Guide to Total Knee Replacement Surgery

Going Home

You should be able to go directly home with an exercise program. However, your surgeon and health care team may decide you need further rehabilitation. If so, you will be referred to one of the following, depending on your needs:

• An out-patient physical therapy clinic or rehabilitation program at your local or rural hospital
• Home care
• An exercise program in your community
• Admission to a sub-acute care or rehabilitation facility

Transportation will be arranged by the hospital if you are being transferred as an in-patient to another facility. You will need to arrange your own transportation if you are going home from hospital.
No two people will progress at the same rate. The speed and success of rehabilitation following total knee replacement surgery depends heavily on you.

It is normal for your knee to be warm and swollen for many weeks following surgery as the healing process continues. You may use ice packs on your knee to help reduce pain and swelling. Ask your physical therapist for specific instructions. It is also normal to feel some numbness in the skin around the incision.

Avoid any sudden jarring, twisting or uncontrolled bending of the knee. Do not sleep with a pillow under your operated knee.
Continue your home exercise program. This will help your leg muscles become strong and supportive and help keep good range of motion in your knee.

Most importantly, walk as much as you can tolerate every day. Begin with short, frequent walks and slowly increase the distance.

Managing at Home
The following instructions will help you to manage daily activities while recovering.   Gradually add activities to your daily routine, remembering to avoid twisting on your surgical leg or forcing it to bend.

Sitting in a Chair
Choose a chair with a firm seat and armrests.  The chair height may be raised by adding a firm cushion. Avoid low or soft chairs and couches.

To Sit:

	Back up until you can feel the chair at the back of your legs. Slide your operated leg slightly forward. Bend both knees and lower yourself gently onto the chair. Reverse the procedure to stand up.

Using the Toilet
A raised toilet seat and toilet armrests may be recommended to assist you in using the toilet.  Make sure the toilet paper is within easy reach.

To Sit:

	Back up until you feel the toilet seat against the back of your legs. Slide your operated leg slightly forward. Bend both knees and lower yourself slowly onto the toilet seat, using toilet armrests, the countertop or sink for support. Reverse the procedure to get up from the toilet.

Getting in and out of Bed
Avoid low beds.  You may lie on your back or on your non-operated side when in bed.  Support your operated leg with pillows when you are lying on the non-operated side.

Do not rest with the pillow under your knee when you are lying on your back.

To Get into Bed:

Sit down on the bed in the same manner as you would sit on a chair.
Slide your buttocks back until your knees are on the bed.
Pivot on your buttocks as you lift your legs onto the bed. Reverse the procedure to get out of bed.
Dressing Special adaptive equipment should be used to help you dress yourself (e.g. reacher, long-handled shoehorn, dressing sticks, elastic shoelaces, sock aid).  Choose loose-fitting clothing, including socks. Wear low-heeled shoes with elastic laces. Be sure to dress the operated leg first and to undress it last.
Bathing You should bathe from a sitting position at the sink or in the tub or walk-in shower with a chair.  Have someone help you with tub transfers and showering until you can do them safely on your own. Transfer Techniques: To Get into the Tub Back up until you can feel the tub against the back of your legs, hold onto the tub grab bar for support and, with your other hand, reach back for the bath seat and lower your buttocks onto it. Pivot on your buttocks and lift your legs one at a time, up and over the side of the tub. Use a hand-held showerhead, long-handled sponge and soap-on-a-rope to make bathing easier. Reverse the procedure to get out of the tub.
	To Sit in the Vehicle: Back up with your walking aid until you can feel the edge of the vehicle against the back of your legs. Hold onto the back of the seat and the vehicle frame for support, slide your operated leg forward slightly, bend both your knees and sit.  Be careful to avoid hitting your head. Slide your buttocks back towards the middle of the vehicle, and then pivot on your buttocks as you lift your legs one at a time into the vehicle. Reverse the procedure to get out of the vehicle.

