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Knee Replacement

AMBULATORY CARE:

What you need to know about knee replacement:

Knee replacement is surgery to replace all or part of your knee joint. It is also called knee arthroplasty.

Knee Anatomy

How to prepare for knee replacement:

  • Weeks before your surgery:
    • Your healthcare provider will check your overall health. He or she will ask about your current knee pain or stiffness. Tell your provider how pain or stiffness affects your daily activities or ability to play sports. He or she may also ask about fatigue, anxiety, or depression you may have.
    • Some medicines will need to be stopped weeks before surgery. These medicines include blood thinning medicine, such as aspirin and ibuprofen. It also includes some antirheumatic medicines. Make sure your healthcare provider knows all medicines you are taking. Also ask how long before surgery to stop taking them.
    • Your healthcare provider may have you do exercises to strengthen your leg muscles before surgery.
    • You may need x-rays to help your healthcare provider plan your surgery. Ask about any other tests you may need.
  • The night before and the day of surgery:
    • Your healthcare provider may tell you not to eat or drink anything after midnight on the day of your surgery.
    • You will be told what medicines you can or cannot take the morning of surgery.

What will happen during knee replacement:

  • You may be given general anesthesia to keep you asleep and free from pain during surgery. You may instead be given regional anesthesia, such as spinal or epidural anesthesia, or a peripheral nerve block. Regional anesthesia keeps you numb from the waist down, but you will be awake during surgery.
  • Your surgeon will make an incision over your knee joint. He or she will remove the damaged parts of your knee joint and replace them with a knee implant. The knee implant may be made of metal and plastic. Your surgeon may secure it with medical cement.
  • Your surgeon will move the muscles and other tissues around your joint back into place. He or she will close your incision with stitches or staples. He or she may use strips of medical tape and a bandage to cover your wound.
Total Knee Replacement

What to expect after knee replacement:

  • It is normal to have increased stiffness and pain after surgery. Your pain and stiffness should get better with exercise.
  • Do not get out of bed until your healthcare provider says it is okay. The physical therapist will help you walk after your surgery. When you walk the same day after surgery, it helps decrease pain and improves the function of your knee. You may use crutches or a walker.
  • You may be in the hospital 1 to 4 days, or you may go home shortly after surgery. Your healthcare provider may talk to you about rehabilitation you can do at home. A physical therapist can teach you exercises to help strengthen your knee and prevent stiffness. You may also need occupational therapy to teach you the best ways to bathe and dress.
  • You may be given a joint replacement ID card. The card will tell which joint was replaced and when it was replaced. Tell all healthcare providers about your joint replacement surgery.

Risks of knee replacement:

You may bleed more than expected or get an infection. Nerves or blood vessels may be damaged during surgery. After surgery, your knee may be stiff or numb. You may continue to have knee pain. You may get a blood clot in your leg. This may become life-threatening. Your implant may get loose or move out of place. The implant may get worn out over time and need to be replaced.

Call your local emergency number (911 in the US) for any of the following:

  • You feel lightheaded, short of breath, and have chest pain.
  • You cough up blood.

Seek care immediately if:

  • Your leg feels warm, tender, and painful. It may look swollen and red.
  • You cannot walk or move your knee.
  • Blood soaks through your bandage.
  • Your incision wound comes apart.
  • Your incision area is red, swollen, or draining pus.

Call your doctor or surgeon if:

  • You have a fever or chills.
  • You have trouble moving or bending your knee.
  • You have new knee pain or pain that does not get better with medicine.
  • You have questions or concerns about your condition or care.

Medicines:

You may need any of the following:

