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Knees

Made up of bone, cartilage, ligaments and fluid, the knee joint has numerous structures that can cause pain, some more so than others. Knee pain is often caused by either a one-time injury or repetitive motions that stress the knee over time, particularly as we age.

If you've experienced knee pain, you know the impact it can have on your quality of life. Climbing stairs, getting in and out of the car, and playing sports can all become quite challenging.

The knee is the joint where the bones of the upper leg meet the bones of the lower leg. The knee allows a hinge-like movement while providing stability and strength to support your body weight. Strength, flexibility and stability are necessary for standing and for activities such as running, jumping and turning. Problems regarding the strength, flexibility and stability of the knee can occur at any age.

Texas Health Resources has a multidisciplinary team of experts including physicians on the medical staff who can quickly and effectively diagnose the source of knee pain and provide you with a range of treatment options. After treatment, Texas Health is committed to helping you recover and return to a healthy and active life. Many Texas Health hospitals offer rehabilitation services with advanced equipment and experienced therapists. Plus, you can take steps today to keep your knees healthy or ease the pain of aching knees.

Keep your knees healthy and pain free

Whether your knees are prone to chronic pain, wearing down due to repetitive motion or are at risk of an injury, you can take steps to help avoid pain and damage:

  • Maintain a healthy weight – every extra pound puts added stress on your knees.
  • Wear shoes with a good fit, and avoid wearing high-heeled shoes.
  • Warm up and do stretches before starting any exercise. Talk to your physician or a trainer regarding the best ways to warm up and stretch.
  • Be smart about exercise. Opt for low-impact exercise, such as rowing machines, swimming or walking.
  • Strengthen your leg muscles to better support your knees and avoid injuries. Talk to your physician or a trainer about working out with weights.

Home care

Many causes of knee pain, especially those related to overuse or physical activity, respond well to self-care:

  • Rest and avoid activities that aggravate the pain, especially weight-bearing activities.
  • Apply ice. First, apply it every hour for up to 15 minutes. After the first day, apply it at least four times per day.
  • Keep your knee elevated as much as possible to bring any swelling down.
  • Gently compress the knee by wearing an ace bandage or elastic sleeve. Either can be purchased at most pharmacies. This may reduce swelling and provide support.
  • Take acetaminophen for pain or ibuprofen for pain and swelling.
  • Sleep with a pillow underneath or between your knees.

Call your health care provider if:

  • You cannot bear weight on your knee
  • You have severe pain, even when not bearing weight
  • Your knee buckles, clicks, or locks
  • Your knee is deformed or misshapen
  • You have a fever , redness or warmth around the knee, or significant swelling
  • You have pain, swelling, numbness, tingling, or bluish discoloration in the calf below the sore knee
  • You still have pain after three days of home treatment

Diagnosing the source of knee pain

Injury, disease, wear and tear, and genetic disposition can all be the source of knee pain. Your physician will diagnose your knee pain based on the findings of a medical history, physical exam and diagnostic tests.

For your medical history, the physician may ask questions such as:

  • When did your knee first begin to hurt?
  • Do you feel the pain continuously or off and on?
  • Is the pain in your entire knee or one specific location such as the kneecap or outer or inner edge?
  • Have you overused the leg?

During the physical exam the physician will manipulate your knee to determine how well the knee moves and where the pain is located.

Depending on the findings of the medical history and physical exam, your physician may use one or more of the following tests to determine the source of your knee pain:

  • X-ray
  • Computed tomography (CT) scan
  • Bone scan
  • Magnetic resonance imaging (MRI)
  • Arthroscopy
  • Joint aspiration
  • Biopsy

Treatment options

Depending on the cause of the knee pain, treatment can range from behavior modification and anti-inflammatories to surgery. In many cases, minimally invasive surgery may be an option. You may be told to modify your exercise routine or be prescribed nonsteroidal anti-inflammatory drugs (NSAIDS). If these treatment options are ineffective, your physician may inject a steroid to reduce pain and inflammation, or refer you to a physical therapist.

Three common surgical treatment options for knee pain or injury are:

  • Knee arthroscopy
  • ACL reconstruction
  • Knee replacement/partial knee replacement

Knee arthroscopy

Knee arthroscopy is surgery that is done to check for problems, using a tiny camera to see inside your knee. Other medical instruments may also be inserted to repair your knee.

