Knee Replacement Aftercare: Tips for Patients and Caregivers
Get tips for knee replacement aftercare. Whether you're a patient or caregiver, find out how to sleep, walk and recover after joint surgery.
If you’re having knee replacement surgery due to arthritis you can expect relief from pain, improved mobility and the ability to resume many of the activities you enjoyed before. But you can also expect some down time during recovery before you reach that point. In the initial days and weeks after surgery you will experience pain and swelling and limitations on what you are able to safely do as you gradually return to many, if not most, of your pre-surgery activities. During this time, understanding knee replacement aftercare is important.
Because knee replacement is an elective procedure and your surgery will likely be scheduled for weeks or months beforehand, there is much you can do before your surgery to prepare yourself and your home for the recovery afterwards. This may include visiting an occupational therapist and physical therapist, stocking up on supplies (such as ice packs and easy-to-prepare foods) and equipment (a walker, cane and shower seat) and creating a list of shows you’d like to watch or books you haven’t had time to read. You’ll also have time to arrange for a caregiver — your spouse or partner, family member or friend, or hired help — to stay with you the first days or weeks after surgery and help you with aftercare following joint replacement surgery.
While you should always follow the advice of your surgeon and medical team, here’s what you need to know and do about some of the common areas of concerns following knee replacement surgery and what your caregiver can do to help you.
Managing Your Pain and Swelling
Some pain and swelling are inevitable after knee replacement, but there are ways to minimize their affects and your discomfort.
Make a schedule. Create a pain medication schedule (typically every four to six hours as advised by your doctor) — and stick to it, advises Melinda Britton, a registered nurse who cares for orthopaedic patients at the Hospital for Special Surgery in New York. It’s easier to keep pain at bay than to ease it once it gets started.
Use alarms. If find yourself waking up at night in pain, Britton recommends setting an alarm for the time your next dose of pain medicine is due, then waking up just long enough to take it. It will be easier to get back to sleep than if pain awakens you a little later.
Add ice. Use icepacks to reduce swelling. If you don’t have icepacks, you can make your own by freezing one part rubbing alcohol to three parts water in a sealable freezer bag or you can use bags of frozen peas that mold to the shape of your knee. Wrap in a towel and place on your knee for 20 minutes at a time as needed.
Change positions. Alternate between lying down and sitting with periods of walking, Britton advises. Avoid sitting for more than 30 to 45 minutes with your foot down. When sitting, try to keep your leg elevated — and out straight — on an ottoman or pillow.
Keep it moving. When lying down, do range of motion exercises and ankle pumps — moving your ankle up so that your toes point back towards you and then down so that your toes point away from you — to promote circulation and reduce swelling. Britton advises doing these a couple of times every hour.
Check for signs of caution. If swelling is excessive or accompanied by other symptoms such as persistent fever, chills, drainage of the wound or pain in leg or calf unrelated to your incision, call your doctor as these could be signs of infection or a blood clot that require immediate attention.
Follow doc’s orders. If your doctor prescribes TED hose — special tight-fitting stockings to reduce swelling and prevent blood clots in your legs — make sure you know the proper way to put them on and when to wear them. Typically, they are worn throughout the day and taken off at night before bedtime.
How caregivers can help:
- Be their reminder. Your loved one may come home after surgery with a number of medications — such as pain relievers, anti-inflammatories and blood thinners. Make sure they remember to take them at their designated times. Also remind them to do ankle pumps, get up and move around frequently, put on their TED hose, if prescribed, and follow any instructions their medical team provides.
- Keep two or more ice packs in the freezer and switch them out as needed. Help them apply ice packs, but also remind them to take breaks. Ice should not be used for more than 20 minutes at a time unless their doctor advises otherwise.
- If your loved one experiences worsening pain, swelling or other troublesome symptoms, have them call the doctor — or call their doctor for them.
Getting Around Safely
You’ll likely need a walker to get around for the first few weeks after surgery before progressing to a cane for an additional three weeks, says occupational therapist Debbie Amini, who is director of professional development for the American Occupational Therapy Association. You’ll also need to make some modifications to your surroundings and activities to get around safely.
Remove or reduce hazards. Make sure furniture is arranged so that there are paths wide enough for your walker and that your floors are free of hazards — such as loose throw rugs, knickknacks and pets — that could cause to you to trip.
Skips the stairs, at first. Avoid climbing steps during your first few weeks home if possible. Have a bedroom set up on the main floor of your home or sleep in a recliner if that is comfortable for you. If you must go to an upstairs bedroom, Britton recommends going up once at night and then back down in the morning. If you must navigate steps at home, you’ll be given instructions and practice on the safest way to climb stairs before you leave the hospital.
Take it slow. When walking go slowly and turn with your toes pointing straight ahead. Take small steps when your turn and avoid pivoting on the leg that had surgery. Wear shoes with nonskid soles.
Get a helping hand. Because you’ll need both hands for your walker, use a basket attached to your walker or an apron with large pockets to transport items. (You can also use the apron when you progress to walking with a cane. For items you will need access to frequently — your medications, phone and TV remote, for example — set up a station near the sofa or recliner where you’ll spend most of your time recuperating.
How caregivers can help:
- Look for and remove obstacles — throw rugs, knickknacks, toys — that could cause a fall. Move furniture to allow a path wide enough to navigate with a walker
- Help them set up room to sleep downstairs if their bedroom is upstairs. If that is not possible, accompany them up and down to help prevent falls.
