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Knee Replacement FAQs: Hospital Post-Op

My knee feels heavy. Is that normal?

Yes. A feeling of heaviness in the knee is normal. The heaviness is not from the weight of the implants, which don’t really weigh much different from the bone and scar tissue that was removed. The heaviness comes from a normal lack of tone in the muscle related to the trauma of the surgery. After a while this will resolve. There is also some blood in the knee that comes from the oozing from the bony surfaces. That will also go away.

Why can’t I lift my leg?

For the same reason as above. The muscle is inhibited by reflex. Most people can’t lift their leg until at least the third or fourth day after surgery. We didn’t cut any muscle or injure the nerves during surgery. You will be able to lift your leg again when the pain improves and the muscle is ready to fire again.

Why is this knee immobilizer on? Do I have to walk with it?

The knee immobilizer is on to make sure the knee is stable when you get out of bed. For the first day we keep the immobilizer on fairly tightly to compress the knee in order to minimize the amount of bruising and bleeding. When you’re in bed you can unwrap the immobilizer from your knee and still be safe. Until the muscle function returns and you can lift your leg out straight, we prefer that you keep the immobilizer on when you’re out of bed.

Will my internal medicine doctor see me?

If your internal medicine doctor is on staff here at St. Vincent’s we write an order informing them of your admission. We certainly encourage them to stop in and see you if they’re in town and their schedule allows it.

Why do you use this ice machine?

The ice machine has been shown to decrease the amount of inflammation after surgery. With a decrease in inflammation there is decreased bruising as well as decreased pain. We use the machine because it weighs less than the bags, is much easier to change and is much easier for you to manage at home.

I feel very tired. Am I ok?

Feeling tired after major surgery is not uncommon due to the anesthetic drugs used and the trauma of surgery. Surgery causes your adrenal glands to respond with a stress response. Also, the narcotic medications used can make you feel tired. It’s quite normal for that tired feeling to last up to 6 weeks in some people.

I’m worried about vomiting. Can I have something for nausea?

Certainly. We use a number of different medications to keep your stomach settled down. Primarily, we use a drug called Anzemet. It has the benefits of Phenergan without Phenergan’s usual unpleasant side effects. If Anzemet doesn’t work, we use a potent drug called Zofran. We try to give you a dose of stomach settling medicine before your first breakfast. We want to make sure that your food stays down so that we can more quickly get you off intravenous medication and onto oral pain medicine.

Why does the nurse keep telling me to use the breathing machine?

It is extremely important to use the breathing machine because it helps mobilize the secretions from your lungs that normally occur after anesthesia. Whenever you’re awake you should use the breathing machine at least every hour. It’s more important how long you keep the inspiration than how far you move the meter.

I had a fever last night. Does that mean infection?

For the first 4 days, most fevers are caused by secretions obstructing the lungs’ airways causing a condition known as atelectasis. Clearing those secretions is the most important task of the breathing machine. Fevers from 101 - 102 are typically due to atelectasis. If you have any burning when you urinate please let us know. We’ll run a urnialysis to be sure you don’t have a kidney infection, the second most common cause for a fever after surgery.

The pain medicine seems too strong and makes me feel funny. Can I take less?

Of course, you can take less medicine, if you wish. You can always refuse pain medicine when the nurse offers it to you. The response of different people to the same dose of medicine varies greatly and we strive to tailor your medication so that you’re comfortable but not over drugged.

How are you keeping me from developing a clot in my leg?

We use Coumadin for most people unless there’s a reason not to use it. This is an old medication but still the most potent. We also have you pump the ankle around and release something that’s called tissue thromboplastin. This is a very effective substance your body makes that is very good at preventing clots. The stocking you wear on your other leg can be removed once your blood is adequately thinned.

How long will I have the IV?

We try to get the IV out on the first or second day post op depending on your response to oral pain medicines.

How far do I have to bend my knee?

You should bend your knee to a point that it is comfortable but challenging. We don’t want you to push through the pain because the knee is a bit inflamed immediately after surgery and you oftentimes can make the knee worse. We’d like for you to be able to bend your knee at least 70 degrees from out straight before you leave the hospital.

When can I eat normally?

You can eat normally when you feel like it. I don’t mind you eating a little something on the night after the surgery but by the next morning we give you medicines to help the food stay down and we prefer that you be on a regular diet by the first post operative day. Please tell the nurses if you’re sick at your stomach with food, as noted above — we’ve got plenty of medicines to help ease that feeling.

The outside of my knee feels hard. Why?

Inflammation from the surgery is the main reason that the knee feels hard. Some people whose knees are very tightly constricted around the kneecap undergo release of tissues in order for the kneecap to function better in the long run. We try not to do this if we can help it because it does make the knee feel hard but we’ll do at surgery whatever it takes to make your knee function best in the long run.

When will the pain get better?

Most people experience a dramatic improvement in pain control by the second post operative week. This is because some of the inflammation from surgery begins to subside. Also by that time we’re doing a better job of helping you keep the oral medications on your stomach.

Why does everyone keep telling me to push the back of my knee down?

We work very hard at surgery to ensure your leg is fully straight or even a little bit hyper extended. You will not back knee too far because the component has a fin inside that will stop the knee from over extending. The normal response of the knee to the trauma of the surgery is to make the muscles on the back of the thigh. (known as the hamstrings) irritable and spasm a bit. We want to overcome that and therefore we ask that you keep the back of the knee pushed into the bed. That’s also why we ask you not to put a pillow under your knee when your knee is out of the brace. If we can maintain full extension, your knee will function much better in the long run.

My leg feels very swollen. Is that normal?

Yes, it is. Your knee is swollen from down deep inside all the way through the soft tissues. So swelling is the normal response of the body and indicates the body’s healing response.

When will I see my incision?

We generally unwrap the knee on the second post operative day.