Download discharge instructions following total knee replacement

DISCHARGE INSTRUCTIONS FOLLOWING A PARTIAL AND TOTAL KNEE
REPLACEMENT
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PHYSICAL ACTIVITY
Walk with a walker/crutches, with weight bearing on your affected leg as instructed by
Physical Therapy, gradually increasing the length of walking as tolerated. Continue the
exercises as taught by Physical Therapy and:
- Pump your ankles frequently (every hour while awake) to help prevent blood clots
from forming.
- Do frequent leg raises.
- Keep your knee straight when lying down.
- You may elevate your leg on a pillow(s), but do not place the pillow(s) directly under
your affected knee.
- Use a raised toilet seat extension at home, if helpful.
- You may have two pair of TED hose stockings for your legs. These aid in circulation
following surgery and should be worn for four weeks following surgery. The
stockings may be removed twice a day for about 30 minutes each time. Apply a clean
pair daily, washing the dirty pair by hand and line drying. This helps to maintain the
elasticity in the stockings. Your legs need to be elevated on the bed or couch when
reapplying the stockings. You will need help to reapply them.
WOUND CARE
Your incisional area will be closed with staples. These will need to be removed 10 – 14 days
following surgery.
Keep a dressing on your incision site as long as there is any drainage. When the drainage
stops, the dressing may be removed. However, if you are more comfortable keeping a
dressing on your incision site, change it daily or if it becomes wet.
You may shower. Keep the incision site covered until there is no further drainage from your
incision site. NO tub baths are allowed until the staples are removed.
Swelling and discoloration/bruising of the knee area is expected. This will gradually resolve.
Lying down and elevating your leg on pillows above the level of your heart, making sure to
keep your knee straight, will help to decrease the swelling.
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MEDICATIONS
A prescription for pain medication will be given to you by your doctor prior to your
discharge from the hospital. These medications are used to reduce your pain and must not
be taken any more often than prescribed. In an effort to keep your pain under good control,
you should take the pain medication routinely as prescribed during the first 24-48 hours
following surgery. Then, as the pain lessens, begin taking it as needed (within the prescribed
guidelines). As you become more comfortable, you may substitute Tylenol for pain control.
Pain medication should be taken with food as this will help to prevent any stomach upset.
Requests for pain medication should be made during normal office hours. Please Note: Pain
medication will only be ordered during regular office hours.
Do not drive while taking pain medications.
Do not drink alcoholic beverages while taking pain medications.
Ice may be used to your knee to help with swelling and pain relief.
You will be on a blood thinning medication after surgery to help prevent blood clots from
forming. We most commonly use Lovenox, an injectable medication. You will be taught to
give yourself these injections while you are at the hospital beginning the day after surgery.
The dosage is 30mg twice a day for ten days. (A total of twenty doses).
For those patients already on Coumadin, your prothrombin time will be closely monitored by
your primary physician with weekly blood draws for the first month following surgery. After
the first month, it is usually safe to resume your normal Coumadin routine.
Take one Ferrous Sulfate 325 tablet two times a day for two weeks after surgery. You may
use “over the counter” iron preparations.
You may resume your routine medications unless otherwise instructed.
Often pain medication and inactivity cause constipation. Eat high fiber foods (fresh fruits,
vegetables, bran) and increase your fluid intake if possible. Also, you may purchase
Pericolace, a stool softener, at any pharmacy to aid in alleviating your constipation. Take
this two times per day.
DRIVING
You most likely will be able to resume driving four to six weeks after surgery. Discuss this
further with your doctor.
OTHER INFORMATION
Be aware that your joint may trigger metal detection devices.
You will receive a card at your follow up visit that indicates that you have had a Total Joint
Replacement.
You may obtain a temporary handicap parking permit application from this office if you feel
it is needed.
FUTURE DENTAL OR SURGICAL PROCEDURES
If you are going to have any dental work (including cleaning), any surgical or other invasive
procedures done, notify your doctor/dentist that you have had a joint replacement. Your
doctor/dentist will order an antibiotic for you prior to these procedures to prevent
microorganisms from spreading to your new joint. IT IS IMPORTANT THAT YOU TAKE
THESE PRECAUTIONS FOR YOUR WHOLE LIFE. Your Total Joint Replacement Card
lists the procedures requiring pre-medication.
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PRECAUTIONS
Notify the office if you:
 Develop new or more severe pain that cannot be controlled by the pain medication.
 Develop redness, swelling, drainage, or foul odor from your incision.
 Develop calf pain or tenderness.
 Have persistent numbness/tingling of the affected foot.
 Develop a temperature greater than 100.5 that is not associated with any other illness. It is
not necessary to take your temperature every day. If you feel warm, take your temperature.
 Have any questions or problems.
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DIET
Following surgery, start by taking liquids such as water or carbonated soft drinks. If this
does not upset your stomach, try soup and crackers. After this, you may resume your normal
diet as tolerated.
FOLLOW UP
You should be seen in the office for a wound check 10 – 14 days following your surgery.
Call the office when you are discharged from the hospital to schedule this appointment.
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RISKS OF TOTAL JOINT REPLACEMENT SURGERY
Although it is unpleasant to think about the risks involved in any major surgery, it is important
for patients to understand that serious risks exist. We cannot mention all the possible risks or
unsatisfactory outcomes, but we will try to discuss the major ones.
The risks involved for total hip and knee replacement surgeries are very similar. Deep vein
thrombosis, DVT, (the formation of blood clots in the leg, thigh, or pelvic region) represents one
of the major risks. If a blood clot travels to the lung, it is called a pulmonary embolism, or PE.
This is potentially a fatal complication. To reduce this risk, a blood thinner medication is used in
very low doses starting the night of surgery.
Infection is another serious complication that may require removal of the implants and a poor
end result. This occurs in about one to two percent of patients and may occur even years after
surgery. Any time bacteria from any source gets into the bloodstream, it could localize in the hip
or knee joint and cause infection. Because it is possible for bacteria from the mouth to get into
the blood stream with dental cleanings, patients are asked to take antibiotics at these times.
It is important to realize that anytime a hip or knee joint is replaced with a prosthesis, there is a
chance that it will have to be revised in the future. Revision surgery refers to surgery for the
removal of the original prosthesis and insertion of a new prosthesis. The need for this may be
caused by wearing out of the implant surface itself or loosening of the implants where they
contact the bone. The length of time an implant lasts depends on many factors. These include
the patient’s weight, age, activity level, how the body ‘accepts’ the implant material, quality of
the bone, and others. Most people over 65 years of age at the time of the initial surgery will have
ten to fifteen years before revision surgery will be necessary.
As with any major surgery, there are risks to all systems of the body. Although the incidence is
low, patients may have heart attacks, strokes, bleeding ulcers, kidney and urinary problems, lung
and breathing problems, reactions to medication, and other problems following surgery. Blood
transfusions may be necessary during or after surgery in a small percentage of patients. Injury to
major nerves or blood vessels is unusual, but may occur. Men, in particular, with prostrate
enlargement may have difficulty passing urine and require a catheter for a period of time after
surgery. For these reasons, we will always ask your internist or one of the hospitals internists to
supervise your general care while in the hospital. Also, having a complete physical exam prior
to the surgery will help to reduce these risks.
Fortunately, the overall results of total knee replacement surgery are excellent. Ninety percent of
patients can expect significant relief of pain, improved function, and a result that will last ten
years or more. We will do our best to reduce the risks and ensure a good result.
1/2009