knee. Do not raise thigh off roll.
manner as you would a chair. Scoot your
Once full control of the surgical leg returns, T he surgical leg will be straight
buttocks back across the bed until hips
you are ready to transition to a CANE. This on the car seat. Feel free to
and thighs are on the bed. Rotate your
may occur very early in your recovery. put the nonsurgical leg on the
body until you are straight on the bed. Lie on back, unaffected knee bent, and foot flat. Lift
floor for balance, repositioning
Straight Leg
IMPORTANT: Do not risk your knee Tip: Use a belt or towel to “lasso” your and comfort. Use pillows to opposite leg up 12 inches. Keep knee straight and toes Repeat 20 times.
Raise
buckling, resulting in a fall, by foot to help manipulate the surgical leg make a back rest and make pointed up. Relax.
abandoning the walker too early. with your arms until pain and muscular sure the door against your
control of the surgical leg improves. back is locked. Sitting with back straight in a chair with affected leg
SAFE USE OF YOUR CANE
Get into bed with the non-affected leg outstretched, gently slide the affected leg underneath
Use the cane in the hand opposite the Seated Knee
first, get out of bed with affected leg first. chair. Keep hips on chair. Try to gently stretch and bend Repeat 20 times.
surgical leg. Apply pressure to the cane Flexion
knee as far as possible. Plant foot and move bottom
with a slight lean as you bear weight on Use sheets and pajamas made of a
forward on chair.
the surgical leg. The goal is to alleviate slippery fabric to make scooting easier.
24 Reclaiming Your Quality of Life hhiorthopedics.com 25Living With Your Resurfaced Knee
POST-OP PHYSICAL THERAPY (CONTINUED)
Exercise Program (Perform at least twice daily)
The following exercises will help you make a complete recovery from your outpatient knee replacement surgery. The exercises are Your new joint components have resulted
designed to improve your range of motion (ROM) and flexibility, as well as to restore your strength. from many years of research, but like any
device, its life span depends on how well
Prop foot of operated leg up on chair. Place towel roll you care for it. To ensure the health of
under ankle and ice pack over knee. You may apply Do for 10 your new knee, it’s important you take
Extension Stretch
gentle pressure on the front of the knee with your hand minutes. care of it for the rest of your life.
to stretch the back of the knee periodically.
SPORTS AND ACTIVITIES
Your new joint is designed for activities
Prone Knee Bring heel toward buttocks as far as possible. If this of daily living and low-impact sports.
Repeat 20 times.
Flexion Stretch bothers your back, keep a pillow under your stomach. Walking, swimming and cycling are
recommended once you feel comfortable.
Aggressive sports, such as jogging or
running, jumping, repeated climbing and
Seated Sit on couch or bed with leg extended. Lean forward heavy lifting may impair or compromise
Hamstring and pull ankle up. Stretch until pull is felt. Hold for 20-30 Repeat 5 times. the function and long-term success
Stretch seconds. Keep back straight. Relax. of your joint and, therefore, should be
avoided.
SURGICAL PROCEDURES
Knee Extension
Sit slightly forward in a chair. Straighten knee. Repeat 20 times. If you’re scheduled for any kind of surgery,
(Long Arc)
no matter how minor, you must take
antibiotics before the incision. Make sure
your surgeon is aware that you have a
With your feet shoulder-width apart and flat on floor,
joint replacement so the appropriate
squat as low as you’re comfortable. Use support as
Armchair Squat Repeat 20 times. precautions can be taken. These
necessary. CAUTION: YOU SHOULD NOT BEND KNEES
antibiotics are typically given in your IV
ENOUGH TO CAUSE PAIN.
if performed in the operating room, and
may include Ancef or clindamycin. If your
procedure is being done in the office, your
Standing, hold onto firm surface. Raise up on toes. Use dental prophylaxis antibiotic will suffice
Calf Raises Repeat 20 times.
chair for balance. (usually either amoxicillin, or clindamycin
by mouth).
INFECTION DENTAL WORK substitute if you are allergic to amoxicillin. If
Standing, march in place. Use a chair or countertop for March for 5 Your joint components are made of You should take antibiotics before having your dentist fails to prescribe an antibiotic,
Hip Flexion
balance. minutes. metal, and the body considers them any dental work completed, including please call our office at 828-322-5172 to
a foreign object. If you get a serious routine cleanings. Bacteria present in obtain a prescription for antibiotics prior to
infection, bacteria can gather around the mouth can scatter throughout the scheduled dental appointments.
your components and your knee joint can bloodstream and accumulate around your
With foot of surgical leg on a step, straighten that leg. The American Academy of Orthopaedic
Single Leg become infected. If you become ill with knee. It’s essential you let your dentist know
Return. Use step or book. Height of step will depend on Repeat 20 times. Surgeons states that you should take
Step-Up an infection or high fever, you should be about your knee replacement. Most dentists
your strength. Start low. You may also exercise good leg. antibiotics before seeing your dentist
treated immediately to avoid spreading to will prescribe amoxicillin to take 1 hour
for the rest of your life.
your knee replacement. before your appointment. Clindamycin is a
26 Reclaiming Your Quality of Life hhiorthopedics.com 27You can also read
