What do you do for the first two weeks following Knee Replacement surgery?
You wake up in the recovery room following the surgery and feel great. Relief washes over you knowing that you’ve finally done it. Smiling you nod off to sleep and they take you up to your room.
Now what?
If phase one was years of dealing with knee pain, having a hard time walking, finally coming to the realization that you need a replacement, actually scheduling it and showing up, then phase two begins now. Likely your surgery was in the morning and by afternoon they bring you a lunch plate. The knee still feels great as the medications and or the nerve block are still in full effect. Soon, physical therapy will come to the room, introduce themselves and tell you it’s time to get up and walk. They bring a walker and a belt to put around your waist so that you don’t fall if you get queasy, weak or simply can’t stand up quite right. Usually that first walk is to the bathroom or to the door and back, possibly further if you feel like it. You get back into bed and it feels good as you’re tired. Therapy will hand you a sheet of exercises similar to the ones you’ll find at the end of this article and hopefully run through those exercises with you.
I recommend that you print these off as they are the standard exercises given by most surgeons and therapists to most patients. (Possibly some slight differences and if your surgeon or therapist gives you different exercises, you should obviously use those). In practicing them prior to surgery you’ll be better prepared to do them after surgery. This same pattern of therapy walks and exercises will be repeated for the next 24-48 hours until they send you home.
Going home:
Hopefully you’ve seen my other blog posts and read the post re: what you should do before surgery which includes home prep, meal/grocery prep and many other suggestions. It will make going home much easier. If home health hasn’t been ordered please ask your surgeon to order it for you. You’ll need another set of eyes on you and having nurses and physical therapists working with you will speed your recovery and improve your safety if something isn’t going quite right.
So what should a normal day look like? It’s better to get into a routine and let’s start with:
Pain medications
First and foremost this is a painful surgery. Respect that. If you need the medication, take it. And it’s better to be on a regular schedule. Frequently people want to wait until pain levels start to rise before taking their meds and this is a mistake. In the medical field we refer to it as being behind your pain or chasing your pain. If you’re behind it, it’s hard to catch up. You’ll want to stay on a regular schedule for the first two weeks. Usually doctors will order 1-2 pain pills every 4-6 hours. Figure out what frequency works for you and stick to it. You’ll sleep better and be able to move around and exercise more if you’re not hurting as much. No one wants to stay on opioids long term and it’s fine to start getting off of them as soon as you can, but the first two weeks are rough and regular pain medications will help. ***A quick side note re: pain meds – they can cause constipation. Everyone is different, but you will likely get constipated if you aren’t used to opioids so plan accordingly, speak with the surgeon and have foods/medication on standby if needed. Many surgeons prescribe a stool softener after surgery.
Icing and elevation
I tell my clients that they need to lie down in bed, with their leg elevated on pillows(higher than their heart and no, recliners don’t count) and with an ice pack a minimum of six 30 minute sessions a day. This will decrease swelling, decrease pain levels and improve healing. The more swollen you are the worse blood flow is (congestion) and the more pain you have. More swelling = more pain/Less swelling = less pain. It’s as simple as that. Set a routine and stick with it. If you have a CPM (continuous passive motion machine) coordinate your ice and elevation sessions with the CPM. Get in all 6 hours of the CPM if it’s been ordered for you.
Exercise/Walking
Twice a day is preferred for your exercises. You may have received a set of exercises from your surgeon or PT and if not click the link at the end of this article and print those. Perform your exercises twice a day and try to get as much bend and straightening as you can while performing them. These exercises really aren’t designed to build strength, but rather to wake up your leg muscles that are still in shock from the procedure. Frequently people will look at their leg and say “It’s not moving like I want it to.” All normal, just push through. For walking, try to get up frequently (1-2 times an hour) and take a lap around the house. We want you walking frequently but not so much you increase your swelling.
Sleep
For the first two weeks sleep will be a bit rough. Get what you can. We move around when we sleep and when you move normally at night you’ll wake up due to the discomfort. Sleep improves after the first two weeks. Just grab as much as you can.
Other notes:
Keep your incision dry
It’s likely you’ll have a silver impregnated dressing covering your incision. If you have a dressing leave it unless instructed to remove it. Do NOT apply creams, balms, salves, vitamin E oil or anything to the incision. Do NOT soak your incision. No baths, pools or hot tubs. If you have staples they’ll be removed between day 10-14. Even after the staples are out you won’t want to apply anything to your incision until it is free of any scabbing (even little ones) and completely closed. Call your surgeon or therapist with any questions. If you run a fever higher than 101.5 degrees, call your surgeon. Some surgeons protocols are different ie: 101 degrees, but high fevers need to be reported immediately.
Clot prevention
A very real potential issue are blood clots and you don’t want one. You’ll either have compression hose, prescribed blood thinners (sometimes an injection), or both. If you’re supposed to wear hose, wear them. If you’re prescribed blood thinners, take them. Clots don’t happen often, but they can, so please do your part to prevent them.
There you have it. The main point here is to try to settle into a routine as much as you can and as early as you can. After you get past the two week point, things get easier. If you have any questions feel free to reach out to me at eastonpt@gmail.com or on my website www.chriseastonpt.com. If you need more information I wrote a book on knee replacements and you can find it here: https://www.amazon.com/Knee-Replacement-Surgery-Patients-Guide/dp/1511642963/ref=sr_1_fkmrnull_1?keywords=chris+easton+knee&qid=1550776264&s=gateway&sr=8-1-fkmrnull
I did promise some exercises and you can find them here:
https://www.my-exercise-code.com
Simply enter code: 6YT9KAS
No personal information is collected and you don’t have to give up your email address 🙂