Postoperative Questions

We will have no restrictions after surgery. We will hold off on formal therapy for 3-7 days after surgery to allow for pain control and swelling control. However, you can work on knee range of motion as desired immediately after surgery, with full weight bearing, and no brace.

Our goal is for you to perform every activity you desire after surgery. In reality, you will probably not be a great skier if you have never skied before, but our goal is for you to be able to do that if you desire. Everyday activities such as walking, bending, stooping, going up/down stairs, jogging, skiing, working out, cycling, etc. should not be an issue. Prior to taking up distance running, we would need a more detailed conversation in clinic.

We will give you 1 baby aspirin twice daily to take for blood clot prevention for 4 weeks. Then we will give you scheduled Tylenol three times daily for 2 weeks (then as needed), Celebrex or Meloxicam once daily (for 3 weeks, then as needed), and oxycodone every 6 hours as needed for pain. Some patients may get Lyrica as well for 1-2 weeks. Lastly, we recommend an aggressive bowel regimen of Colace, Senna, and Miralax after surgery for at least 3-5 days or until normal bowel regulation, and can prescribe that if desired.

Additional information about postoperative medications via the AAOS website. (Link and Link)

Additional information about prescription safety from the AAOS website. (Link)

Additional information about opiods via the AAOS website. (Link)

AAHKS information regarding postoperative pain management (Link)

We will treat this with medications and lifestyle. We encourage walking and working on foot pumps at least once every 1-2 hours when awake. You will also take medication for a period of time as well. You will take 1 baby aspirin twice daily to prevent blood clots for 4 weeks. If you are already taking Xarelto or Eliquis, you will take a half dose for 1 week then resume your normal dose. If you are taking Coumadin, you immediately resume your normal dose the day after surgery. If you take aspirin and Plavix, you take 1 baby aspirin twice daily for 3 days, then resume your normal aspirin and Plavix therapy. 

AAOS article regarding blood clot prevention and warning signs (Link)

You will have an Ace wrap and a dressing on your incision from the OR. Remove the Ace wrap on day 1 after surgery and use that as desired after that. Leave the dressing over your skin in place. If you have drainage and it is saturated, let us know. Otherwise, the dressing is waterproof. You can shower and do PT with the bandage. Remove it after 7-10 days, then re-apply a new bandage. We will then take the second one off in clinic at your follow-up appointment.

You can shower with your dressing in place. I would wait 24-36 hours after surgery to shower, as the heat of the water can lead to some dizziness, but after that you may shower as desired. I do recommend having someone at home on your first showering attempt after surgery.

Most patients require PT to maximize their outcome. We will hold you out of starting PT for ~5 days, then you may begin. However, if you are highly motivated, and prefer to perform the exercises on your own, then we can discuss that options as well.

AAHKS handout for gait training after joint replacement (Link)

AAHKS handout for total knee replacement excercises (Link)

We will have you start about ~5 days after surgery. This allows for some swelling and pain control to occur. However, you may begin working on knee range of motion at home on your own immediately after surgery.

Immediately after surgery, when pain allows, you may begin doing the AAOS standardized postoperative knee therapy exercises. (Link)

AAHKS handout for gait training after joint replacement (Link)

AAHKS handout for total knee replacement excercises (Link)

If you work in a sedentary job, you can probably begin returning part time at about 3-4 weeks after surgery to see how things go, then improve from there. However, if you have a job involving walking, standing, manual labor, etc, it will be at least 6-8 weeks before you can return. Partial knee replacements tend to return sooner than totals.

We recommend trying to limit any aggressive activities for about 3-4 weeks to allow for pain and swelling control. After that time, we recommend you listen to your body. However, we have no formal restrictions regarding this.

AAHKS information regarding return to sexual activity. (Link)

You can drive when you are no longer requiring a walker and weaned from narcotic pain medications. Everyone is different regarding this. Some patients will be at this stage within a week, while others may take a month.

We recommend everyone initially use a walker to prevent falling. Then you can slowly wean from this. However, do not wean too early. Only wean from the walker when it is more of an accessory than a functional tool. 

AAOS article on usage of canes, crutches, and walkers (Link) 

We have no specific restrictions. Our recommendation is to listen to your body. If you do not tolerate a specific activity, stop, back down for a few days, then gradually try again.

