What to Expect after Knee Replacement
Pain after joint replacement has multiple sources. A major contributor to pain is swelling. Consistent and constant elevation of the operative extremity above the heart will reduce swelling. Placing you leg on a chair or stool is usually not enough right after surgery. We recommend placing a sofa cushion, towels, or pillows under the foot of your mattress to keep the leg above the level of the heart. Having your leg down in a dependent position will increase swelling and pain. Additionally, the application of ice may also offer relief. Please apply ice in 30 minute intervals while awake. Insure that your skin is protected from direct contact with the ice and never fall asleep with ice on your skin as it may result in frostbite.
Please use the listed pain medications in this priority (e.g., Tylenol, anti-inflammatory, Ultram, Neurontin, narcotics) for maximal pain relief and minimal systemic side effects. As your pain improves, please wean yourself off these pain medications using the opposite priority (e.g., narcotics, Neurontin, Ultram, anti-inflammatory, Tylenol).
1) Acetaminophen (Tylenol) 1,000 mg by mouth four times daily
NOTE: Do not take more than 4,000 mg in a 24-hour period
AVOID: History of liver disease
2) Celecoxib (Celebrex) 100 mg by mouth twice daily
NOTE: Do not take more than 400 mg in a 24-hour period
AVOID: History of kidney disease or serious cardiac events
3) Tramadol (Ultram) 50 mg by mouth four times daily
NOTE: Do not take more than 400 mg in at 24-hour period
AVOID: Psychiatric Medications (i.e., SSRI)
4) Gabapentin (Neurontin) 300 mg by mouth three times daily
NOTE: Do not take more than 2,400 mg in at 24-hour period
5) Oxycodone (Roxicodone) 5 mg by mouth every 4 hours
Note: This medication is responsible for many uncomfortable side effects, including drowsiness, fatigue, nausea, vomiting, and constipation
Medications to Control Side Effects
1) Omeprazole (Prilosec) 40 mg by mouth daily while on anti-inflammatory
2) Odansetron ODT (Zofran ODT) 8 mg by mouth up to three times daily for nausea
3) Docusate (Colace) 200 mg by mouth twice daily while on narcotics
You may need to return to clinic to have sutures/staples removed. If you have dissolving sutures, you do not. You are free to shower at home, if you wound is dry and without drainage for 24 hours. Please do not use soap. Let the water run over the wound and pat it dry. Refrain from touching, rubbing, or massaging your wound. If you have a cast or brace, please refrain from adjusting the cast/brace yourself, placing objects inside the cast/brace to scratch, or getting your cast/brace wet. Small amounts of liquid (e.g., less than 8 ounces (about the size of a can of soda) can be blow dried without using heat. New pain that develops inside your cast/brace should be reported to Dr. Amanatullah’s Office at (650) 723-5643.
When there is no scab on the wound and only a scar remains, it is safe to immersing your wound in water (e.g., bath, pool, hot tub); to apply creams, salves, or lotions to your wound; and rubbing or massaging your wound. Application of vitamin E or other over the counter products can help reduce the appearance of the scar. Application of SPF 50 or greater sunscreen to your scar can prevent discoloration and reduce the appearance of the scar once there is no scab on the wound and only a scar remains. Scar massage with or without lotion can help to desensitize the surgical area.
After leaving the hospital, you should continue your anti-coagulant (e.g., Aspirin, Xarelto) for 6 weeks as ordered to prevent blood clots. It is common to have swelling in your leg for up to one year after surgery. New swelling in operative leg that does not resolve with 30 minute of elevation and/or any difficulty breathing should be reported to Dr. Amanatullah’s Office at (650) 723-5643.
Infection and Antibiotics
It is common to have redness and warmth near the incision for up to one year after surgery. However, swelling of the entire knee that limits motion, redness extending beyond the local wound area, persistent or new onset drainage from the wound, or a fever above 103ºF/39.4ºC may indicate an infection. If you are concerned about any of these symptoms, please call Dr. Amanatullah’s Office at (650) 723-5643.
It is also important to remember that anytime you have a systemic bacterial infection it needs to be treated immediately with antibiotics to prevent infection of your joint replacement. This applies to the bladder, teeth, skin, etc. Colds and the flu are viral infections and do not require antibiotics.
Should you require any type of invasive procedure in the next two years such as colonoscopy, dental procedures, or genitourinary surgery you should be covered with antibiotics one hour before the procedure. Your doctor or dentist should be able to prescribe the appropriate pre-operative antibiotic: Amoxicillin 2 g, Cephalexin 2 g, or Clindamycin 600 mg my mouth for oral procedures; Amoxicillin 2 g or Ciprofloxacin 500 mg by mouth for gastrointestinal or genitourinary procedures.
We will see you at two weeks and six weeks after surgery to check in on your progress. We want to know how your pain is coming along, what medications you need for pain, how your wound is looking, your range of motion (knees only), how far you are walking, if you need an assistive device (e.g., cane, stick, crutch, walker), and answer any questions. These visits can be done via the telephone if you prefer. You should see Dr. Amanatullah for at three months, one year, then two years, and every five years after surgery. You will have x-rays at each visit and new instructions may be given at each appointment based on your progress. If any questions or concerns arise, please feel free to contact Dr. Amanatullah’s Office at (650) 723-5643.
Note: In general, Dr. Amanatullah does NOT use drains, continuous passive motion, knee immobilizers, patient controlled anesthesia or intravenous pain medications, or place a urinary catheter. Your planned follow-up will be 3 months, not 6 weeks, after surgery.