NOTE: If your leg is swollen, elevate your entire leg on pillows so that your foot is above the level of your heart while lying in bed.  You should rest in this position for 45 minutes, 2 to 3 times a day.

Sexual Activity

Most people are able to return to sexual activity when it is comfortable to do so. This activity is safe for your operated leg as long as all the precautions for your knee are followed. Remember:

1. Do not force your new knee to bend.
2. Do not twist your new knee inward or outward.
3. Avoid positions that cause pain.

Home Management

You will benefit from being organized before surgery. For example, you can purchase food and prepare meals ahead of time, rearrange cupboards to minimize bending, and move everyday items to ground level to avoid climbing stairs.
If additional assistance is needed when you return home, community services such as Meals-on-Wheels, Home Care, and homemaking services will be arranged by your Case Manager.  You may have to pay for some of these services.

Meals

• Carry hot liquids in containers with lids (Thermos or thermal mug with lid) to avoid burns
• Use the oven only if you can do so without bending your knee the wrong way or too much.  A microwave or stovetop is preferred.
• Use prepared meals, frozen meals, Meals-on-Wheels or order in food.

Kitchen

Keep frequently used items within easy reach and use a long-handled reacher if items are out of reach. Avoid storing food in lower compartments and on low shelves. Slide objects along the countertops – don’t lift them. Use a wheeled trolley or cart to transport items when your hands are occupied with a walking aid. Wear an apron with large pockets or a fanny pack or attach a bag to your walker to carry things. Sit on a high stool when doing countertop tasks.

 Shopping

• Shop at stores that are easy to get to and have good parking facilities and elevators.

• Bring your walking aid with you.
• Bring your reacher to pick up items off the lower shelves.
• Use a backpack to carry purchases.
• If possible, get help from family or friends.
• Your local grocery store may deliver for a small fee.
• Dairy companies will deliver milk and other dairy products to your door.
• Use canned or frozen goods to decrease the frequency of shopping trips.

Laundry

• Have someone do laundry for you. If this is not possible, reduce the laundry loads to a few items at a time, carrying them in a plastic bag, backpack or wheeled cart.

• A reacher may make it easier to get laundry in and out of front-loading washers and dryers.

• Sit on a high stool to iron clothes

Housework and Yard Work

• You should be able to do light housekeeping, such as dusting and washing dishes.
• Arrange to have help with heavy work, such as vacuuming, washing floors, changing bed sheets, cutting the grass and shovelling snow.
• Take out small amounts of garbage at a time if there is no one to do this task.
• Hire assistance if possible.

Driving

• 1. Discuss this with your surgeon. He or she will tell you when it is safe to resume driving. This generally depends on which leg had surgery and whether you drive a car with a standard or an automatic transmission.
  2. Information about alternative transportation in your community is available at the Hip and Knee Clinic.

Activities and Sports

You may feel some stiffness in your new knee, especially during activities that require the knee to be bent to an extreme range. One of the aims of surgery is to improve your knee’s range of motion to regain function. How much knee movement you obtain is often related to how much stiffness you had before the surgery.

Kneeling on your new knee is often uncomfortable and should be avoided unless your surgeon tells you it is safe to do so.
You may occasionally feel some soft clicking in the knee during bending or walking. This sensation should decrease over time as the muscles surrounding your knee strengthen.

Your new knee may activate metal detectors at airports. Tell the security guard about your surgery if the alarm is activated. Your surgeon can give you a letter or prosthesis card, which you can carry when you travel to confirm you have a prosthesis.
Take special precautions to avoid falling and injuring your knee. You may require complicated surgery if you fracture the leg or dislocate your prosthesis.

Tell your dentist or other doctors involved in your care that you have had knee replacement surgery.  You may need antibiotics before having other procedures as there is a risk of infection spreading to your new knee.
It is important to keep the muscles surrounding your new knee strong. Participating in regular, light exercise programs will maintain strength and mobility in your new knee joint.

 

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