Historically there was concern that the plastic in these knees would wear out. That is very uncommon at this time. We have this generation of plastic with 20 year results showing no wear and biomechanical studies suggesting this up to 40 years of wear. Ultimately, we can confidently say that the plastic will not wear out within 20 years, but there are other areas of possible failure within the knee that we will continue to monitor over the years.

If you get a joint infection, we will first have to obtain blood and fluid from the knee to confirm the infection. We will then discuss different options for treatment. All patients will need at least 1 more surgery, a period of IV antibiotics, then long term oral antibiotics.  This will be a long road, but we will be here together. 

AAHKS article regarding knee prosthetic joint infection (Link)

No. Historically, all patients have needed antibiotics during dental work. However, recent guidelines have recommended against this due to the rise of antibiotic resistance, adverse effects from the antibiotics, and the questionable data supporting their original use. 

This is different following partial and total knees. For a total knee, the first 1-2 weeks are aimed at pain control. Then weeks 2-4 are geared towards improving range of motion. At weeks 4-6, the goal is strengthening. Lastly beyond week 6, the goal is to maximize your recovery and get you back to daily life. Frequently after a total knee, it takes 6 weeks to really turn the corner, and 10-12 weeks to get back to normal life. Following a partial knee, these times can be decreased by 40-50%.

This is uncommon after partial knee replacement surgery, but can happen about 5-10% of time after total knee replacement–the knee looks and functions appropriately, but the patient just isn't happy. In short, there is no easy answer to this question. We will continue working with you to have your knee function as well as possible. 

Fever is not uncommon after surgery, as this is a large deal for your body to recover from. If the fever is over 101.5, reach out. Otherwise, low grade fevers are not uncommon. The biggest goal is to work on deep breathing exercises (4x/hour) for about 2-3 days after surgery to ensure that the lungs stay full and do not have what is called atelectasis which is common after any surgery. 

Swelling, redness, and bruising are not uncommon after TKA.  One thing to know, is the bruising will frequently get worse after THA, before it gets better. Regarding the swelling and redness, we will continue to monitor it over time. Continue working on aggressive ice/elevation, gentle knee range of motion, and ankle pumps. These should help improve this over time. However, if this remains persistent or progressive swelling continues to occur, return to clinic for evaluation. Notably, the bruising should improve over 3-4 weeks.

DVTs can occur after TKA. Please give us a call and we will talk this over. Swelling and redness in the leg may be signs of DVT, but also can be normal after TKA. However, if this is progressive and continues to increase after nonoperative treatment measures, then we will likely obtain an ultrasound of your legs. If you have heart racing or shortness of breath, contact us immediately and go to the nearest ED.

You may shower immediately after surgery with your waterproof dressing in place. However, you are to not submerge your incision for 6 weeks to allow for full healing and maturation of your incision to not allow water in.

We recommend continued local wound care for the first 6 weeks after surgery to allow for the incision to fully heal and mature. After that, you may begin by placing Vitamin E cream over the scar to assist with decreasing scar formation. After 3 months, you may use any scar cream you desire on the incision to decrease the prominence of the scar.

You may drive when you are only using a cane to mobilize and are not requiring narcotic medications. This is usually 1 to 3 weeks after surgery.

Our goal is to get your knee feeling as “normal” as possible; however, we are unable to turn back time, and your knee will never feel like you are 17 again. One complaint people have with total knees is that they just sometimes don’t feel “natural” and feel mechanical or metallic, and all patients have a different tolerance for this feeling. Partial  knees tend to feel more like a natural knee than total knees, but they still never feel normal.

The entire goal of having knee replacement surgery being performed is to improve your quality of life, and to be able to perform the activities that you desire. With that said, our goal is to impose no restrictions upon you. However, patients with knee replacements tend to have difficulty kneeling moving forward, and may have to implement the usage of knee pads. Also, patients who desire to return to long-distance running will require a more detailed discussion in clinic.  We will impose some restrictions on you for 3-4 months, but then remove essentially all restrictions for you at that point. The key will be to listen to your body and slowly increase your activities to your desired level.

We would prefer you hold off for ~5 days after surgery before working with PT in earnest. You can work with PT immediately after surgery, but we just request that you refrain from deep knee flexion and passive-assisted range of motion. The key in the first couple weeks of surgery is maximizing your knee extension and gently working on knee flexion to limit your knee swelling and pain.

