9 Steps to a Smooth Recovery after Total Knee Replacement Surgery

Below is a list of important things to do after a total knee replacement to help you have a successful and easier recovery.

1) Prepare a Safe Home Environment

You will be using a walker or crutches the first few weeks after total knee replacement surgery. You want to make sure your furniture is arranged so that you can fit the walker/crutches through all pathways. There should be no cords or throw rugs in the pathways for you to trip over.

Tub seats, grab bars, and dressing aids will make your activities of daily living safer and this equipment will be recommended to you by your occupational therapist. Showering is not recommended until a home safety evaluation is performed by your home care occupational therapist.

Also remember footwear is important. You want to make sure you are wearing non-skid socks/shoes. Do NOT walk wearing only regular socks, TEDS, or bare feet because your walking and balance will be different the first few weeks after surgery and you do not want to slip and fall.

2) Balance Activity and Rest

Some of you have been looking forward to resting as you recover, others are afraid to move, and then we have those of you who do not know how to rest and overdo it when you return home.

In order for you to have a successful recovery after a total knee replacement, it is very important for you to move. Get up and walk or stand at least once every hour during the day. You want to focus your activity on your therapy program to restore motion and strength, while avoiding strenuous activities.

As much as it is important to move, it just as important to rest and allow your body to heal.

3) Position Your New Knee Correctly

Whenever you are resting with your leg up, keep the operated leg as STRAIGHT as possible. This means NO pillows under the knee. Having the knee bent throughout the day/night, will cause knee flexion contractures, decreased motion of your joint, and poor surgical outcomes.

Total knee replacement leg position

4) Chill Out

Use an ice or cold pack surrounding the operated knee to control pain and swelling. It is important to ice the whole knee, placing the ice/cold pack on top AND underneath the knee.

Cold Pack Placement

Make sure you place a towel between the ice/cold pack and your operated leg and keep in place for 20 minutes. Use the ice immediately after performing your exercises and throughout the day to control pain and swelling.

You can make your own cold packs by squeezing a bottle of dish soap into a one quart Ziploc bag, then place that bag into a second Ziploc bag (in case it leaks) and place it flat in the freezer.

5) Keep Wound Infection Free

Keep the incision clean and dry. Do not use any lotion on the incision unless instructed by your doctor or nurse. If you note any new redness, swelling, or drainage from the incision call your home care team right away. If your incision does drain, cover it with a sterile dressing.

6) Prevent Blood Clots

There are several methods used to prevent blood clots after surgery and they will vary depending on your needs and surgeon recommendations.

TEDS or other anti-embolic stockings are compression stockings that are effective in preventing blood clots and to help control the swelling. Follow your doctor’s orders for wear schedule of the stockings.

Blood thinners are usually started after surgery. Coumadin (warfarin), Lovenox (enoxaparin), Xarelto (rivaroxaban), and aspirin are the most common blood thinners. If you are on Coumadin, you will need to have your blood level checked periodically to make sure you are getting the appropriate dose.
Movement is also an important step in blood clot prevention. This ankle pump exercise specifically will help with circulation and edema control. Perform 10 repitions of this exercise every hour while you are awake.

If you notice any of the following symptoms call your home care provider immediately as these are all possible signs of a blood clot:

tenderness, redness, or pain in your calf
increase swelling of the operated leg
increased warmth in the back of the leg
a red streak moving up the leg
If you develop sudden shorness of breath or chest pain call 911 immediately as this could be a sign of a blood clot in the lungs and can be life threatening.

7) Take Medication as Directed

It is important to take only the medication that you were instructed to take after surgery by your physician. You do NOT want to start taking any vitamins, supplements, or over the counter medication without your doctor’s permission as they could interact with the other medication you are taking, especially the blood thinner. Take medication at the same time every day as directed by your physician.

8) Manage Your Pain

Make sure you take adequate pain medication to allow you to sleep well at night and to participate in your exercise program with minimal discomfort. Do not be afraid to use the pain medication as directed by your physician. With less pain you will have a faster recovery. Remember to take your pain medication with food. Take action as soon as the pain starts. Use ice/cold pack along with the medication to help relieve the pain.

9) Eat a Balanced Diet

Your appetite may not be what it used to be before surgery, but you want to make sure you are getting the proper nutrition for healing. Continue to drink plenty of fluids. 8 cups of water a day will help you stay hydrated and help prevent constipation. Note that constipation often occurs after surgery as a side effect of the pain medication.

Try to limit your coffee intake and avoid alcohol altogether.

If you are taking Coumadin, you need to restrict your vitamin K intake. Foods rich in vitamin K include broccoli, cauliflower, brussel sprouts, liver, green beans, garbanzo beans, lentils, soybeans, soybean oil, spinach, kale, lettuce, turnip greens, cabbage, and onions.

Please remember you just went through major surgery. Your activity level and medications have changed. It is not unusual to experience difficulty concentrating or lack of interest in activities/hobbies after surgery. Muscle soreness, tightness, and stiffness are all normal after surgery.

These are general guidelines. If you have been instructed otherwise by your doctor or healthcare provider please follow their instructions. If you have any questions do not hesitate to contact your home care provider.

Happy Day! Here’s to a Speedy Recovery!

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