Transitioning Home

Preparing your Home

Before your surgery, you will receive instructions for how to best prepare your home. We suggest purchasing and preparing your meals ahead of time. If your bedroom is on the second floor, consider making up a temporary bedroom on the first floor close to a bathroom. However, we will teach you to walk up and down stairs before discharge so that you can use a bedroom on the second floor if necessary.

Bathing and Wound Care

Keep the incision covered with a sterile dressing until the wound is dry for 24 hours. Once the wound is dry, remove the dressing and you can begin showering. After each shower, apply a new dressing. Don’t soak your knee in a bath tub, hot tub, or swimming pool. Bruising, swelling, blistering, redness, and warmth around the knee are normal after knee replacement.

You can buy Covidien 7541 Telfa Adhesive Island Dressings for $30 (Amazon.com: Covidien 7541 Telfa Adhesive Island Dressing, Sterile 1’s in Peel-Back Package, 4″ x 8″ Pack of 25). If drainage does not stop within 72 hours of the surgery, email a picture of the wound to Dr. Howell at smockkm@ah.org and call his office 916-689-7370 or 209-334-8535.

We will give you a staple removal kit to take home. At 12-14 days post-surgery, have your skin staples removed at Dr. Howell’s Sacramento or Lodi office or at your local primary care office when it’s more inconvenient. A day after removing the staples you can swim and use lotions, powders and oils on your incision. incision with an uneven edge can occur from inadvertent rotation of the staples during insertion. The unevenness gradually disappears within 3-4 weeks.

Reducing the Risk of Blood Clots

Patients that can take anti-inflammatory medicines will be treated with a baby aspirin 81 mg two times a day with a meal for 28 days after the surgery.

Patients who can’t take aspirin or anti-inflammatory medicines or were prescribed a blood thinner such as Pradaxa (dabigatran), Xeralto (rivaroxaban), Eliquis (Apixaban), or Coumadin (warfarin) before surgery will be treated with Coumadin for twenty-one days after surgery. The pharmacists from the Adventist Health Lodi Memorial outpatient pharmacy monitor the prescription of the daily dose of Coumadin based on a sliding dosage scale with use of an INR laboratory result (call 209-333-3009 with questions). The INR laboratory result is obtained from a blood sample drawn every three or four days by either a visiting nurse or outpatient lab. The sliding dosage scale recommends Coumadin:

• 5 mg daily when the INR is < 1.5
• 5 mg daily when the INR is between 1.5 and 2.0
• None when the INR is > 2.0

Twenty-one days after surgery this Coumadin protocol is discontinued. For patients using an anticoagulant other than Coumadin before surgery, they are to notify their primary care physician or cardiologist and ask them to restart and manage the pre-surgery anticoagulant beginning three days after discontinuing Coumadin. For patients using Coumadin prior to surgery, they are to notify their primary care physician or cardiologist and ask them to manage the Coumadin dosage and monitor the INR beginning twenty-one days after surgery.

At Home Activity Guidelines and Exercises

The goal in the first four weeks is to gain knee motion, manage swelling, and avoid strengthening exercises. Please follow the guidelines below, as others are distracting and Counter-productive.

• Every hour you are awake take a short walk.
• After the walk, sit on the sofa or end of the bed and perform the bending and straightening exercises described in Section 6 for 5 to 10 minutes
• When not walking, lie on the bed or sofa and elevate your leg 1½ – 2 feet above your heart on a bolster or pillows as described in Section 6.
• Consider buying an EZ UP Pillow on Amazon for $40.
• Don’t sit in a chair or recliner until the knee easily bends past a right angle or 90 degrees.
• When you overdo it, elevate the leg on the bolster, ice the knee, and rest for the remainder of the day.
• When you walk safely without the walker, discard it.
• Most patients can perform these activities and exercises at home without the assistance of a physical therapist.

Managing Discomfort and Constipation

Take the oral pain medication as prescribed every 4-6 hours and gradually taper off over the first week or two. If you can take Advil or Aleve, then take these anti-inflammatory medications to decrease your use of the oral pain medication. Addiction from a short course of pain medication for a few weeks is rare. Continue taking over the counter Colace to soften your stools and reduce the risk of constipation. When needed, add the use of prunes, Metamucil, or milk of magnesia.

Follow-Up Visit at 4-5 Weeks to Assess the Pace of Recovery

The following are signs of a good pace of recovery at four to five weeks:

• Straightening the knee to 0 degrees
• Bending the knee from 90 to 110 degrees
• Walking without the walker or cane
• Climbing stairs
• Driving the car

At four to five weeks, your recovery should be 50% and your Oxford Knee Score should have improved to 29 15. It is normal to sense swelling, redness, warmth, stiffness, soreness, and numbness on the outside of the incision. Patients with difficulty straightening and bending their knee before surgery take longer and work harder to regain motion than those patients that have full motion. At three months, recovery is about 70% and you may return to recreational activities such as gardening, tennis, golf, biking, bowling, and hiking. At six months, recovery is about 90%. The pace of recovery is best assessed by comparing improvements in your function between 4 week intervals rather than day to day.