This article outlines the necessary precautions to take after total knee replacement surgery. The medical team at the hospital and my doctor gave me several suggestions on how to avoid setbacks and how to improve my recovery.
I also learned some dos and don’ts through trial and error. We’ll discuss the dangers of falling, infection, blood clots and several other things that might impede your TKR recovery.
Hopefully my experience will make your recovery from knee replacement less painful and free from setbacks. The more you know before surgery, the better your recovery will be.
Do as much reading and researching as much as you can and get information from friends and acquaintances that have had TKR. I asked a lot of questions whenever I met someone that had previously had TKR and I’m glad I did.
Everyone has a different experience with total knee replacement and recovery but I was surprised how consistent the advice was.
Precautions After Total Knee Replacement Surgery
My doctor, my medical team, and my physical therapist all emphasized the importance of not falling, especially during the first 8 weeks after TKR surgery. The doctor explained to me that the implants were porous on the side nearest the bone and slowly but surely the bone would grow and attach to the implants.
This takes time, about 8 weeks. During that time it’s important not to fall.
Balance will be an issue immediately after TKR surgery. If you fall you could damage your surgical knee but you could also fall and injure a hip or break an arm. This would seriously delay your recovery.
One thing you can do to reduce the chance of falling is to prepare your house before TKR surgery.
After TKR surgery remove any rugs or carpets that you could slip on. Make it easy on yourself by clearing wide paths free of furniture to get around the house with your walker the first week or two of knee replacement recovery.
Have easy access to lights when you are getting up often at night. Have all necessary medications and other items within reach of your bed and the chair you will be spending the majority of time in during the day.
The less you have to move initially the less chance you will have of falling. Use the walker until you transition to a cane or walking poles.
When you use the restroom the walker should be able to slide over the toilet seat – this makes it easier to urinate for a male. You’ll need the stability the walker provides.
If you need to sit it’s best to get an elevated toilet seat. There are legs attached to an elevated toilet seat that lock in place and the increased height makes access to the toilet much, much easier.
Without the elevated toilet seat it’s very difficult to lower and raise yourself to and from the toilet seat. It’s very easy to slip and hurt yourself.
Falling should also be considered when changing clothes. I found it best to be seated in a chair with my walker nearby.
I could remove and put on clothing while sitting then complete the task while standing with my walker. You won’t be able to stand on one leg and put on underwear and pants. It will be a slow process and you will need to be patient at first and take your time.
Bathing is another activity where some people fall. As I mentioned in an earlier article I bathed the first 12 days from a sink. I had a stable chair by the sink and alternated bathing my body sitting down and standing with the aid of my walker.
I was cleared to take a shower on the 13th day and I was concerned about falling on the tile floor.
My wife placed a towel on the tile for me to stand on and I was cautious moving around during the first few showers. I stood for short periods of time under the shower and then sat on the built in bench using the handheld shower head.
I had to step over a raised threshold to get in and out of the shower and was careful to have my walker or a walking pole nearby to aid me in getting in and out of the shower. I dried off sitting in a chair and standing with the walker.
According to my medical team, it’s normal to have mild swelling, some redness around the knee, and warmth around the incision for 3 to 6 months. My home therapist always checked my incision for infection, felt around the knee and took my temperature daily.
During the first few visits to the off site physical therapist he always checked my incision closely. There are two types of infections that you can develop.
- Superficial Knee Infection
- Deep Knee Infection
Superficial infection usually occurs soon after surgery in the incision. Deep knee infection can occur as long as you have the implant. Superficial infection is much easier to treat. Deep knee infection can require follow up surgery.
Some people are more at risk for deep knee infection if they have prior medical conditions. Some of these conditions include HIV, Diabetes, Obesity and several others.
My doctor was especially concerned about future dental work because bacteria can travel from the mouth to the knee. You need to be especially cautious if you have teeth pulled or a root canal.
Even regular cleanings and routine dental work could lead to an infection. My doctor prescribed an antibiotic for me after surgery to take an hour before any future visits to my dentist.
There are a few actions I took to prevent superficial infection. I kept the incision clean and used anti bacterial ointment on the incision as per my physical therapist’s suggestion.
I did not shower for the first 12 days. I did not submerge my knee in water avoiding baths, swimming pools and hot tubs.
Avoid Long Periods of Inactivity
The first few days when you are at home it’s hard to get up and move about. You need to force yourself to get up often.
It’s very easy to lie in bed or sit in your recliner but making the effort to get up, move around and put some weight on your surgical knee helped speed up my recovery.
Even while lying in bed or sitting in my recliner I was advised to do frequent ankle pumps and ankle circles to enhance my circulation.
Once you are assigned exercises by your physical therapist it’s important to do them as often as the therapist suggests. I forced my self to get up and do the exercises 3 times a day.
Many times I had to talk myself out of skipping workouts or taking shortcuts. It was hard, especially during the first two weeks but the results for me were worth the pain.
It’s easy to get depressed and lack the motivation to put in the recovery work. Thankfully my wife and son were around to encourage me and help get me through the early workouts.
I knew someone that didn’t work as hard the first two weeks and had to visit the doctor, be anesthetized and have the doctor manipulate and stretch the leg to increase range of motion in the knee.
When I first looked at my leg after surgery I was surprised at the amount of swelling. The entire leg was huge.