Arthroscopy may be recommended for these knee problems:

  • A torn meniscus. Meniscus is cartilage that cushions the space between the bones in the knee. Surgery is done to repair or remove it.
  • A torn or damaged anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL)
  • Inflamed or damaged lining of the joint. This lining is called the synovium.
  • Misalignment of the kneecap (patella). Misalignment puts the kneecap out of position.
  • Small pieces of broken cartilage in the knee joint
  • Removal of Baker's cyst -- a swelling behind the knee that is filled with fluid. Sometimes this occurs when there is inflammation (soreness and pain) from other causes, like arthritis.
  • Some fractures of the bones of the knee

Before the procedure

Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.

During the two weeks before your surgery:

  • You may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), and other drugs.
  • Ask your doctor which drugs you should still take on the day of your surgery.
  • Tell your doctor if you have been drinking a lot of alcohol, more than one or two drinks a day.
  • If you smoke, try to stop. Ask your doctor for help. Smoking can slow down wound and bone healing.
  • Always let your doctor know about any cold, flu, fever, herpes breakout or other illness you may have before your surgery.

The procedure

Typically, the surgeon will make small incisions (cuts) around your knee, and a narrow tube with a tiny camera on the end will be inserted through one of the incisions. The camera is attached to a video monitor in the operating room. The surgeon looks at the monitor to see the inside of your knee, and will then repair or remove the problem in your knee.

After the procedure

After the surgery, you will have an ace bandage on your knee over the incision dressing. Many people go home the same day they have surgery. Your doctor will likely give you an exercise program to follow.

ACL reconstruction

ACL reconstruction is surgery to replace the ligament in the center of your knee with a new ligament. The anterior cruciate ligament (ACL) keeps your shin bone (tibia) in place. A tear of this ligament can cause your knee to give way during physical activity.

Not treating a torn ACL can lead to tissue damage and early arthritis. ACL reconstruction may be recommended for these knee problems:

  • Knee that gives way or feels unstable during daily activities
  • Knee pain
  • Inability to continue playing sports or other activities, especially ones with cutting or pivoting
  • Other ligaments are also injured

Before choosing to have this surgery, you should understand the time and effort rehabilitation (recovery) will take. You will likely need to stick to a program for four to six months before you can return to full activity. The success of the surgery typically depends on you sticking with your rehabilitation program.

Before the procedure

Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.

During the two weeks before your surgery:

  • You may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), and other drugs.
  • Ask your doctor which drugs you should still take on the day of your surgery.
  • If you have diabetes , heart disease or other medical conditions, your surgeon will ask you to see your doctor who treats you for these conditions.
  • Tell your doctor if you have been drinking a lot of alcohol, more than one or two drinks a day.
  • If you smoke, try to stop. Ask your doctor for help. Smoking can slow down wound and bone healing.
  • Always let your doctor know about any cold, flu, fever, herpes breakout, or other illnesses you may have before your surgery.

The procedure

The tissue that will replace your damaged ACL will come from your own body or from a donor. A donor is a person who has died and, before death, chose to give all or part of their body to help others.

Tissue taken from your own body is called an autograft. Tissue taken from a donor is called an allograft.

The procedure is usually done by knee arthroscopy . With arthroscopy, a tiny camera is inserted into the knee through a small incision (cut). The camera is connected to a video monitor in the operating room. Your surgeon will use the camera to check the ligaments and other tissues of your knee.

Your surgeon will typically make other small cuts around your knee and insert other medical devices in order to replace your ACL.

After the procedure

You will probably go home the day of your surgery. You may have to wear a knee brace for the first one to four weeks. You also may need crutches for one to four weeks. Most people are allowed to move their knee right after surgery to help prevent stiffness. You may need medicine to manage your pain.

Physical therapy can help many people regain motion and strength in their knee. Therapy can last two to six months.

How soon you return to work will depend on the kind of work you do. It can be anywhere from a few days to a few months. A full return to activities and sports usually takes four to six months.

Partial and total knee replacement

Today, joint replacement surgery does not have to cause a major disruption to your life. Texas Health hospitals provide joint replacement programs that focus on wellness and rehabilitation, and are committed to shortening your hospital stay while speeding up the recovery process. In many cases, minimally invasive surgical options may be available.

Joint replacement pre-operative classes

A number of Texas Health Resources' hospitals offer joint replacement pre-operative classes to help you feel informed and answer your questions prior to joint replacement surgery. To find a class near you, call 1-877-THR-WELL.

