Expect an early morning. You’ll need to arrive about two hours before your surgery to complete paperwork, change into a gown, and meet your medical team. After surgery, our goal is to get you moving. Many patients can go home the same day if they can urinate and walk. If you have more complex health issues or difficulty urinating, you may need to stay overnight.
Stay active and eat a healthy diet (high in fiber, low in sugar, and rich in protein). Consider arranging support from family or friends, and prepare by freezing extra meals. Remove trip hazards from your home, limit yourself to one floor if possible, and wear comfortable, loose-fitting clothes and easy-to-remove shoes. Shower the morning of surgery, but avoid shaving near the incision area.
Physical therapy is crucial for a successful knee replacement. The knee is not just the joint surface we are replacing but also the soft tissue (ligaments, capsule, tendons, muscle) that surround it. With a knee replacement you have a great new joint surface but we need you and your therapist to work hard to get the soft tissues right as well.
Physical therapy can be done at home or at an outpatient facility, with outpatient therapy generally providing faster progress.
The first two weeks of recovery really set us up for success. Your goals during the first two weeks are to safely walk around your house without falling, to be able to bend your knee to and not past 90 degrees, and most importantly, for you to get your knee all the way straight ( knee extension).
Knee extension – second only to not falling, is your priority. Any time that you are relaxing or lying down, prop your heel up on a pillow and allow the back of the knee to hang freely. While doing this, fire your quad muscle to drive the back of your knee into the bed and/or press on your thigh to stretch the back of your knee. This will help stretch the hamstrings and allow the knee to fully straighten. If this is neglected early it is hard to get back on track.
Knee replacement surgery is highly successful, but like any procedure, it carries risks:
- Infection: We take extensive measures to prevent infection as it is a very bad outcome. Prevention starts well before the surgery with patient selection and optimization. Patients can take infection prevention into their own hands by optimizing their weight, blood sugar, and medication in addition to nicotine cessation. Intraoperatively we clean your skin, give you antibiotics during surgery, and use sterile instrumentation/implants.
- Implant loosening: Though rare, wear and stress over time can cause the implant to loosen. Advances in technology have reduced this risk.
- Persistent pain or stiffness: Some mild swelling and discomfort are common. A metal and plastic knee can feel different from your natural knee.
- Clicking: The new knee may sometimes make clicking sounds due to the metal and plastic components interacting.
- Numbness: You may experience some numbness around the incision area, which usually improves over time.
- Kneeling discomfort: Some people find kneeling uncomfortable on a knee replacement.
During surgery, you will likely receive spinal anesthesia along with a numbing injection around your knee. After surgery, we will start a scheduled pain regimen, including medications and ice, to manage discomfort. For the first 24-48 hours, it’s important to take your prescribed pain medication on time to stay comfortable. I recommend setting a 6 hour timer.
- Aspirin (81 mg): To help prevent blood clots, take twice a day for 4 weeks.
- Ondansetron (4 mg): Take every 8 hours if needed for nausea.
- Multivitamin: Helps with recovery by supporting overall health.
- Protein supplement: Boosts healing, either through food or protein drinks.
- Miralax: A stool softener to avoid constipation caused by reduced activity and pain medication.
- Blood thinners: Depending on the type (e.g., Eliquis, Xarelto, Coumadin), you’ll need to stop them several days before surgery and resume afterward as instructed by your doctor.
- NSAIDs: Stop 5 days before surgery (e.g., ibuprofen, Aleve).
- Diabetes and blood pressure medications: We’ll review these with your primary care doctor and anesthesiologist.
- Autoimmune medications: Your care team will guide you on managing these medications.
Your incision will be covered with a sterile dressing, and we’ll wrap it to help reduce swelling. The ACE wrap can be removed the third day after surgery. Keep the dressing below it clean, dry, and intact for the first two weeks. You can shower on day 3 after surgery using protective wraps (e.g., Saran Wrap) to avoid soaking the dressing. No swimming or submerging for 3 months.
In the first two weeks, focus on avoiding falls and working on knee extension and flexion. After the first follow-up (2 weeks), you’ll begin strengthening exercises and physical therapy.
Your first follow-up will be at two weeks post-surgery. Additional visits will be scheduled at six weeks and twelve weeks. After that, we’ll tailor follow-ups based on your needs.
You can resume driving when you are off pain medication, have good control of your leg, and feel confident in a controlled environment. If your surgery was on your right leg, it may take longer to drive safely.
If your job is sedentary, you may return after about two weeks. For physically demanding jobs, it may take up to three months to fully recover.
If you’re having a dental procedure that involves bleeding (e.g., extraction), it’s recommended to take antibiotics beforehand. You can get a prescription from the office if needed. You do not need antibiotics for a cleaning.
Recovery varies by individual, but here’s a general idea:
- First two weeks: Focus on walking safely and achieving full knee extension.
- 6 weeks: Most people are moving well and managing daily activities. Some may experience mild tightness.
- 12 weeks: You’ll likely be back to most activities, with ongoing improvements. After the 12-week mark, your recovery continues to improve gradually for up to a year.
Most concerns can be addressed with a phone call or clinic visit. If you experience severe symptoms like chest pain, shortness of breath, or a fever over 102°F, go to the emergency department immediately