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Dr. Eddie El-Yussif’s Knee Replacement Post-Operative Instructions

Joint replacement surgery requires that you take an active role in your care and rehabilitation. These instructions provide important information about your care in the early postoperative period.

Table of Contents:

Pain medications:

  • Only take pain medications if needed
  • Only take pain medications as prescribed.
  • If you feel the pain medication is not helping, call our office.
  • Do not drink alcohol when taking pain medication.
  • Pain medications can be constipating. Drink plenty of fluids and take nonprescription stool softeners if you are having trouble having a bowel movement
  • While on narcotic pain medication, do not drive a car, drink alcoholic beverages, make any important decisions such as signing important papers, use a hot stove or other equipment that may cause injury, or be responsible for the care of children.
  • Order of Medication:
    • First Line:
      • Take Celebrex or Mobic if you were given a prescription. You may not have been given a prescription for one of these if we felt that you had a contra-indication.
      • Take acetaminophen (Tylenol) if you were given a prescription.
        • Make sure not to take more than 3000 mg of acetaminophen in a 24-hour period.
    • Second Line:
      • Take Oxycodone only for severe pain if you were given a prescription.
        • Only a 7-day supply of narcotic pain medication will be prescribed at the time of discharge.
        • Take Norco (hydrocodone/acetaminophen) only for severe pain if you were given a prescription. If taking Norco and acetaminophen (Tylenol), make sure not to take more than 3000 mg of acetaminophen in a 24-hour period.
  • We recommend avoiding long-term opioid medication as they are addicting and the longer you take them, the higher chance for addiction.
  • Risks of Narcotics:
    • tolerance, dependence, addiction, increased risk if suffering from mental and substance abuse disorders, hyperalgesia, respiratory depression, overdose
  • Important information about narcotics:
    • diversion of a controlled substance is a felony
    • you must properly dispose of opioids
    • It can be dangerous taking a controlled substance (narcotic pain medication) with a central nervous system depressant (benzodiazepine, alcohol, etc.) and therefore not recommended
  • We will wean you off the narcotic after surgery by decreasing the amount of narcotics for each refill (either frequency, dose, or both).
  • Prescription Refills:
    • Refills are best made on Tuesdays, Wednesdays and Thursdays, as providers may not be available on Mondays and Fridays
    • Plan ahead for refills. If you anticipate that you will need a refill, call our office a couple of days before you run out of your last dose.
    • Narcotic refills are not possible on the weekends.
    • Allow for 1-2 business days for a refill.

Deep Vein Thrombosis (DVT, Blood Clot):

  • If you have pain, tenderness, swelling, or redness in your calf, it may be a sign of blood clot formation. Notify your physician immediately. You can get a hold of the on-call provider 24/7 by calling our office (586-228-6200).
  • If you have shortness of breath, chest pain, and persistent coughing, it may be a sign of a blood clot in your lungs (Pulmonary Embolism). Notify your primary care physician immediately. If you cannot get hold of your PCP, then call 911 or go to the nearest emergency room.

DVT prophylaxis:

  • You will be given a prescription for a blood thinner. It is important to take the blood thinner as prescribed to minimize the likelihood of getting a blood clot. The best way to minimize developing a blood clot is by walking frequently.
  • Start the blood thinners 12 hours after surgery and continue it for 6 weeks.
  • If you are on a blood thinner before surgery for cardiac reasons, then continue that blood thinner as prescribed by your cardiologist
  • You will be given a prescription for one of the following. This is based on multiple factors such weight, risk factors for DVT, renal function, GI function, history of gastric bypass, cardiac history, and allergies.
    • Aspirin 81mg (enteric coated if you're not diabetic) every 12 hours
    • Aspirin 325mg (enteric coated if you're not diabetic) every 12 hours
    • Take Xarelto 10 mg daily
    • Eliquis 2.5 mg every 12 hours
    • Lovenox 30 mg subQ every 12 hours
    • Coumadin as directed by Home Care RN for an INR goal of 1.5 to 2.0
    • Coumadin as directed by your family doctor or cardiologist

TED Hose Stockings:

  • We recommend that you wear TED hose stockings for 4 weeks after surgery.
  • You may remove the stockings for the following reasons:
    • Showering
    • At night two weeks after surgery if there is no swelling in the legs
    • If the stockings are irritating your legs

Driving:

  • Do not drive for 4 weeks after a Right knee arthroplasty or 2 weeks after a Left knee arthroplasty. Also, do not drive if you feel unsafe or if you are taking any narcotics.

Incision:

  • Keep your incision clean and dry.
  • Keep your incision covered and away from any pets.

Dressing:

  • Adhesive Dressing:
    • If you have an adhesive dressing (including a PICO wound vac) on your knee after surgery, you should remove it 7 days after surgery.
  • Ace Wrap
    • If you have an ACE wrap on your knee after surgery, you may remove it the day after surgery.
    • You may leave the incision unwrapped after 3 days.

Shower:

  • If you do not have an indwelling nerve catheter, you can shower the day after surgery if your incision/dressing is dry and not draining. If the incision is draining or your dressing is saturated, contact your home care nurse if you have home care or call our office if you do not have home care. The incision should be re-dressed in a similar dressing for 1 week.
    • The home care nurse should examine your incision and check for drainage / saturation. Call our office if there is any active drainage.
  • If you have an indwelling nerve catheter, you can shower on post operative day 3 when the catheter is removed.