Advanced robotic partial knee replacement

Surgeons are using advanced robotic technology to facilitate partial knee replacement surgery at some Texas Health hospitals. The new robotic technology is an option for partial knee replacement surgery which has a system that enables the orthopedic surgeon to pre-plan procedures and map them in three dimensions, based on the patient's individual anatomy. Using small incisions in the skin, a robotic arm guides the orthopedic surgeon during the procedure so that only the diseased portion of the knee is removed, sparing healthy bone and tissue.

ACL Knee Repair

Surgical procedures to repair a torn anterior cruciate ligament (ACL) are aimed at restoring the stability and full function of the knee.

Minimally Invasive ACL Repair

Learn More

Anterior Cruciate Ligament Repair

 

Most ACL repairs involve surgical reconstruction, during which the ligament is replaced by another tendon from your own body (autograft).

Commonly, an ACL surgery will involve an incision and many months, sometimes up to a year, of recovery.

Minimally invasive ACL repair is usually performed by a surgeon making a small incision in the knee where a fiberoptic scope is inserted.

The surgeon makes additional small incisions around the knee to place instruments that remove the damaged ligament and to place the new ligament in the knee. He or she then fixes the new ligament to the bone using pins and screws.

Benefits include:

  • Tiny scars instead of one large scar
  • Shorter hospital stay — a few days instead of a week
  • Reduced postoperative pain
  • Shorter recovery time — a few months instead of a year
  • Quicker return to daily activities, including work

 

Call or click to get details or request an appointment!

1-877-THR-WELL

From how to prepare your home to what the procedure involves, access our comprehensive information about knee replacement surgery:

  • Indications and risks
  • Preparing for surgery
  • Procedure
  • Recovery in the hospital
  • Recovery at home
  • Physical activities for knee replacement patients
  • Activities of daily living
  • Long-term success
  • Frequently asked questions

Indications and Risks

Knee joint replacement may be recommended for:

  • Knee pain that has failed to respond to conservative therapy (including medication, injections and physical therapy for six months or more)
  • Knee pain that limits or prevents activities of importance to the patient
  • Arthritis of the knee
  • Decreased knee function caused by arthritis
  • Inability to sleep through the night because of knee pain
  • Some tumors involving the knee

Knee joint replacement is usually not recommended for:

  • Current knee infection
  • Poor skin coverage around the knee
  • Paralysis of the quadriceps muscles
  • Severe peripheral vascular disease or neuropathy affecting the knee
  • Severe limiting mental dysfunction
  • Terminal disease (metastatic disease)
  • Morbid obesity (more than 300 pounds)

Please note that obesity always complicates knee replacement surgery. Obese patients will need to discuss their options with their surgeon.

Risks include:

  • Blood clots in the legs (deep vein thrombosis or DVT)
  • DVT that breaks loose and goes to the lungs (pulmonary embolus)
  • Pneumonia
  • Infection necessitating removal of the joint
  • Loosening of the prosthesis
  • Dislocation of the prosthesis

People who have a prosthetic device (such as an artificial joint) need to take special precautions against infection. They should carry a medical identification card indicating that they have a prosthetic device. Also, they should always inform their health care provider of their prosthetic knee joint. Knee replacement patients should receive antibiotics prior to dental work or any invasive procedure.

Preparing for surgery

There are a number of ways you can prepare your home for your return after surgery.

Meal planning:

  • Prepare and freeze or purchase small portion meals for times you may be alone.
  • Stock up on staples which can be frozen for later use such as bread, vegetables and fruit.

Safety:

  • Remove throw rugs from around the house.
  • Have a well lit pathway to your bathroom (night lights).
  • Make sure all stairways are secure and have hand railings.
  • Tuck away long phone, computer or lamp cords. Plan to use a cordless phone if you have one.
  • Arrange your furniture so you move easily through the house with your walker/crutches.
  • If possible, have rails installed in your tub or shower. You may also want to purchase a shower bench or chair, nonskid mats and a hand-held shower nozzle.
  • Arrange for care of small pets that may run "under foot."
  • If your bedroom is upstairs, you may want to prepare a sleeping area downstairs for the first week or two after you return home from surgery.

Help at home:

  • You may need help at home for the first few days after returning home. Have a family member or friend that can assist you with meals, bathing and dressing, and to take you to your follow-up appointment with your surgeon and to your outpatient rehabilitation therapy appointments.

