Common Questions and Answers
What do I do if my scar is thick or puckering?
Scar mobilization can help decrease tethering of the skin to the underlying tissues. Once the wound has healed nicely (usually 4 weeks after surgery) you can start manipulating the scar. Place your thumb or palm on the incision and with increasing force rub in circles moving your way down the scar to break up the scar tissue.
Scar mobilization can help increase knee flexion as well.
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!
If my skin has numbness or is really tender, will this go away?
Numbness around the incision is quite common after a knee replacement (from cutting the skin nerves passing through the incision). It can take up to a year for you to get to your new normal and some people have some residual numbness.
Tenderness around the knee is usually from tendonitis and inflammation. This will sometimes worsen a few months after the knee replacement and will usually resolve when your knee strength improves. Anti-inflammatories (including medications and creams) can be helpful in the short term.
If significant pain or discomfort please let my office know.
What excercises are most important to help me function normally?
The first goal is to get full extension. When you stand for prolonged periods you lock out your knee in extension and to do this you need to have full extension. To make sure you have full extension, sit on a flat hard surface with your entire leg straign (hip to heel) and your patella (kneecap) and toes pointing straight up. You shouldn't be able to slide your hand under your knee. If you can, then you still have some work to do...
The second goal is to get full flexion. You will need at least 100 degrees before you see me at six weeks but I would eventually like you to get over 130 degrees (unless for some revision knee replacement surgeries I have told you otherwise).
Finally we work on strengthening. Strengthening after a knee replacement means not only getting the leg muscles stronger but also getting your core muscles stronger. When people have pain after a knee replacement most often it is from having weak pelvic stabilizer muscles. Please refer to your physiotherapist or my section on muscle strengthening for more guidance.
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.
Can I kneel on my knee?
Yes, you are allowed to kneel on your knee after a knee replacement. For some people the scar is tender and if this is the case you may want a pad to kneel on. To kneel easily you need to have good flexion and people with >130 degrees of flexion will usually find it easier to kneel.
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 firstname.lastname@example.org 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.
When can I travel after a knee replacement?
I usully don't put any restrictions on travel post op. All I ask is that you attend your regular follow up. Travelling may increase your risks slightly as discussed below.
If you have prolonged immobility (ie sitting in a plane or vehicle for hours) this can increase your risk of blood clot. We give 2 weeks of blood thinners post op but if you are travelling and still have symtomps/swelling after coming off blood thinners then you can take ASA daily a few days before and after travelling if this is safe for you to do (and if you are worried discuss this with your family doctor).
Please note ... if you leave the province or country you may not have the appropriate coverage or they may not cover you because it is a pre-existing condition.
When do I need to take antibiotics?
If you have an infection not associated with your joint replacement, you should have this treated early with antibiotics (especially if it is associated with fevers and chills).
If you are worried about an infection in or around your joint replacement PLEASE do not start antibiotics without contacting my office.
If you are having an invasive procedure or routine teeth cleaning within 4 to 6 months of your joint replacement it would be ideal to delay if possible. If you cannot delay then you should have prophylactic antibiotics (and these can be prescribed by your doctor/dentist or myself).
If you are having routine dental work AFTER 6 months it is currently the recommendation of the Canadian Dental College and the Canadian Medical Association that prophylactic antibiotics are not routinely needed.
When can I return to work?
Return to work is quite variable after a joint replacement. It depends on your ability to function and the type of job you are returning to. For you to be successful you must be able to have time to perform physio/rehab.
If you are returning to a sedentary job, you can often return to work when you are mobilizing safely and have your pain under control (sometime in the first six weeks). For semi-labor jobs it can be up to 4 to 6 months until you can return safely.
The best plan for return to work is to have your physiotherapist develop a return to work plan. If you need to have this reviewed by me please send a copy to my office.