Guide to Total Knee Replacement Surgery
After surgery
Your heath care providers want to make your stay in hospital as comfortable as possible. With proper pain management, you should not experience severe pain after surgery. However, you will experience some pain even when you take pain medication.
Pain control is important because:
- With less pain, you will be more mobile and active. This will aid in preventing post-operative complications, such as pneumonia and blood clots.
- With less pain, you will be more comfortable, less tired and able to tolerate the activities required of you. You will also recover more quickly.
Please read the following information carefully. It will help you and your health care providers work together to develop an effective pain control plan.
How You Can Help Control Your Pain
- Tell your health care providers about your concerns and any allergies to medication, and ask questions.
- Inform your health care providers when you begin to have pain. Do not wait until the pain worsens.
- If you have had previous surgeries, tell your health care providers which pain medications were most effective and which, if any, you prefer.
- Give your health care providers the names and quantity of all medications you were taking prior to being hospitalized for surgery.
The Pain Scale
The following pain scale is an important tool you and your health care providers will use to monitor your pain. You will be asked to rate your pain level using this scale.
Medications for Controlling Your Pain
- Oral Medication
- You will be given pills to control your pain when you start eating and drinking following surgery. You can expect to start oral pain medication sometime during the first or second day after surgery. Nurses will continue to give you pills for pain control, as you will need them for the duration of your stay. Your doctor will write a prescription when you are discharged from hospital so you can continue taking your medication at home, as needed.
- Intravenous (IV) Route
- In this method, the pain medication is mixed into a small IV bag and hung beside your regular IV solution. It is then transfused into your bloodstream. Nurses will frequently check your vital signs and ask you to rate your pain level on the pain scale.
Diet
An IV will be used to provide the nutrition and fluid you need until you are able to eat and drink enough on your own. Once you are able to eat and drink, your diet can be expanded as long as it does not make you nauseated.
It is important that you eat a well-balanced, high-fibre diet following surgery and after you are discharged from hospital. Certain foods promote healing and increase energy level and strength. Eating healthy food also helps avoid infections and prevent constipation.
Calcium helps heal bones and keeps them strong. Good sources of calcium include milk, yogurt, cheese, canned salmon, soy, calcium-fortified tofu and milk rice.
Protein is needed to heal tissue and strengthen muscles. Foods such as beef, pork, fish, poultry, eggs, milk, dairy products, soymilk, beans, nuts, peanut butter and tofu are good sources of protein.
Iron is necessary to build the hemoglobin in your blood, which carries oxygen to your tissues. Blood loss from surgery can decrease your hemoglobin and make you feel weak, tired and light-headed. Good sources of iron include: red meat, fish, poultry, canned oysters and clams, tofu, fortified whole grains and some leafy green vegetables such as spinach.
Bowel and Bladder Management
The catheter inserted to drain your bladder during and after surgery will be removed the following morning.
You may feel some abdominal bloating and gas pains in the days following your surgery. Nurses will use a stethoscope to listen to your abdomen for bowel sounds. These sounds are natural and are a sign your bowel is returning to normal. You will usually start passing gas soon after bowel sounds are heard.
The pain control medication you will take after surgery often causes constipation. Nurses will encourage you to take the following measures to prevent constipation and help your bowel return to normal function:
- drink at least eight cups of water a day;
- eat a high-fiber diet; and
- go for frequent short walks.
You must continue these preventative measures for at least as long as you are taking the pain medication.
You should have a bowel movement before being discharged. Nurses will offer you stool softeners or natural laxatives. It is important to tell the nurse when you have had a bowel movement.
Personal Hygiene
Nurses will assist you with personal hygiene until you are able to do this yourself. You will receive basin baths at the bedside or sit in a chair next to the sink the day after surgery. Your doctor will tell you when you may have a shower.
Rest and Exercise
Both rest and exercise are needed for a healthy recovery. You will tire easily the first few weeks after your surgery. Let the way you feel be your guide. Stop what you are doing and rest when you begin feeling tired. You will benefit more from short, frequent walks than from one long walk.
Rehabilitation
You will be assisted in moving from your bed to a chair and will be standing and, if able, walking within the first 4 to 8 hours after surgery. Your level of activity will increase on a daily basis. You will also begin a rehabilitation program to help improve the range of motion and maintain the muscle strength in your new knee.
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Your doctor will decide how much weight you will be allowed to put through your operative leg. Your health care team will provide instructions and guidance and you can also refer to your hospital discharge instruction sheet.
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Your physical therapist will teach you to walk with the required walking aid(s) and teach you the exercises that will be an important part of your post-operative rehabilitation.
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An occupational therapist will review and suggest modifications to your activities of daily living (ADL), such as dressing and bathing, if you are having difficulty with skills that you will need at home.
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Your level of independence with exercises, and your mobility and home management skills will be assessed. Based on this assessment, the health care team will recommend a discharge date and community services you may require.
Avoid Excessive Leg Swelling
Your surgical leg may swell as you become more active following surgery.
To reduce the swelling, lie down with your leg elevated 2 to 3 times per day for 45 minute at a time. Use pillows to support your elevated leg, keeping the knee as straight as you can tolerate. Your foot should be above the level of your heart.
A cold pack can also be applied to the hot or swollen area. Use crushed ice in a bag, an instant cold pack or a bag of frozen peas or corn. A thin damp towel should be placed between the skin and the cold pack to avoid damaging the skin. Do not leave the cold pack in one place for more than 15 minutes at a time.
