The Cooper discharge nurse has arranged a home care team of physical therapy and nursing to assist you in your knee rehab program. These orthopedic specialists will coordinate your home program. Special equipment for home should be delivered to your home on the day of discharge.
Do not touch your wound area unless you have clean, well washed hands. For wound care, paint the incision with betadine, use Telfa non-stick dressing with ABD pad and hypoallergenic tape and six inch ace wrap. Do not wrap the ace wrap too tightly. All wounds should have minimal drainage by 5-7 days post-op. Please alert your home nurse if there is any persistent drainage after this time. Staples should be removed by the home nurse 10 days after date of surgery. If the skin is healthy, steri-strips will be applied. The steri-strips may be removed 5 days later. You may shower once the staples are removed. If you have any wound concerns, you or the home nurse should call our office. Please do not call your family doctor regarding your wound care.
Range of Motion Exercises
You must do exercises 4 times daily; focus on bending your knee as far back as possible. Use your other knee to help push it back, expect soreness/tightness in the front and top of your knee. Hold each bending exercise for 5-10 seconds and do not forget to breathe. Flatten your knee by pushing your knee against a level surface such as the bed or sofa. This is called the quadriceps setting exercise. Your thigh muscle should tighten as you do the exercise. Hold this position for 5-10 seconds and repeat 20-30 times. Do this quad setting exercise sitting, standing, and laying down position. This is one exercise you can never overdo.
Expect soreness under your knee (hamstrings). By two weeks post-surgery I expect you to have range of motion from flat (0 degrees) to a bent knee position of 100 degrees of flexion. Learn to relax your thigh muscles (quads) when you sit and also when you do the bending exercises.
DVT( Clot) Prevention
If you have been prescribed Coumadin post-discharge: this drug must be carefully monitored to make sure the blood level (INR ratio) is between 2.0 to 2.5. If you have taken Coumadin before your surgery, most likely the internist will place you on the same medication dose and schedule you had pre-op.
One note of caution: diet and other medications, even vitamins, can change your response to Coumadin. If you were taking a vitamin before surgery, go back to the same brand vitamin. Multivitamins usually have Vitamin K in the ingredients, which can cause the Coumadin to be less effective in thinning your blood.
If you have been prescribed Aspirin: take enteric-coated ASA 325 mg, full-strength (ECOTRIN) twice daily with meals, breakfast and dinner. Buffered ASA such as ASCRIPTIN is also well tolerated. Take the Aspirin for a total of six weeks after your operation. If you cannot tolerate the full strength aspirin, you should try a baby 81 mg dose twice daily for the same time period. Do not take plain, uncoated aspirin (may cause stomach upset).
If you have been prescribed Lovenox injections: A nurse will teach you how to safely and comfortably inject the medication into the skin around your abdomen. Inject daily (one injection a day) for ten days and then after the 10 day period, start Aspirin twice daily for 4 weeks more. Use the same aspirin as described above.
TEDS stockings: Use the below-knee stockings for 4 weeks post-op. You may take them off at night time but someone must put them on your legs in the morning.
DO NOT SIT WATCHING TV ALL DAY! Elevate both legs with pillows like you did in the hospital, no sitting for more than one hour. Get up, walk around, stretch and elevate your legs throughout the day. DO NOT allow your legs to swell. DO NOT sit in your easy chair with your legs in a down position.
Increase your walking tolerance slowly. Remember to lay down and elevate your legs several times a day. If your legs swell…..lay down and elevate them….play it smart!
Expect some tightness, sore muscles, and increased pain at night time. Night symptoms come from fatigue cramps. Stretching helps the discomfort and soreness. Use pain medications as you need them but take only what you need and no more. Narcotics usually cause constipation, confusion, and decreased energy levels. Add Celebrex 400mg/day to help with your therapy (use for 4 weeks). DO NOT take Motrin, Advil, Alleve, or any NSAID other than Celebrex if you are on Lovenox DVT protocol. Use lots of ice packs…. “ICE, ICE, SO VERY NICE”, 20 minutes 3-4 times a day. Never apply heat to the knee area!
Call the office when you get home to make your appointment three weeks after your surgery date. At that time, you will receive a new set of instructions for the next phase of your rehabilitation. X-rays of your knee replacement will be performed at the office for all patients. (most insurance companies cover this service…if not I will still obtain x-rays as a courtesy) On your first post-op visit, I will examine your wound and leg. I will examine your walking pattern and record your knee extension and flexion measurements. Pain meds can be refilled at that appointment. My nurse will explain and demonstrate to you the stair stretch exercise to increase knee flexion. Also, most patients can start driving at 3-4 weeks, so you will receive an outpatient prescription for therapy close to your home. Good luck and I look forward to seeing you on your first post-op visit. You are well along the way to achieving a successful knee replacement!