Total Knee Replacement: A Patient's Guide.
Edited By: Seth S. Leopold, M.D.
Last updated Tuesday, April 15, 2008
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Recovering from surgery
Pain and pain management
Whenever possible, we use an epidural catheter (a very thin, flexible
tube placed into the lower back at the time of surgery) to manage
post-operative discomfort. This device is similar to the one that is
used to help women deliver babies more comfortably. As long as the
epidural is providing good pain control, we leave it in place for two
days after surgery. After the epidural is removed, pain pills usually
provide satisfactory pain control. Patients with a good epidural can
expect to walk with crutches or a walker, and to take the knee through
a near-full range of motion starting on the day after surgery.Use of medications
Following discharge from the hospital, most patients will take oral
pain medications--usually Percocet, Vicoden, or Tylenol #3--for one to
three weeks after the procedure, mainly to help with physical therapy
and home exercises for the knee.
Aggressive rehabilitation is desirable following this procedure, and
a high level of patient motivation is important in order to get the
best possible result. Oral pain medications help this process in the
weeks following the surgery.
Most patients take some narcotic pain medication for between 2 and 6
weeks after surgery. Patients should not drive while taking these kinds
of medications.
Effectiveness of medications
While any surgical procedure is associated with post-operative
discomfort, most patients who have had the total knee replacements say
that the pain is very manageable with the pain medications, and the
large majority look back on the experience and find that the pain
relief given by knee replacement is well worth the discomfort that
follows this kind of surgery.Recovery and rehabilitation in the hospital
Physical therapy is started on the day of surgery in the hospital, or
the very next day after the operation. Patients are encouraged to walk,
and to bear as much weight on the leg as they are comfortable doing.
Range-of-motion exercises are initiated on the day of surgery or the
next morning. The physical therapist should be an integral member of
the health care team. In addition, the patient’s own high level of
motivation and enthusiasm for recovery are very important elements in
determining the ultimate outcome.Hospital discharge
The average hospital stay after total knee replacement is three days,
and most patients spend several more days in an inpatient
rehabilitation facility. Patients who prefer not to have inpatient
rehabilitation may spend an extra day or two in the hospital before
discharge to home.
Convalescent assistance
We recommend inpatient rehabilitation for most patients to assist
them with recovery from surgery. The average stay in a rehab unit is
about 5 days. This is especially important for older patients and
individuals who live alone.
Some patients whose physical condition doesn’t permit the aggressive
therapy program that inpatient rehabilitation units pursue may instead
elect to have a short stay at an extended-care facility. These
arrangements are made prior to hospital discharge.
Patients are encouraged to walk as normally as possible immediately
following total knee replacements. Most people use crutches or a walker
for several weeks to a month following total knee replacements, and
then a cane for a couple of weeks beyond that.
Patients are allowed to shower following hospital discharge.
Patients should not resume driving until they feel their reflexes
are completely normal, and until they feel they can manipulate the
control pedals of the vehicle without guarding from knee discomfort.
Certainly, patients should not drive while taking narcotic-based pain
medications. On average, patients are able to drive between three and
six weeks after the surgery.
Surgery for Severe arthritis of the knee at the University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, Washington
If you are interested in making an appointment to discuss this procedure in Seattle, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call the Bone & Joint Surgery Center at 206-598-BONE (2663) or Eastside Specialty Clinic at 425-646-7777 to make an appointment. Our clinical center is located in Seattle Washington, USA
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