Going Home

9. Going Home From The Hospital
Several days prior to release, you will be contacted by the Discharge Planner. Careful preparations must be made for going home. Prescriptions will be written for a "reacher", "sock-cone" and a long-handled shoe horn. Although you will be independent with most activities of daily living when you leave the hospital, it is important that you not be alone for the first two weeks. During this period of time, it is extremely helpful to have someone help prepare meals, clean the house and get you some of the things that you will need. It is not necessary that this person be medically trained.

If further physical therapy is required, this will be arranged and a physical therapist will visit your house. Also, visiting nurses can be arranged if necessary.

Occasionally it may be necessary to spend a short time in a rehabilitation hospital if progress with physical therapy is slow or other medical problems require more nursing care, or if you live alone and friends or family are not available. Special orthopaedic rehabilitation units at several facilities are available. Private insurance, Medicare or Medi-Cal usually pay for such services.

For the first six weeks, you will be limited in your activities. You may go out for short walks (less than a block) and short rides in the car, but most of the time you should spend recuperating. You will not have regained sufficient strength until at least six weeks to twelve weeks after surgery. Therefore, it is unwise to plan any large trips or outings during this period of time.

Riding in the car presents some difficulties. We would suggest if you have a large vehicle, you should ride in the front seat with the seat all the way back. An alternative, especially in smaller cars, is to use the back seat and sit crossways. You should not plan on driving until at least six weeks after your surgery.

10. Post Operative Office Visits
Normally, your sutures will be removed 10 days to two weeks after surgery. It will either be done by a visiting nurse, or by your referring physician. The first "official" postoperative visit will be at six weeks after your surgery, at which time you will have x-rays taken. Depending on the type of surgery, you may not be allowed to put more than 10% of your weight on the operative leg until six weeks after surgery. Your surgeon will inform you at the six week visit what restrictions can be changed and how much weight you will be able to bear on the limb.

By three months after surgery, you will usually be strong enough to resume most normal activities. Normally, 75% of the strength is gained by three months, 90% by six months and 100% by one year after surgery.
Routine post-operative visits and x-rays are at six weeks, three months, one year, two years and then every other year. It is very important that you continue to have the knee checked at least every other year for the rest of your life. Plans to return to work can be made at your three month visit. Usually, you are off work between three to six months.

11. Living With Your New Knee
Exercises such as swimming and bicycle riding are encouraged. Walking a reasonable amount (less than a mile) is also a good exercise. You should wear shoes that have a cushioned heel to avoid impact loads on the knee while walking. Impact loading activities such as tennis, racketball, jogging and jumping or lifting heavy objects (greater than 20 lbs) are to be avoided.

12. Prophylactic Antibiotics
Without appropriate precautions it is possible for bacteria from the bloodstream to settle in the knee joint causing an infection after a total knee replacement. Patients with dental infections have been known to have the infection spread to their knee joints. Similarly, infections elsewhere in the body can also spread to the knee. In addition, manipulation of areas that are known to have bacteria can also cause bacteria in the blood stream. Any dental procedure that causes some bleeding of the gum can result in bacteria in the blood stream. Therefore, it is wise to take prophylactic antibiotics before and after these procedures.

Similarly, any procedures on the bowels or bladder also require prophylactic antibiotics. The usual prescription for dental procedures is Amoxicillin 3.0 gm one hour before and 1.5 gm 6 hours after. If you are allergic to Amoxicillin, an alternative can be ordered. Simple mention of the fact that you have had a total knee replacement will usually alert your doctor or dentist, and they will take the appropriate action.

13. Summary
In summary, lots of things are going to happen both before and after your surgery. By reading this, we hope that you will be prepared for some of these things. Hopefully, this will generate some questions. Please ask your surgeon or any of the staff. Please remember that the goal of the surgery is to relieve pain and to restore function so that you should be able to perform the routine activities of daily living. Your knee will never be "normal" again, but it should give you a significantly improved level of function and pain relief as compared to your pre-operative status.