DISCHARGE AND FIRST WEEK
Bandage
At the completion of surgery, the incision—which is closed with resorbable sutures and overlying Dermabond skin glue—will be covered with a dressing to stay in place for three weeks. We are quite pleased with the adhesive and have had few problems with blistering. No other covering is necessary when showering. The core of the bandage is silver nitrate — World War I technology at its best! -and- It kills all bacteria!! Between the fact that I don’t use irritating staples and the bacteria-killing property of the silver nitrate, we have virtually eliminated superficial skin infections. Do not remove this bandage. If its edges come loose, secure it with medical tape.
Walking
A walker will be provided for stability, but full weightbearing is preferable. It has been said in many ways, “There are no restrictions after total knee replacement—go, go, go!”
Pain Control
The first few days are comfortable but, alas, our scientists have not been able to develop long-acting pain medicines devoid of side effects and possible addiction. Hydrocodone remains the mainstay for pain control during the first month after total knee replacement. The State of Texas is restrictive but fortunately liberal enough that we can write for sensible quantities of 10 mg hydrocodone pills. They can be cut in half or taken whole. Supplement it with prescribed tramadol and/or Aleve/Advil.
Elevation
It’s wise to elevate your knee above your heart for 45 minutes every morning and an hour every afternoon. Reducing swelling in this fashioned also decreases pain. We advise that you elevate your knee above your heart. The hospital will provide a foam wedge, but it is not high enough to elevate your knee. Be innovative in this respect.
Ice
Ice “coldness” has the benefit of numbing the applied area and decreasing swelling. Neither Medicare nor insurance companies will pay for cooling devices. My practice has identified the best product available – and it is no more expensive on Amazon! If you don’t elect to purchase the Breg [model number here], be prepared with lots of ice cubes or frozen gel packs.
Physical Therapy
Physical therapy remains a vital component of total knee replacement rehabilitation. They challenge you with two large goals—(1) regain motion and (2) regain strength. Ideally, physical therapy will work with you three times a week for four to six weeks.
Sleep
Other than complaints of hydrocodone side effects, sleep loss is a major issue for four to six weeks after total knee replacement. It’s just very difficult to get comfortable. Several factors add up to help you sleep –
- Caffeine – No caffeine after noon because caffeine is a 12-hour drug.
- Decrease nap time significantly.
- Take Benadryl and melatonin before bedtime.
- We’re not opposed to writing for a small quantity of Ambien to help you during the first month after surgery.
- At bedtime, take at least one-half of the hydrocodone pill and be prepared to take the other half if awakened in the middle of the night.