Packing for the hospital

Pack your suitcase for the hospital a day or two before surgery. Include the following items in your bag:

  • Personal care items such as a toothbrush, toothpaste, deodorant, hairbrush, comb, etc.
  • Slippers, tennis shoes or flat, rubber-soled shoes with an enclosed heel and toe for walking in the hall.
  • Clothing such as short gowns, shorts, T-shirts, short pajamas and a short lightweight bathrobe.
  • Glasses, dentures, hearing aid and other personal care items with their cases.
  • Bring loose fitting clothing to wear home.
  • A list of medications you are currently taking, including the amount, strength and how often you take it.
  • A copy of your Living Will, Advanced Medical Directive (if you have one).

Maintain good hygiene

It is important to maintain good hygiene, by keeping skin clean and dry, especially in the days before surgery. To help reduce bacteria living on your skin, it is recommended you shower with Hibiclens® (Chlorhexidine gluconate), an antiseptic/antimicrobial skin cleanser daily for 5 days prior to surgery. Leave this product on your skin (making sure to get in skin folds) for at least 90 seconds before rinsing. Do not wash your face with Hibiclens® (Chlorhexidine gluconate), as it can cause corneal burns. Do not apply with a cotton washcloth, as it is inactivated by cotton. Hibiclens® (Chlorhexidine gluconate) is available over the counter at most pharmacies.

Leaving for the hospital

  • You need to shower.
  • Brush your teeth. You may brush and rinse with water but do not swallow the water.
  • Take medications. Take only the medications as instructed by your physician, with a small sip of water as soon as you get up.
  • Wear proper clothing. Wear loose fitting clothing that is easy to remove.
  • Leave jewelry and other valuables at home.
  • Remove all make up.
  • Remove all fingernail and toenail polish.
  • Bring your eyeglasses and or hearing aids. If you wear contacts, bring the case.

Procedure

Partial knee replacement

Partial knee replacement is a less invasive alternative to total knee replacement. Partial knee replacement may be an option for patients who have severe arthritis of the knee that is confined to a limited area.

The procedure removes only the most damaged areas of cartilage in a specific area of the knee and replaces these surfaces. Partial knee replacement requires a smaller incision than traditional total knee replacement and typically has a quicker recovery time.

The knee has three compartments or surfaces. The femur — the long bone of the thigh — ends with two "knuckles" or condyles. Where these condyles connect with the shin bone forms two of the compartments. The third compartment is the underside of the kneecap.

If a patient's arthritis is confined to one of these compartments, partial knee replacement may be an option. Because only the damaged surface of the knee joint is replaced, trauma to healthy bone and tissue in the knee is minimized and recovery may be quicker than recovery for total knee replacement.

Total knee replacement

The operation is performed under general anesthesia. The surgeon will decide which type of implant and implant material — metal, plastic or ceramic — will work best for the patient. The surgeon will implant the two parts of the prosthesis onto the ends of the thigh bone and the shin bone.

After surgery

After surgery, you will likely need immediate, careful monitoring, while you recover from anesthesia and gradually awaken. You will be moved directly from the operating room to the recovery room, which is called the PACU (post-anesthesia care unit). In PACU, you will likely be provided with cardiac (heart) respiratory monitoring and oxygen while your anesthesia wears off.

You will receive medications for pain as needed, and nurses will usually check your dressings and circulation to your operative leg; and encourage you to take deep breaths, and to move your ankles and feet. Typically, after two to three hours, once stable, you will be transferred to your hospital room.

Recovery in the hospital

Patients will likely return from surgery with a large dressing on the knee area. A small drainage tube may be placed during surgery to help drain excess fluids from the joint area. Patients also return from surgery with several IV (intravenous) lines in place to provide fluid and nutrition. The IV usually remains in place until they are able to drink adequate amounts of fluids.

Antibiotics are given to reduce the risk of developing an infection, which would require removal of the artificial joint. Patients also usually return from surgery wearing AVI foot pumps. These devices are used to reduce the risk of developing blood clots, which are more common after leg surgery.

