Activities After Knee Replacement
If you are a candidate for knee replacement surgery, you can look forward to living a healthy active lifestyle, only without the pain from arthritis. But change does not happen overnight, and your active participation in the healing process is necessary to ensure a successful outcome.
Although you will be able to resume most activities, you should avoid activities that place excessive stress on the new knee. The following suggestions will help you adapt to your new joint and resume your daily activities safely.
Although you will probably want to rest after surgery, early mobilization is important. You will be expected to be up and walking within hours of your knee replacement. If you had considerable preoperative pain in your knee, you probably cut back on your activities before surgery and your leg muscles may be weak. You will need to build up strength in your quadriceps muscles to develop control of your new joint. Your doctor and a physical therapist will give you specific instructions on helpful exercise to do before and immediately after your knee replacement.
Proper pain management is important in early recovery. Although pain after surgery is quite variable and not entirely predictable, it can be controlled with various modalities. You will likely receive an perioperative nerve block from the Anesthesiologist, which will help control the pain for the first 18-24 hours. Your surgeon will also inject medication in the knee joint at the time of surgery. Multimodal medical therapy is the gold standard. This includes the use of anti-inflammatories, Tylenol/acetaminophen, nerve medications, and opioids. IV medication is rarely used.
A physical therapist will typically visit you on the day of your surgery and begin teaching you how to use your new knee. Discharge from the facility requires the patient to perform the basic tasks of daily living using the appropriate walking aids. Typically this is in the form of walker for the first few weeks. Some surgeons may use a continuous passive motion exercise machine to help straighten and bend your knee. Even as you lie in bed, you can pedal your feet and pump your ankles on a regular basis to promote blood flow in your legs.
Your hospital stay will vary, with an increasing number of patients successfully able to be discharge home the very same day. If hospitalization is required, it is typically no more than 1 or 2 nights. This depends on your ability to perform your basic needs at home. Before you go home, you will need to meet several goals:
- Get in and out of bed by yourself or with minimal assistance
- Walk with a walker on a level surface and possibly safely climb up and down 2 or 3 stairs if necessary to do so at home
- Tolerate food and liquids, although your appetite may not be back to normal for a few days
- Void or use the restroom
You will experience swelling in your leg after you are discharged. Elevating the leg, wearing compression hose, and applying an ice pack for 15 to 20 minutes at a time will help reduce the swelling. If you notice an abrupt increase in swelling, accompanied by increased pain, shortness of breath, feeling of a rapid heart beat, or any other serious condition, please contact your surgeon immediately.
Activities at Home
You may need some help at home for several weeks. Driving typically resumes between 2 and 6 weeks, so arrangements should be made beforehand. In-patient rehab following elective knee replacement should be avoided due to some studies showing worse clincal outcomes in patients going to an inpatient rehab/nursing home following joint replacement. The following tips can make your homecoming more comfortable:
- Rearrange furniture so you can maneuver with a walker or crutches. For example, you may temporarily change rooms (make the living room your bedroom) to avoid using the stairs.
- Remove any throw or area rugs that could cause you to slip. Securely fasten electrical cords around the perimeter of the room.
- Install a shower chair, gripping bar, and raised toilet in the bathroom.
- Use assistive devices such as a long-handled shoehorn, a long-handled sponge, and a grabbing tool or reacher to avoid bending too far over.
General guidelines for wound care include:
- Keep the wound area clean and dry. A dressing will be applied in the hospital and should be changed as necessary. Most dressings are waterproof and need not be changed unless directed by your surgeon or his/her staff.
- Notify your doctor if the wound appears red or begins to drain.
- Take your temperature as needed and notify your doctor if it exceeds 101F.
- Swelling is normal for the first 3 to 6 months after surgery. Elevate your leg slightly and apply ice.
Take all medications as directed. You will be given or instructed to take a blood thinner to prevent clots from forming in the veins of your calf. The most commonly used medication is Aspirin, although other blood thinners are available at your surgeon’s discretion. If a blood clot forms and then breaks free, it could travel to your lungs, resulting in a pulmonary embolism, a potentially fatal condition.
Because you have an artificial joint, it is especially important to prevent any bacterial infections from settling in your joint implant. Be sure to notify your dentist that you have a joint implant and let your doctor know if your dentist schedules an extraction, periodontal work, dental implant, or root canal work.
If you are taking pain medication, we recommend you use an over the counter stool softener to counteract the side effects of opioids.
Wound healing requires an appropriate diet balanced with carbohydrates, protein, and healthy fats. Continue to drink plenty of fluids. It is also recommended to take a fiber supplement or consume foods rich in fiber while taking pain medications. Diabetic patients should be mindful of their blood glucose levels in the postoperative period.
Resuming Normal Activities
Once home, you should continue to stay active. The key is to remember not to overdo it! While you can expect some good days and some bad days, you should notice a gradual improvement and a gradual increase in your endurance over the next 3-6 months. The following guidelines are generally applicable, but the final answer on each of these issues should come from your doctor.
- Physical Therapy Exercises – Continue to do the exercises prescribed for at least two months after surgery. Riding a stationary bicycle can help maintain muscle tone and keep your knee flexible. Try to achieve the maximum degree of bending and extension possible.
- Driving – Ameican Acadmeny of Orthopedic Sugeons recommend 4-6 weeks after knee replacement. Remember that your reflexes may not be as sharp as before your surgery.
- Airport Metal Detectors – The sensitivity of metal detectors varies and it is unlikely that your prosthesis will cause an alarm. Total joint cards are no longer provided to the patient due to the increasing prevalence of total joints in our country.
- Sexual Activity – can be safely resumed approximately 4 to 6 weeks after surgery.
- Sleeping Positions – You can safely sleep on your back, on either side, or on your stomach.
- Return to Work – Depending on the type of activities you perform, it may be 4-6 weeks before you return to work in a sedentary position, or even 8-12 weeks in a manual laborious setting.
- Other Activities – Walk as much as you like, but remember that walking is no substitute for the exercises your doctor and physical therapist will prescribe. Swimming is also recommended; you can begin as soon as the sutures have been removed and the wound is healed, approximately 4-6 weeks after surgery. Acceptable activities include dancing, golfing, and bicycling. Avoid activities that put stress on the knee. These activities can include: tennis, pickletball, contact sports (such as football, baseball), or racquetball, jumping, skiing, or jogging. These are not hard blocks, so consult your surgeon if you desire to perform these more stressful scenarios.