A step-by-step post-operative guide to your recovery from total knee replacement
Ok, so now your knee is done and you are in the Recovery Room. Most of my knee patients have had a spinal (regional) anesthetic. This is simply because over thousands of cases, regional anesthesia has been shown to be safer for you! It also decreases venous clotting ( by dilating leg veins ), and decreases the need for narcotics, which have many negative side effects ( morphine can caues confusion, lethargy, itching, constipation, and respiratory depression in some patients!) Our pain management protocol is ”multi-modality” which means we use many different non-narcotic medications to control your pain with less side effects.
Because we also use a femoral nerve block as an additional pain management technique on all of our total knee surgeries, you will be very comfortable- with essentially NO PAIN – when you first wake up in the Recovery Room. The femoral block is an injection of a “novacaine” like drug into the groin pre-op by the anesthesiologist. This numbs the femoral nerve, and greatly reduces the pain you feel for up to 26 hours. It also has an effect of making the quadriceps muscle weaker until the block wears off, so you have to hold on to your walker to prevent a fall. Patients may choose the “spinal” or a “general” anesthetic. ( I think the spinal patients recover faster, as they have less nausea and less fatigue, and they have a more positive attitude right after surgery. ) Attitude is Everything!
We try to avoid narcotic medications as much as possible early on. We do use non-narcotic medications such as Toradol (a strong NSAID like motrin), IV Tylenol, Celebrex, Ultram, and Naprosyn as well as muscle & anxiety relaxers like ativan, xanax, and librium. Much of the hospital care focuses on pain management – but it is the immediate mobility which is the key to success. We must get you going ASAP! Since we began mobilizing patients an hour or two after surgery, all of our complication rates have gone down!!
Our patients will be walking on the Joint Center floor ( 6 West at Scottsdale Healthcare Osborn) within two hours of the surgery. This also GREATLY decreases the risk of clotting in the veins. Our DVT rate is less than one percent with this early motion protocol. We also use aspirin, coumadin, or lovenox as a blood thinner, depending on the risks and special circumstances for each patient. Most patients will be discharged on two aspirins a day for 30 days. A foley catheter in the bladder is removed on day one. These allow us to measure urine output which is an accurate indicator of overall body function. It is hard for some people to get to the bathroom immediately after surgery, and so it is a matter of convenience as well. (The anesthetic medications often make it harder to urinate initially!).
All patients get 24 hours of IV antibiotics to prevent infection. ( Infections are rare, and our infection rate is about 1/200 or .5%, and appears mostly to be a matter of “bad luck”). The most important thing patients can do to prevent infection is to CALL US if there is any wound drainage after they go home. Also avoiding the bath tub and pool is important until the wound is sealed.
Some younger patients will go home on the day after surgery. Most Total knee patients elect to stay an extra day however, as the nerve block wears off and the more “normal” pain returns. Total knee replacement hurts more than a total hip replacement, mostly because of the need to BEND the knee (and repaired quadriceps muscle) as soon as possible. Physical therapy starts in the hospital on the day of surgery. You may bear full weight with the walker. It is rare for patients to go to a nursing home or rehab facility unless they are elderly or frail, or have nobody to help them a little at home.
Outpatient physical therapy will be arranged for you at your convenience. We do have our own rehab center here at the Scottsdale Joint Center, and one advantage of doing it here is we are around to keep a closer eye on your progress. You can, however, have PT anywhere in Phoenix that is convenient for you. Most patients stop taking narcotic pain pills after the second week. Motrin and Tylenol work well after that.
You can go back to work (depending on your job) whenever you choose to. I have many knee replacement patients back in the office part-time after one week. You can play golf at 6 weeks and tennis at 10 weeks post-op in most cases. You can drive your car when you feel you’re ready, usually one week after a left total knee and three weeks after a right knee surgery. Over 90% 0f patients will be very happy with their new knee. However, it has recently been shown that about 10% of patients still have some reservations about the knee or pain with some activities. We try to lower expectations to some extent, as a TOTAL KNEE is not a normal knee (after all it is a metal and plastic device that your body must adapt to!). I must say that it is my observation that most patients continue to improve for over a year after surgery.
We used to ask patients to come back for a follow-up visit yearly, but most do so well that seems to be “over-treatment”. You should come back once at a year out for an X-ray to detect anything unusual, and then after that you may follow up only as needed. You can expect your knee replacement to last about twenty years, however it may last less or longer in any particular individual. The best explanation for longevity that I have heard is that one knee out of a hundred will fail per year over the long term. That means if one hundred patients had their knees replaced on the same day, 80 would still be happy with their knee function 20 years later. As many as 20 patients over 20 years may have had the knee revised due to a variety of possible failure mechanisms.
The most common causes of knee replacement “failure” are:
- Loosening of the cement bond
- Stretching of ligaments with resulting instability
- Infection (0.5% risk)
- Loss of motion (0.2% risk)
- Fracture (0.1% risk)
The good news is that re-do or REVISION Total Knee Replacement has excellent results as well. This is why younger patients are choosing to get their knees fixed sooner. I often say “the next ten years of your life are your best ten years”, and so I am usually optimistic that total knee replacement is the best option for disabling knee arthritis.
Please come in to our office to see us if you have other questions!