You may also experience the following in your post-operative care:

  • Fluids may be administered intravenously so you remain properly hydrated.
  • A urinary catheter may be placed to drain your bladder.
  • A drain may have been placed in the surgical site to remove fluids.
  • You may have an oxygen tube under your nose to help you breathe.
  • Compression devices may be wrapped around your legs or feet to prevent blood clots.
  • You may have a cold therapy system around your joint to minimize pain, swelling and inflammation.
  • You may have a continuous passive motion device on your knee that is used to gently flex and extend the knee joint.
  • After surgery you will be started on a clear liquid diet. The nursing staff will advance you to a regular diet according to your tolerance.
  • You may lose your appetite and feel nauseous or constipated for a couple of days. These are ordinary reactions. You may be given stool softeners or laxatives to ease the constipation caused by the pain medication after surgery.
  • Instruction on how to use an incentive spirometry device (a plastic device to encourage deep breathing) and cough and deep breathing exercises to gradually increase the depth of breaths in order to prevent lung collapse and pneumonia.

Staying ahead of the pain

Patients usually experience moderate to severe pain after surgery. However, you may receive patient-controlled analgesia (PCA), intravenous (IV) analgesics or epidural analgesics to control the pain for the first couple of days after surgery. PCA is a locked machine which allows you to give your own pain medication as ordered by your physician. You cannot give yourself too much medication. It is designed so that you can give yourself pain medication, because no one knows your pain level like you do. It is important you push the pain button before you become too uncomfortable. Your family members and friends should not push the button for you.

The pain should gradually decrease, and by the first day after surgery, oral analgesic medications may be sufficient to control pain.

It is important to control the pain enough to enable you to participate in physical therapy. Nurses typically administer pain medications about one-half hour prior to therapy so you will be comfortable during the therapy session.

Physical therapy

Physical therapy may begin the day after surgery. Some pain should be expected when starting activities after surgery, but it is very important to begin moving as early as possible. Your surgeon will prescribe pain medication to help minimize the pain experienced during therapy.

A physical therapist will assist you in learning how to safely get in and out of bed, and walk with your walker or crutches. The physical therapist will assist you in regaining strength and motion and will review precautions with you that will protect your new joint as you recover. After surgery, you will be told how much weight you can put on your new joint when walking. This will be referred to as your "weight bearing status."

Participating in physical therapy strongly increases your recovery.

A typical physical therapy schedule includes:

  • Physical therapy evaluation
  • Instruction in specific exercises
  • Training in bed mobility and sitting on the side of the bed
  • Instruction in walking with a walker or crutches

The first day after surgery and throughout your hospital stay you may:

  • Have physical therapy once or twice a day
  • Receive ongoing reinforcement precautions if applicable
  • Continue specific exercises and increase repetitions as tolerated
  • Continue with bed mobility and instruction in sitting and standing
  • Begin walking at least 25 feet and increase the distance with each treatment as tolerated

Typical minimum goals for physical therapy are:

  • Walk 75-100 feet with an assistive device, using the correct weight bearing
  • Walk up and down stairs and/or steps with assistance
  • Demonstrate your home exercise program
  • Demonstrate safe transfers, mobility and sitting techniques

Your length of stay

Patients typically remain in the hospital two to four days after surgery. However, some patients may need to stay temporarily at a rehabilitation unit or long-term care center until mobility has improved, and they are safely able to live independently. These centers provide intensive physical therapy to assist patients in regaining muscle strength and flexibility in the joint.

Recovery at home

With today's modern, less invasive surgical techniques, the goal of joint replacement is to speed recovery and help patients return to their normal, productive lives as soon as possible. Patients should talk to their surgeon about what kind of recovery they can anticipate. Permitted activities and rate of recovery depend on the type of condition the patient had prior to surgery and the surgical method that was performed.

Once you are home, call your health care provider right away if you experience:

  • Fever over 100.9°
  • Drainage from the incision with pus or odor
  • Redness with warmth around the incision
  • Chest congestion
  • Calf pain or swelling in your legs
  • Increasing hip pain
  • Dizziness or confusion

A dedication to working at recovery is essential for the best results from joint replacement surgery. Patients will receive written instructions concerning physical therapy when they leave the hospital, and the patient's physician will refer them to either home therapy services or send them to an outpatient rehabilitation center. Patients will learn exercises they should do at home, and typically a commitment to these exercises will help patients recover faster.

Patients may want to participate in an aquatic program offered at some of our Texas Health hospitals. In this program, participants are led by certified aquatic fitness professionals through a series of specially designed exercises that, with the aid of the water's buoyancy and resistance, can help improve joint flexibility and muscular strength. The warm water and gentle movements can also help relieve pain and stiffness. A physician's permission is required to participate in the class. For more information on aquatic programs, call 1-877-THR-WELL.