  • Prescription pain medicine may be given. Ask your healthcare provider how to take this medicine safely. Some prescription pain medicines contain acetaminophen. Do not take other medicines that contain acetaminophen without talking to your healthcare provider. Too much acetaminophen may cause liver damage. Prescription pain medicine may cause constipation. Ask your healthcare provider how to prevent or treat constipation.
  • NSAIDs , such as ibuprofen, help decrease swelling, pain, and fever. This medicine is available with or without a doctor's order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If you take blood thinner medicine, always ask your healthcare provider if NSAIDs are safe for you. Always read the medicine label and follow directions.
  • Blood thinners help prevent blood clots. Clots can cause strokes, heart attacks, and death. The following are general safety guidelines to follow while you are taking a blood thinner:
    • Watch for bleeding and bruising while you take blood thinners. Watch for bleeding from your gums or nose. Watch for blood in your urine and bowel movements. Use a soft washcloth on your skin, and a soft toothbrush to brush your teeth. This can keep your skin and gums from bleeding. If you shave, use an electric shaver. Do not play contact sports.
    • Tell your dentist and other healthcare providers that you take a blood thinner. Wear a bracelet or necklace that says you take this medicine.
    • Do not start or stop any other medicines unless your healthcare provider tells you to. Many medicines cannot be used with blood thinners.
    • Take your blood thinner exactly as prescribed by your healthcare provider. Do not skip does or take less than prescribed. Tell your provider right away if you forget to take your blood thinner, or if you take too much.
    • Warfarin is a blood thinner that you may need to take. The following are things you should be aware of if you take warfarin:
      • Foods and medicines can affect the amount of warfarin in your blood. Do not make major changes to your diet while you take warfarin. Warfarin works best when you eat about the same amount of vitamin K every day. Vitamin K is found in green leafy vegetables and certain other foods. Ask for more information about what to eat when you are taking warfarin.
      • You will need to see your healthcare provider for follow-up visits when you are on warfarin. You will need regular blood tests. These tests are used to decide how much medicine you need.
  • Take your medicine as directed. Contact your healthcare provider if you think your medicine is not helping or if you have side effects. Tell him or her if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.

Self-care:

  • Apply ice on your knee for 15 to 20 minutes every hour or as directed. Use an ice pack, or put crushed ice in a plastic bag. Cover it with a towel. Ice helps prevent tissue damage and decreases swelling and pain.
  • Do not get the area wet until your healthcare provider says it is okay. When your provider says it is okay, carefully wash the area with soap and water. Dry the area and put on new, clean bandages as directed.
  • Care for your incision area as directed. Do not put powders or lotions over the area. If you have strips of medical tape over the incision area, let them fall off on their own. If they do not fall off within 14 days, gently remove them. Check the area for signs of infection, such as swelling, redness, or pus.
  • Go to physical or occupational therapy , if directed. A physical therapist will teach you exercises to build muscle strength, decrease pain and swelling, and prevent blood clots. An occupational therapist will show you how to do daily activities safely. He or she may recommend assistive devices to help you dress, bathe, and pick up objects. The assistive devices will help you prevent knee damage from twisting or bending.

Prevent blood clots:

  • Wear pressure stockings as directed. Pressure stockings help keep blood from pooling in your leg veins. Your healthcare provider can prescribe stockings that are right for you. Do not buy over-the-counter pressure stockings unless your healthcare provider says it is okay. They may not fit correctly or may have elastic that cuts off your circulation. Ask your healthcare provider when to start wearing pressure stockings and how long to wear them each day.
    Pressure Stockings
  • Do not cross your legs for 6 weeks or as directed. Your risk for blood clots is greater when you cross your legs. You might also move your implant out of place.

Activity guidelines:

  • Know your limits. Start activities slowly and give yourself rest periods. Pain and swelling can increase when you do too much. Do not do an activity until your healthcare provider says you are ready.
  • Use assistive devices as directed. Your thigh muscles will be weak after surgery. Assistive devices will help you not fall.
  • Go up the stairs by placing your non-operated leg on the step first. Then bring your operated leg to the same step. Repeat.
  • Go down stairs by placing your operated leg down on the step first. Then bring your non-operated leg to the same step. Repeat.
  • Do light housekeeping only. Ask your healthcare provider which housekeeping activities are okay for you. Do not vacuum, change sheets on a bed, or anything that makes you reach up, bend, or twist.
  • Do not drive for at least 6 weeks or until your healthcare provider says it is okay.
  • Do not play contact sports, tennis, golf, or ski until your healthcare provider says it is okay. These activities can loosen your knee implant.

Prevent falls:

Fall Prevention for Adults
  • Remove all loose carpets and cords. These can cause you to trip and fall.
  • Use a shower bench or chair when you take a shower to limit the time you are standing.
  • Use a toilet seat riser with arms if your toilet seat is low. A toilet seat riser will help prevent bending or twisting your knee.

Metal detectors and MRIs after joint replacement surgery:

  • The metal in your joint may set off metal detectors, such as at an airport. Tell the officials about your joint replacement surgery. You may also want to show your joint replacement ID card, if you were given one.
  • MRIs are considered safe for people with joint replacements. The type of metal used is not magnetic. Tell all healthcare providers about your joint replacement surgery.

Follow up with your healthcare provider as directed:

Your provider may contact you weeks after your surgery. He or she may ask if surgery helped relieve your pain or stiffness. Tell your provider how well you are able to do your daily activities after surgery. Also tell him or her if you are having any problems with mobility or range of motion. Write down your questions so you remember to ask them during your visits.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Further information

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