KNEE

Immediately After Your Surgery

 In the hospital we will make sure that your pain is under control and that you get initial instructions from your physio prior to discharge.  Below are some commonly asked questions about what to do before you see me at 6 weeks.

Common Questions and Answers

What should I do with my incision when I go home?

Most of the time I use a dry bandage to cover the incision. The bandage is there to make sure the staples do not catch on your clothes and it will also catch the occasional bit of oozing from your wound. It is not nesseccary to keep the bandage on if your wound is dry. You can leave it open to air especially if you are wearing shorts. When you shower, take the bandage off and wash the incision with soap and water, then pat dry with a towel. You may then place a new dry bandage over if needed. Do NOT soak the incision in a bath or swimming pool until the incision is really well healed (usually 4 weeks after it stops oozing). When replacing the bandage make sure your knee is bent. If you put the bandage on a straight knee it will limit your ability to flex your knee. If there is continued oozing that lasts more than a week OR increases in volume please let my office know. Staples should be removed by your family physician or a health care worker at 2 weeks post op unless otherwise instructed. You will need to phone to make this appointment.



When can I resume driving?

The evidence on when to drive after a joint replacement is conflicting and the most common theme is that you need to be relatively pain free and able to move you leg quickly from the gas to the brake to be safe. A good guideline for most people is that you can gradually return to driving when you are off narcotic medications AND using minimal assistance of walking devices. For most of my patients after a total knee replacement this will be somewhere around 5 to 6 weeks post op.
Please use common sense and be safe. If you are unsure or feel unsafe please wait to check with myself, another health care provider or SGI!



When should I stop my pain medications?

Narcotic medications (ie hydromorphone) should be stopped first. Gradually decrease and then discontinue them when you are able to. Extra medications can be returned to the pharmacy. Tylenol is safer and should be discontinued second. Non-Steroidal Anti-Inflammatories (ie Advil, Aleve etc.) should not be used while on blood thinners. Longer acting anti-inflammatories such as Aleve or Celebrex are excellent to help manage post op swelling. They can be resumed when you are off blood thinners IF you were able to have them prior to your surgery. Patients with medical conditions such as high blood pressure or diabetes should not use these medications unless under the guidance of their family doctor. If you have any questions please contact your pharmacist or family doctor.



What excercises should I do after my surgery?

In the first 6 weeks it is VERY important to follow the instructions that the physiotherapist gave you post-operatively (most specifically the range of motion excercises). By the six week mark I would like you to have full extension AND at least 100 degrees of knee flexion.



When should I use a cane?

Initially most people will start with a walker. You may transition to a cane when you are stable enough that you will not fall and hurt yourself. As your stability and strength increases over time you can stop using the cane. If you notice that during an activity you are starting to limp you should either stop the activity or use the cane for the remainder of the activity. Limping means your muscles are not strong enough yet! If you limp too much it can cause pinching in your hip or knee OR trochanteric bursitis (lateral hip pain). Too much activity will not wreck your knee replacement but it can be quite uncomfortable and it can also increase inflammation which can limit knee range of motion.



What else can I do for my pain, swelling and stiffness?

Heat can be good for rehab especially if you are feeling stiff (ie. in the morning). Ice, cooling pads or even cooling machines (such as ColdTherapy or Game Ready) can be helpful to decrease inflammation. This may be useful after activities or excercise. Compression can be used to decrease swelling in the foot and leg. Tensor bandages, compression stockings or compression machines (such as Game Ready) can decrease swelling and improve circulation. Swelling in the leg can last for months after a joint replacement. These machines can be used immediately after surgery.



Questions about blood thinners?

Usually after a knee replacement you are put on blood thinners for 2 weeks to decrease the risk of blood clots. Rivaroxaban and ASA are the two common blood thinners I use (not usually at the same time however). If you have excessive bruising or bleeding from the wound please contact my office as I will likely need to decrease or discontinue your blood thinner. Also note that Rivaroxaban (aka Xeralto) has exceptional drug status in Saskatchewan so the government should cover the majority of the cost after a knee replacement.



Where can I get Cold Therapy or Game Ready Machines

Cold therapy (ie cryocuff) or similar machines will circulate iced water over the area of concern. These machines are available many places in the city however if you are having difficulty locating a place to rent or purchase you can call Mike at SOSMC (https://www.sportsmedcenter.ca/contact). Game Ready is a unique device that provides compression and cooling in one device. To rent this please contact Stephanie Thoms at s.thoms@sasktel.net or (306) 229-6093. Benifit companies will often cover a portion of these costs.



If my knee clicks does that mean it is broken?

Clicking in the knee is very common and can have many causes. When the metal and plastic contact eachother it can create a click and this is normal for most knee replacements. Clicking can also come from scar tissue and as your muscles get stronger, your knee will track better and this clicking should go away. Sometimes clicking comes from the patella (kneecap). Most often the clicking from your kneecap does not cause any issues. If clicking is associated with signifigant pain or instability you should contact my office.



Should I wear compression stockings?

Compression stockings can be a great way to manage swelling in your legs. Perscription stocking work well but can be expensive and hard to put on so often over the counter stockings will work best. The higher up the leg they reach the more they will manage your swelling, and of course, if you have your feet up you can take them off! You have to just be careful that the stockings dont irritate the incision as it is healing.