Activities for knee replacement patients

Ankle pumps

Immediately after surgery, you will likely be encouraged to do ankle pumps every hour. Ankle pumps help increase the circulation in your lower legs.

Turning in bed

Turning in bed helps prevent skin breakdown, lung congestion and blood clots from forming.

The nursing staff will assist you in turning on your side and position/support you with pillows. You should not place a pillow directly under your knee.

Walking

You will likely begin walking either the day of surgery or the morning after your surgery. Physical therapy will teach you how to get out of bed and how much weight you can place on your new joint. You will probably sit up for approximately an hour. Each day, the distance you walk and time out of bed will be increased. You will learn how to walk to the bathroom, in the hallway and climb stairs with assistance.

Bending the knee

Your therapist will assist you in bending your new joint. You will need to practice your bending exercises in your room between your therapy sessions. By discharge, your goal is to bend your knee approximately 70-80 degrees.

Knee replacement exercises

Ankle pump

  • Lay on the floor or a flat surface
  • Bend your ankle up toward your body as far as possible
  • Now point toes away from your body
  • 15-20 repetitions two to three times per day

Quad set

  • Sit or lie on your back with your leg straight
  • Press the back of your knee down
  • This will tighten the muscle on the top of your thigh
  • Hold three to five seconds
  • 15-20 repetitions two times per day

Heel slide

  • Lie flat on back
  • Slide heel toward buttock, bending the knee as far as possible
  • Hold three seconds and slowly lower
  • 15-20 repetitions two times per day

Sort arc quads

  • Lie on your back with a six-inch roll under your knee
  • Raise heel off floor until knee is straight
  • Hold three to five seconds and slowly lower
  • 15-20 repetitions two times per day

Straight leg raises

  • Lie on your back with one leg straight and one leg bent
  • Keep the leg completely straight and then raise 12 inches off the bed
  • Hold three to five seconds and slowly lower
  • 15-20 repetitions two times per day

Long arc quad

  • Sit on chair or bed with thigh supported
  • Straighten knee fully
  • Hold three to five seconds and slowly lower
  • 15-20 repetitions two times per day

Hip flexion (seated march)

  • Sit in a chair with knees bent
  • Bend hip to lift foot off floor
  • Hold three to five seconds and relax
  • 15-20 repetitions two times per day

Seated heel slides

  • Sit in chair with foot flat on floor
  • Bend knee, sliding foot back toward the chair as far as possible
  • Hold three to five seconds and relax
  • 15-20 repetitions two times per day

Tips for activities of daily living

Getting in and out of the car

Getting INTO the front passenger seat:

  • Push the car seat all the way back and recline it, if possible.
  • Back up to the car with your walker until you feel it touch the back of your legs
  • Reach back for the car seat with one hand, keeping your other hand on your walker or cane.
  • Keeping your operated leg in front of you, duck your head as you carefully sit down.
  • Turn your body slowly as you lift one leg at a time into the car. Be sure to lean your upper body back onto the reclined seat when you lift your operated leg into the car. You might need to use your hands to assist your operated leg into the car.
  • You can move the seat back to a more upright position, but keep it slightly reclined.

Getting OUT of the front passenger seat:

  • Again, recline the seat back if possible.
  • Turn your body slowly as you lift your legs out of the car, leaning back to prevent yourself from bending too far forward at the hip.
  • Keep your head down as you push off the seat back with one hand. The other hand should be on your walker or cane.
  • Keeping your operated leg in front of you, stand up carefully and hold onto your walker or cane. Get your balance before starting to move.

Getting in and out of bed

Getting IN bed

  • Back up towards the bed until you feel the backs of your knees touching the bed. You should be standing beside the middle of the bed, at an equal distance from the head of the bed and the foot.
  • Sit down on the mattress, placing one hand on your walker/cane and the other on the bed.
  • Using your hands for support, slide yourself backward toward the middle of the mattress.
  • In the early stages, you can hook your unoperated leg under the operated leg to support it as you move yourself to the middle of the mattress; however, you should try to stop using this method as soon as possible in order to allow your leg muscles to get stronger.

Getting OUT of bed

  • Make sure your walker is handy.
  • Slide yourself over to the edge of the bed.
  • Slowly move your legs over the edge of the bed, and sit up gradually using your arms for support.
  • Place your operated leg in front of you. Be sure that the foot of your unoperated leg is flat on the floor, ready to take your weight when you stand up.
  • Place one hand on your walker and then push up from the bed with your other hand until you are standing.
  • When using a walker, balance yourself by holding onto it with both hands.
  • IMPORTANT: Do not pull on the walker or rely on it to support your full weight. It can tip over easily, and you could fall.
 