- Help them find temporary accommodations for a pet that jumps or is constantly underfoot or keep the pet contained while they are up and moving about.
- Help your loved one determine if there are any adaptive devices they need but did not get before the surgery. Many can be ordered online for next-day delivery.
Staying Active — Physical Therapy and Occupational Therapy
Regular physical activity and physical therapy and/or occupational therapy are also crucial to recovery and gaining mobility.
Move regularly. Try to get up and move at least a little bit every hour or so throughout the day, says Britton.
Gradually increase. You will begin to walk while you are still in the hospital. When you get home start with the distance you walked in the hospital then gradually increase distance and frequency, Britton says. During your first days or weeks at home, all walking should be indoors — away from the hazards of rocks, uneven pavement or icy sidewalks. When your doctor or physical therapist gives their OK — and you have a safe place to do so — you can begin to walk outside.
Stick to your PT and/or OT. Physical therapy (PT) and/or occupational therapy is important for strengthening your leg and restoring the movement of your knee. After surgery you’ll likely have physical therapy (and possibly occupational therapy) for at least several weeks and possibly as long as three or four months, depending on your progress and preferences. Do your best to keep all your therapy appointments and practice any exercises the therapist teaches you. If pain makes it difficult to perform your exercises, arrange your schedule to take pain medication 30 to 45 minutes before your therapy appointment.
How caregivers can help:
- Unless a physical therapist or occupational therapist comes to the house, you can help by driving your loved one to and from therapy appointments.
- Sit in on therapy appointments if your loved one and the PT and OT agree. Learn what activities they can do and which ones they should avoid. At home, encourage them to do their therapy.
- Remind them to walk. A short walk once an hour is ideal, increasing the distance a little bit daily. Offer to walk around the house with them and later on, outside, for companionship and safety.
Eating, Bathing and Sleeping
Good nutrition, good hygiene and good rest are all important while you recuperate.
Prep before your homecoming. Before your scheduled surgery prepare and freeze some healthy meals you can simply pop in the microwave when you are recuperating at home. Rely on grocery delivery services for fresh foods and produce and restaurant delivery services when you don’t feel like preparing a meal.
Maintain clean incision sites. Keep the area around your incision clean and dry. Your doctor or nurse will apply a dressing before you leave the hospital and give you instructions on how to change it
Following bathing instructions. Ask your doctor when it is safe to bathe. The answer will depend largely on the type of wound closure and dressing you have, says Britton. While it is safe to shower in a waterproof dressing with absorbable sutures underneath, you’ll likely need to postpone bathing if you have bandage and staples. If your doctor says it’s OK bathe, take showers instead of baths to avoid submerging the incision or having to climb in and out of a tub. A walk-in shower with a shower bench is best, says Amini.
Sleep properly. Aim to get at least eight hours of sleep at night while you recuperate. The best position for sleeping is on your back. If you want support, you can use a form wedge to elevate your leg and support your knee or use a firm pillow that extend up past the knee down to the calf, says Amini. Another option, if you can tolerate it, is to sleep with a rolled-up towel under the ankle — but never under the knee, which should stay straight while you sleep, says Britton.
How caregivers can help:
- If dressings need to be changed, learn how to help with this task. Observe the wound for increased redness or drainage, which could be signs of infections.
- Offer to help with meal preparation and/or shopping. If your loved one feels up to and want to cook a simple meal, place cooking utensils and ingredients on a countertop where they are easy to reach. A desk chair on wheels will allow them to move around the kitchen without having to stand.
- Stay close by while the person showers in case they call for help. Help them with getting in and out of the shower, drying off and getting dressed.
- Encourage them to get rest. At bedtime or nap time try to minimize sounds that would disturb their sleep — noisy children, barking dogs or TVs with the volume turned up.
- Keep bedding clean and help them get comfortable at bedtime, arranging pillows or blankets. If they use a pillow or wedge to elevate the knee, make sure their leg is straight. Make sure they have one dose of pain medicine and water bottle or glass of water on a bedside table if they need to take dose during the night.
Relieving Boredom and Staying Productive
While you may spend your first days at home napping, there’s no reason to be confined to weeks of bedrest or boredom.
Stock up on entertainment. Create a list of movies and shows you have been wanting to watch or books you have wanted to read. Cooking or home decorating shows are good for your first days home when you may be drifting in and out of sleep and don’t want to follow a plot.
Keep your computer handy. Set your computer in an accessible spot with an appropriate chair and footrest or use a laptop or tablet in your bed or recliner to answer emails, play games, connect with friends on social media, do online shopping or search ideas for your next gardening or remodeling project.
Start that hobby you always wanted. If you have ever wanted to learn a new language, start a sports card collection or take up knitting, drawing, needlework or calligraphy, now is a good time to start. Everything you need to get started is available online.
How caregivers can help:
- Spend time with your loved one. Watch a favorite movie or show together or discuss a book. If you have a streaming service that your loved one doesn’t, share your login information so they can find shows and movies they might not otherwise have access to.
- Help them identify activities they can do that aren’t strenuous and don’t require a lot of time on their feet — such as baking cookies or caring for pets.
- Help them set up a computer or craft station. Collect needed supplies and put them together in an area that doesn’t require bending or reaching to access.
- Bring them books, puzzle books and magazines or anything they request to help pass the time during their recovery.
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