Baths:

  • Do not take baths until 1 month after surgery. This includes not soaking your incision in any water (bath, pool, hot tubs, lakes, etc). Your incision must also be healed before soaking your incision.

Joint Swelling:

  • It is normal to have some joint swelling after surgery. If you feel that the swelling is associated with pain, then you should call our office for an appointment to be evaluated for a possible knee aspiration.
  • Icing your knee and elevating your legs above your heart will help.

Leg Swelling:

  • It is common to have some leg swelling after surgery. Elevate your legs to decrease the leg swelling. Also wear the TED hose stockings to decrease leg swelling. Contact us if you are having calf pain so we can make sure that you do not have a blood clot.

Topicals:

  • We recommend no topicals (oils, lotion/cream) directly over your incision for 1 month after surgery.

Temperature/Fever:

  • Your temperature may be slightly elevated for several days after surgery. This is typically secondary to atelectasis, where your lungs are not expanding completely. You should use your incentive spirometer for 10 times per hour, every hour, for the first 5 days after surgery.
  • If a fever persists above 101.4F, you should call our office to rule out a joint infection.

Stool Softener:

  • You will receive a prescription for a stool softener (Colace) upon discharge, which you should take twice daily as needed for constipation. You should also take it the first few weeks after surgery while taking narcotics because narcotics can cause constipation.

Bowel Movement:

  • Walking is the best way to get your bowels moving.
  • Prune juice may help to make the bowel movement softer.
  • High fiber foods make it easier to have a bowel movement. High fiber foods include cereals, beans, vegetables, and whole grain breads.
  • Coffee may help have a bowel movement.
  • 2nd day after surgery:
    • If you are not passing gas, or if you have not had a bowel movement by the 2nd day after surgery, then you should try Milk of Magnesia or Miralax.
  • 3rd day after surgery:
    • If you have not passed gas or have not had a bowel movement by 3rd day after surgery, you should try a suppository.
  • 4th day after surgery:
    • If you are having any abdominal pain and/or you have not passed gas or had a bowel movement by the fourth day after surgery, please call our office for further instructions.

Discharge Diet:

  • Drink six to eight glasses of liquids (water, juices, electrolyte juices) each day.
  • If you are taking warfarin (Coumadin), review the diet instructions in the information provided.
  • High fiber foods help with bowel movements. High fiber foods include cereals, beans, vegetables, and whole grain breads.

Weight bearing:

  • You can put full weight on your operative leg.

Assistive Device:

  • Use a walker or a cane as needed.
  • A physical therapist will train you to ambulate with a walker before you are discharged from the hospital. Your outpatient physical therapist should wean you from a walker to a cane, and then eventually off all assistive devices.

Travel:

  • Do not go on long travels (driving or flying) until 6 weeks after surgery. Travel too soon after surgery can increase the risk of blood clots.

Tobacco/Nicotine:

  • Any product that contains nicotine should be avoided for at least 6 weeks after surgery because nicotine constricts the blood vessels and results in decreased perfusion to the wound/incision which then increases the chances of a knee infection.
  • We highly recommend you avoid smoking and all nicotine products.

Ice:

  • We recommend that you ice your knee for the first few weeks after surgery. Ice helps minimize pain, swelling, and inflammation.
  • It is helpful to ice your knee after physical therapy.
  • We recommend that you ice for about 20 minutes / hour, up to 5x / day
  • Do not fall asleep with ice on your knee.

Antibiotics before Dental Procedures:

  • Inform your dentist that you've had a knee replacement. We recommend that you wait 2 months after surgery to have routine dental cleaning. Your dentist may prescribe antibiotics for you prior to having dental work done.
  • In most instances, antibiotic prophylaxis for dental procedures is rarely appropriate per AAOS and ADA.
  • However, it may be appropriate for patients with:
    • uncontrolled diabetes (within a year postop)
    • history of periprosthetic joint infection
    • severely immuno-compromised.
  • If the patient does not have any risk factors such as those stated above, we only recommend prophylaxis antibiotics for 1 year from the day of surgery. If they require antibiotics, we recommend the following medication one hour prior to the dental procedure:
    • Amoxicillin 2gm (four 500mg tablets)
  • If allergy to amoxicillin, we recommend Clindamycin 600mg

Call our office if:

  • there are signs and symptoms of infection: red, swollen, or have purulent drainage
  • your incision come apart
  • your dressing becomes saturated
  • you have significantly more pain in your joint that is not relieved with pain medication
  • your leg becomes red, swollen, warm to touch
  • you have numbness or tingling
  • you fall or injure your joint but are still able to walk
  • you develop a fever (temperature over 101.3F) without any other signs of infection (ex. Sore throat, UTI, sinusitis, etc.), and the fever is not resolved with the incentive spirometer
  • you have nausea or vomiting
  • you have severe swelling at the surgical site
  • you have active drainage from the incision site.

Call your Primary Care Physician if:

  • you develop a cold, sinus symptoms, flu-like symptoms, chills or fever (temperature over 101.3F)
  • you have difficulty urinating
  • your blood pressure is greater than 160/90
  • your blood pressure is less than 90/50
  • you feel lightheadedness or dizziness

Go to the Emergency Room or call 911 if:

  • you fall or injure your joint and can’t walk or bear weight on your leg
  • you are having chest pain or difficulty breathing