Going up and down stairs

It's important that all stair railings, both inside and outside your home, are secure. In the first few weeks at home, limit stair climbing to one round trip per day if possible. Hold onto the railing at all times to keep your balance.

  • Put your hand on the railing. If using a cane, hold it in the hand opposite your operated leg.
  • If possible, start UP the stairs with the foot of your unoperated leg.
  • Lift your cane and your operated leg at same time as you step up.
  • Take one step at a time. Don't move until you feel strong and steady.
  • Always start DOWN the stairs with your cane and the foot of your operated leg.
  • Now move the foot of your unoperated leg down onto the same step.

Taking a shower

General tips:

  • DO NOT step out of the shower stall or tub onto a scatter rug or towel.
  • If you want a soft surface, tape a non-skid bath mat securely to the bathroom floor beside the tub.
  • Until you feel steady on your feet, use a shower bench or seat which rests on a rubber mat or non-skid adhesive on the bottom of the tub or stall.
  • If you will be using any grab bars beside the tub or on the wall, make sure they have been properly installed and can support your weight.

Getting INTO the shower

  • Place the shower chair in the tub or stall facing the faucets.
  • Reach back for the seat of the shower chair with one hand. Your other hand will stay on your cane or walker.
  • Carefully lower yourself on the shower seat. Turn to face the faucets and lift your legs into the shower one at a time. Keep your operated leg out straight.

Getting OUT of the shower

  • Turn around on the seat and bring your legs out of the shower, one at a time. Push yourself up from the seat of the shower chair with one hand, while the other hand is resting on your cane or walker.
  • Stand up outside the shower. Be sure that you have regained your balance before moving again.
  • An easy way to think about it is: "Up with the good leg; down with the bad."

IMPORTANT: If you are unsteady or anxious, you should have someone with you to help you get in and out of the shower stall or bathtub safely.

Long-term success

The results of a total knee replacement are often excellent. The operation typically relieves pain in more than 90 percent of patients, and most need no assistance walking after recovery. Implants need to be checked with an X-ray every two to three years to establish normal wear patterns. Modern implants are designed to be repaired. Repairing the implant is a much less serious surgery than complete revision to a new prosthesis but must be done before there is any damage to the bone or possible loosening of the fixation of the implant.

Frequently asked questions

Q: How long will I be in the hospital?

A: Patients typically remain in the hospital two to four days after surgery. However, some patients may need to stay temporarily at a rehabilitation unit or long-term care center until mobility has improved and they are safely able to live independently. These centers provide intensive physical therapy to assist patients in regaining muscle strength and flexibility in the joint.

Q: What if I live alone?

A: Two options are usually available to you. You may return home and receive help from a relative or friend. You can have a home health nurse and physical therapist assist you at home for two to four weeks. You may also stay at a rehab facility following your hospital stay, depending on your insurance, and if you qualify.

Q: Will the surgery be painful?

A: You will likely have discomfort following the surgery, but appropriate medicine will be prescribed by your physician to try to keep you comfortable. Generally, most patients are able to stop very strong medication within one day. Most patients control their own medicine with a special pump that delivers the drug directly into their IV.

Q: Will I need a walker, crutches or cane?

A: Yes, it will likely be recommended that you use a walker, cane or crutches for about six weeks. The physical therapist can arrange for them if necessary.

Q: Where will I go after discharge from the hospital?

A: Most patients are able to go home directly after discharge. Some patients may transfer to a rehabilitation or skilled nursing facility. The discharge planner will help you with this decision and make the necessary arrangements. You should check with your insurance company to see if you have rehabilitation or skilled nursing facility benefits.

Q: Will I need help at home?

A: Yes, the first several days or weeks, depending on your progress, you will need someone to assist you with meal preparation, etc. If you go directly home from the hospital, the discharge planner will assist you in making the necessary arrangements. Family members or friends need to be available to help if possible. Preparing ahead of time, before your surgery, can minimize the amount of help required. Having the laundry done, house cleaned, yard work completed, clean linens put on the bed and single portion frozen meals will reduce the need for extra help.

Q: Will I need physical therapy when I go home?

A:Yes, you will have either outpatient or in-home physical therapy. The discharge planner will help you arrange for home therapy or outpatient therapy services.