The tourniquet placed on top of my thigh caused major pain and swelling. My knee and the area around my knee were swollen as well as my lower leg and ankle.
I also noticed that I had compression socks and air-cuffs on both legs to encourage circulation and an ice cuff around my knee to reduce swelling. I learned during my first physical therapy, just four hours after surgery, that the swelling made it very difficult to bend my knee.
The more the swelling went down, the easier it was to do my therapy and to begin walking with less pain. For this reason I iced my knee as soon as I got home several times (5 to 7) times a day.
As the swelling decreased I was able to perform tasks easier and I had less pain doing my therapy. The swelling decreased daily and by week two the swollen mass around my knee was beginning to look more like a knee.
Elevate and ice as often has you can. It made a big difference in my recovery.
Taking steps to prevent a blood clot after TKR surgery is an important part of knee replacement recovery. I was told the first 10 days after the surgery was a high-risk time and I would remain at high risk for the first 3 months.
My doctor told me at my pre operation appointment that I should have a supply of Aspirin (325 mg) at home and take one daily for the first 42 days post surgery. Aspirin reduced blood clots. In the past my doctor used to prescribe anti clotting medication but he doesn’t anymore unless you have previously been on medications like blood thinners.
I had compression socks on at the hospital but my medical team said it was up to me if I wanted to wear them at home. I took Aspirin every morning and made it a point get up and move around often.
I did my therapy religiously and pumped my ankles when sitting in my recliner. If you feel abnormal swelling or an unusual pain anywhere in your body that might feel like a cramp contact your doctor ASAP for treatment.
Over Doing It (Exercise)
You can exercise too much. My physical therapist told me to exercise often and increase repetitions and walking distance.
She did warn me that if I saw redness, swelling or if the area near the knee was hot that I should back off, rest and go slower. She assured me, however, that it would be difficult to cause permanent damage to my knee.
I had a couple of setbacks, once when I walked an extra distance and once after increasing my time on the exercise bike. I iced the knee several times on those days, rested and was able to resume activity (workouts) the next day.
I was anxious to build up muscle around my knee and increase flexibility so I pushed a little too hard.
Pain Pill Dependency
Any time you’re taking prescription medicine that can become addictive, you need to be careful; follow your doctor’s orders! My doctor was careful to prescribe only 50 pills with no refills.
I used 38 pills and 12 still remain in the container. I took them on a regular basis every 4 hours for the first few days. On day 5, I started taking less Percocet and started taking Tylenol more and more.
As I weaned myself off the Percocet I still took one to overlap two workouts and a few times if I had trouble sleeping I took one at night. After day 14 post-surgery I did not take any more Percocet.
This is the strategy that I followed. Consult your doctor and physical therapist and see what plan of medication is right for you.
Immediately after surgery I only had the choice of sleeping on my back. When the swelling and pain began to subside I was able to sleep on my right side (surgical knee).
Later, if I had my toes dangling off the bed, I could sleep for very short periods of time on my stomach. Only after 3 weeks was I able to sleep on my left side if I used a pillow between my knees.
Have an extra pillow or two nearby. I often used pillows to elevate or cushion my knee when I was having trouble sleeping.
Sleeping in a strange position early on can have consequences. If you fall asleep on your stomach the top of your knee might rub against the bedsheets and irritate your wound. You could also wake up with a more painful knee.
If you sleep in an uncomfortable recliner you could end up with back pain. The first few weeks after knee replacement surgery I rotated between the bed and a recliner. The recliner was mostly for naps and the bed was better for stretching out.
I had surgery on my right knee. It was impossible for me to drive, as I was not able to break.
Years ago when I broke my right leg I was able to drive left footed by propping my right leg up on the front bench seat. Our two cars both have front seats with a divider so it’s impossible to prop your leg up.
When you begin to make progress, be careful before getting behind the wheel. If you have a spouse or friend who can drive it may prevent you from harming yourself or others.
I started to drive during the 6th week post surgery. I practiced in my neighborhood using my right leg on the gas and my left leg on the brake. After a few practice runs I felt more confident with my surgical knee and used the right foot to accelerate and brake.
Walking on Your Own (Don’t get stuck somewhere without phone)
Use the aid of a walker, a cane, or walking poles when you begin taking walks outside. My therapist or a family member always accompanied me during my first two weeks of walking.
I also carried walking sticks for support during those first two weeks. Once I began walking alone I always took my cell phone in case I fell or couldn’t make it back home.
My therapist warned me that when I increased my walking distance I should always remember that I had to walk back home the same distance. Increase the distance you walk slowly, don’t overdo it.
Listen to your doctor, medical team, and your physical therapists. Follow their instructions for a good recovery after TKR.
Be patient and be careful. For me, the possibility of falling and damaging my knee and infection were foremost on my mind after surgery.
As my incision healed rapidly and as I gained confidence walking they became less of a concern. Knowing that the home physical therapist was monitoring my incision and my general health was reassuring during the first two weeks post-surgery.
I encourage you to use good judgment while taking pain medication. Watch for signs of redness, infection, and swelling yourself and report any unusual signs to your home therapist or to your doctor.
Don’t try and be a tough guy or gal and over extend yourself. Go slow and you’ll achieve positive gains. Your recovery won’t happen overnight, it’s a process that will take time. Be patient.