The patient, after total knee arthroplasty, expects to return to pre-operative lifestyle without pain, which is true, but requires a reasonable amount of time. For this reason, active involvement of the patient in the postoperative rehabilitation program will help achieve the goal faster and have a better overall outcome.
At the end of the program, the patient returns to almost all of his daily activities; however, movements and exercises that subject the knee to overloading, such as jogging, should be avoided.
DISCHARGED FROM HOSPITAL
Hospitalization after total knee arthroplasty will take 1-4 days and depends on the speed of the patient’s recovery.
Before discharged from hospital, the patient must have achieved several goals, such as:
- Getting up from bed alone
- Reducing pain to acceptable levels
- Be capable of self-service in terms of feeding and using the bathroom.
- Be able to perform appropriate home strengthening exercises.
- Walk with the help of a walking cane or stroller on a level and smooth ground and go up and down 2-3 steps.
- Understand all the instructions that will be given to ensure quick and correct recovery.
If the patient is unable to meet these goals, then it may be preferable to spend some days in hospital or in a rehabilitation center. Although the possibility of complications after total knee arthroplasty surgery is small, if and when they do occur they may prolong the time for complete recovery. The treating physician will inform the patient of these complications and possible symptoms, so that the patient may be alert.
Symptoms and worrying signs that may indicate inflammation:
- Fever> 38℃
- Redness, tenderness or edema of the surgical wound
- Diagnosis of trauma
- Increasing pain with activity and rest
Symptoms and worrying signs of possible thrombosis:
- Leg or foot pain away from skin incision
- Sensitivity above or below the knee
- Increased edema (swelling) in the calf, foot or ankle joint
Very rarely, a clot can travel through the bloodstream to the lungs and cause a pulmonary embolism, a potentially life-threatening condition. Signs suggesting that a blood clot has traveled to the lungs are:
- Breathing difficulty
- Sudden onset of chest pain
- Localized chest pain with accompanying cough
Should any of these symptoms occur, the physician should be immediately notified.
During the first few days or weeks after discharge from hospital, the patient may require the assistance of a third person. Before surgery, it is useful to inform the patient’s relatives and friends, so that they can assist during the postoperative period.
PREPARING THE HOUSE
Some guidelines may be helpful to patients regarding changes needed for the first few days after surgery:
- Moving any natural barrier that could get in the way of the patient and cause a fall.
- Arrange the cables in the house so they do not get in the way and cause an accident.
- Moving furniture so that the patient can move freely with a walking cane or stroller.
TAKING CARE OF THE SURGICAL TRAUMA
During home treatment, the patient should take care of the surgical trauma to avoid infection:
- The wound area should remain clean and dry. Changes of bandages should be made carefully and in accordance with the instructions of the treating physician.
- The treating physician will decide if and when the injury may get wet. If the injury changes and redness appears, the surgeon should be informed.
A mild-to-moderate edema is normal for the first 3-6 months postoperatively. To reduce edema, the patient must lift the leg and place ice pads. In addition, strap-bandaging may also reduce edema, but should be performed by experienced staff. In the case of abrupt and prominent edema, the physician should be informed immediately, as this may be a symptom of thrombosis.
Medication should be taken as directed by the treating physician. Home remedies may include narcotic or non-narcotic preparations, oral anticoagulants or injections, as well as pills for dizziness and nausea. An important factor is the prevention of any infection that can affect the joint. The patient should receive preventive antibiotic treatment whenever there is a risk of inflammation, such as during a visit to the dentist, who should be aware of the procedures the patient has undergone.
From the very first days, the patient can follow a normal diet. Your doctor may recommend taking vitamin or iron preparations. He/she may also recommend avoiding vitamin K intake, especially when combined with anticoagulation therapy. Also, the patient’s weight should be kept at a normal level so that the joint is not overloaded.
RETURN TO DAILY ACTIVITIES
The patient must be active after returning home. The key to recovery is to add new exercises daily. Although there will be good and less good days, there will be a gradual improvement. In general, the following guidelines apply:
DRIVING: In most cases, driving may begin as soon as the drug administration is stopped and when the patient’s reflexes return to normal. These decisions will be made in consultation with the treating physician.
SLEEP: The patient can sleep freely on any side.
RETURN TO WORK: Depending on the type of work and the speed of recovery the patient may need several weeks to return to work. These are – in this case – decisions to be made in consultation with the treating physician.
EXERCISE AND SPORTS: The patient is advised to continue with the physiotherapist’s exercises for two months postoperatively. In some cases, your doctor may suggest using a static bicycle at home to maintain muscle tone and knee flexibility. Two months postoperatively, the patient can begin a series of exercises such as:
- This is an excellent exercise after knee arthroplasty.
Plane trips can be carried out with the permission of the treating physician and depending on the stage of recovery, as changes in air pressure can cause swelling in the affected leg.