David P. Adkison, MD, St. Vincent's Orthopedics, PC
Knee Replacement FAQs: Office Post-Op
Why is my leg bruised and swollen?
Swelling is part of the body’s normal response to the trauma of surgery. The bony surfaces that are trimmed away to remove the signs of arthritis (and to make the knee replacement components fit perfectly) ooze and it takes a while for some of the bruising to reach the surface. This is not a dangerous condition. You can apply a heat pack to the bruised areas if you wish.
When will it go away?
Bruising takes about 10 -14 days to completely resolve. Don’t be surprised if the bruising starts in your knee and ends up in your ankle simply because that’s where gravity takes it.
How do you know there’s no infection?
Infected total knees tend to present with ’hard to manage’ pain very early. Furthermore, if infected, the wound will break down and drain pus. In the absence of fever and progressive pain there’s little chance that the knee is infected.
When can I drive?
You can drive safely as soon as you can hold your leg out straight for ten seconds and bend your knees 90 degrees.
How long do I need the walker?
You can discontinue use of the walker whenever you feel like it, although we do recommend that you transition to the use of a cane in the opposite hand. Walking with a cane gives other people a nice visual warning that you’re not able to make quick moves. However, as long as you feel you need the walker for stability, it’s quite all right to use it. The downside to using the walker is that it may make your shoulders ache and you may not be using the muscles in your leg to their potential.
Should I be doing leg extensions to make my thigh muscle stronger?
The answer is absolutely not. Doing leg extensions places an unusual stress on the kneecap and with a polyethylene resurfacing on the underside of the kneecap, the forces are just too great to let us advocate use of this exercise. You’re much better off doing leg presses in which you push with the bottom of your foot to strengthen your muscle. When you do this leg press exercise, your muscles are balanced very nicely and there is not as much leverage against the kneecap.
What are you looking for on x-ray?
We want to make sure that the components of the knee replacement are lined up and that we have good fixation all the way around. We’re also checking that the joint line is in the optimal location.
When can I go to outpatient therapy?
You can go to outpatient therapy when you have convenient, reliable transportation and when your pain is under good enough control to let you travel and be involved for a couple of hours. We prefer to get you in outpatient therapy as quickly and as safely as we can.
When will I be able to climb stairs?
Usually, you can climb stairs when your knee bends 110 degrees (110 degrees is 20 degrees past the bend you should have when sitting in a chair). Climbing stairs will also require good muscle control. Someone who has had weak muscles for a number of years may find it more difficult to climb stairs in a step over step fashion but we anticipate that you will be able to do that at some point when the muscles are strong.
Do I have to take antibiotics for dental or GI procedures?
We prefer and strongly recommend that you do. We’re always glad to provide you a prescription. We usually use a drug called Clindamycin. You take 2 pills an hour before the dental procedure. The same is true for GI procedures, especially a colonoscopy.
Should I start back on my anti-inflammatory pills?
If you’re not on chronic blood thinners, we try to get you off the blood thinner in about 10 days. Once you’re off blood thinners you can take any anti-inflammatory that’s helpful.
When can I stop the blood thinners?
As I stated above, we try to stop the blood thinners by 10 days. If there are any signs that you may have a clot in your leg or if you’re on chronic medication we’ll adjust that time period, as needed, to keep you safe.
Why do you want me to take a multivitamin?
In the past few years we’ve come to understand that a substance in the blood called homocysteine can be related to heart disease. All the studies have shown that a multivitamin daily will decrease your chance of having a dangerous level of homocysteine. Furthermore, a multivitamin is a good way to help you get back into a favorable nutritional status post operatively.
Can I get in the tub?
As soon as your staples are out you may get in the tub — including the hot tub or the pool.
Should I put Vitamin E on the scar?
Yes, you may. Vitamin E seems to help the hardness on the outside of the scar resolve more quickly and to make the scar less visible. If you’re going to be out in the sun, make sure you put sunscreen on because the skin is very easily burned in the area of the scar.
Why do my muscles on the side of my leg feel tight?
This is usually related to the re-straightening of your knee. Also, deep bruising can make the muscles reflexively tight. With proper therapy and stretching this tightness will resolve.
How long will I limp?
This varies greatly from person to person. Some people limp as a matter of habit and even after we straighten the knee out and correct the problem they continue to limp. Quite often we have to keep a patient in extended therapy to work this habit away from them. Most people resolve their limp in approximately a month.
How long will physical therapy be needed?
This also varies greatly from person to person. Some people complete their physical therapy in 3 weeks while others take 3 months. We’ll tailor your physical therapy based on the progress you make in regaining your motion, how stable you feel, whether or not you’re having to use a cane and whether you have a limp. In general, people who have had bad arthritis longer tend to have weaker muscles and will require a longer period of post operative therapy.
When will I be fully recovered?
Full recovery varies greatly from person to person. Some people are essentially fully recovered after 3 months while others take as long as 9 months or even a year. In general, full recovery has to do with muscle weakness and the overall accommodation of your body to the new implant and the way your knee works.
How often will you need to see me back?
I see you back for the first post operative visit, usually at 9 - 10 days after surgery unless you’ve gone to Lakeshore at which time I’ll see you back when you’re discharged. The next visit is usually about 6 weeks later to check your range of motion and how you’re recovering. In general, I’ll see you 3 months after that and then again at the 1 year anniversary.
Bonus: Will I set off alarm in the airport?
Probably. You have a scar to show to help convince the security people that you really have a joint implant. Additionally, we give you a card that fits into your wallet that shows that you have an implant in your knee. Some people, curiously enough, do not set the alarms off, which probably has to do with their body’s magnetic field.
Birmingham, Alabama 