Sleep after knee replacement surgery is routinely altered for at least 6 weeks, and then will slowly normalize between 6 and 12 weeks, with overall normalization by 12 weeks after surgery. Notably, patients with poor sleep prior to surgery are at higher risk for poor sleep after surgery.

We can call in medications prior to surgery or you can self-medicate. Constipation is quite common with usage of opiate pain medication, thus we recommend aggressive management. Our standard regimen is docusate, senna, and Miralax. If this does not work, then we will increase with dulcolax suppositories, an enema, or magnesium citrate–all of which are over the counter.

We recommend holding off on airline travel or prolonged care rides for at least 6 weeks after surgery to prevent blood clots. However, if you must travel, we recommend frequent stops/walking a short distance every 1-2 hours.

AAHKS article regarding return to travel after knee replacement (Link)

We recommend slowly increasing activities following surgery. At first this will only include physical therapy based activities, with a slow increase in activity level. Most people will be able to return to the gym on a very limited basis about 2-3 months after surgery. After 3-4 months, we will remove all restrictions.

AAHKS article regarding return to sports after knee replacement (Link)

Beginning at 2-3 weeks after surgery you may return to putting. At 4 weeks after surgery you may begin chipping. At 6 weeks after surgery you may move to wedge and iron shots. Then at 8-10 weeks after surgery you can begin using your full bag of clubs and slowly increase to full swings. 

The nerves on the front of the knee come from inside to outside. These are transected when the incision is performed. These take time to recover, and sometimes there is a permanent numbness over the outside of the knee. This is just part of performing the surgery.

Knee swelling is common after surgery. Some patients have this worse than others. This happens periodically to all patients. This can lead to pain and decreased knee range of motion. When this happens, just rest and allow it to calm down. Aggressive ice, elevation, and compression can decrease this swelling. This should improve after 6-10 weeks.

Significantly increased knee pain, swelling, redness, drainage, and fevers are concerning signs. Also, if the knee is doing well, but then has a drastic increase in pain and swelling/decrease in function, this should raise the alarm for infection. 

It is not uncommon to have periodic increases in pain with changes in activity for the first year. This should continue to improve with longer time from surgery. If this gets worse, contact the clinic and we can get you in for evaluation.

All patients continue to heal for 1 year after surgery. Some patients continue to even heal after 1 year from surgery. However, most healing and recovery is done by 1 year after surgery.

This is incredibly common after joint replacement. There has been multiple studies performed regarding sleep disturbances after joint replacement. It commonly occurs for about 12 weeks after surgery. It tends to slowly improve after 6 weeks, and then fully improve to your pre-surgical state at 12 weeks after surgery. No medications, including Ambien, Lunesta, and melatonin have been found to assist in postoperative sleep disturbances, but only increase complications. Thus, we recommend working with a strict sleep plan to normalize your sleep pattern/rhythm.

AAHKS article regarding sleep disturbances after knee replacement (Link)

This is incredibly common with patients having continued complaints of pain that is worse at night. The short answer for why this occurs is “I don’t know.” The only recommendation we have is continuing aggressive ice, elevation, compression, and anti-inflammatories. 

This is common after surgery, especially after more complex reconstructions (severe deformity for first time joint replacement or revision surgery). This can come from decreased leg range of motion after surgery, lack of elevation, lack of activity, etc. This is frequently seen by urgent care, PCP, and other providers and immediately diagnosed as cellulitis. However, this is frequently not the scenario, but just a superficial tissue reaction of your body reacting to venous blood and bruising pooling in the most distal aspect of the extremity. So, prior to going on antibiotics immediately after surgery, please let us know, because this can be a complicated picture after surgery.

Your range of motion after surgery depends on your range of motion prior to surgery. If you were stiff prior to surgery, you are at higher risk of being stiff after surgery. The implants also have some limitations on deep flexion, so getting beyond 120 degrees of flexion can be very challenging after total knee replacement. Partial knee replacement patients tend to also have better range of motion than total knee replacement patients. This is something to discuss in detail prior to surgery in clinic, if it is a concern for you.

This is something that is increasing in popularity in the literature, and can be an option. This is a more viable option for patients with a partial knee replacement, but we can also do this for patients with a total knee replacement. However, we will have to check you back in clinic more often to ensure that you are meeting range of motion goals.