Timeline for Knee Replacement (What to Expect)

Surgery Scheduled with Joshua Hickman, MD

• Review the information about your surgery at joshuahickmanmd.com
• Ensure that you have a preoperative appointment scheduled with Dr. Hickman or the physician assistant 1-3 weeks prior to surgery
• Make a list of all current medications including dosages and times taken. This must be brought to your preoperative appointment.
• Receive primary care physician clearance for surgery if instructed by Dr. Hickman's office
• Schedule an appointment with a physical therapist to start physical therapy 3-5 days after surgery. This should be completed before the preoperative appointment. You will be given a physical therapy prescription when you leave the hospital or surgical center.

One to Three Weeks Prior to Surgery

• Stop all anti-inflammatory medications (Diclofenac, Aleve, Naproxen, Ibuprofen, etc.) one week before surgery.
• If you are on a blood thinner, contact Dr. Hickman's office or be sure to discuss this at your pre op to determine when it needs to be stopped.
• Make sure to attend your preoperative appointment with any questions you may have.
• Notify your physician if you or any family member has a history of previous DVT/blood clot.

Day Before Surgery

• The hospital or surgery center will call with instructions and arrival time
• Bring your own loose-fitting clothing for therapy after surgery
• Nothing to eat or drink after midnight
• Bring a list of medications including dosages and instructions to the hospital
• If you use a CPAP machine, bring it with you to the hospital
• Scrub your knee and entire leg with the scrub brush given to you at your preoperative appointment. This is to be done the night before and morning of surgery.

Day of Surgery

• Upon arrival to the hospital or surgery center, you will have labs drawn and an IV placed
• IV antibiotics will be given 30 minutes prior to surgery to decrease the risk of infection.
• Before surgery, you will receive a nerve block, which significantly decreases pain after surgery
• You will be given spinal anesthesia (we work to perfect the optimal anesthesia and pain control as well as decrease nausea)
• You will be given minimal sedation to relax and sleep through the surgery but no tube will be placed down your throat, you will breathe on your own during surgery
• Surgery time is approximately 60-90 minutes.
• We will wear special suits and practice sterile techniques in an effort to prevent infection
• A small incision is made to preserve muscle
• The implant will perfectly match your anatomy and will allow for normal function and motion
• A bandage and ice will be placed on your knee
• You will be in the recovery room for approximately 45 minutes
• Specialized nurses trained in joint replacement recovery will welcome you to the floor. Our staff takes pride in serving your needs and routinely is ranked at the highest level of quality care
• Your diet will consist of solid foods and you will have several menu choices
• There are no restrictions on light to normal activities
• Important Tasks on Day 1:
  • Sit up in bed, eat regular food, and drink
  • Urinate on your own (if not within 4 hours of arrival on floor, notify the nurse)
  • Deep breathe
  • Stand and get out of bed with staff assistance
  • Walk the halls with assistance
  • IF THESE TASKS ARE ACCOMPLISHED AND ARE MEDICALLY STABLE YOU MAY GO HOME THE DAY OF SURGERY

First Day After Surgery

• Your dressing will be changed
• You will have physical therapy in the morning and afternoon
• An occupational therapist will discuss issues including driving, getting in and out of vehicles, getting dressed, and other helpful home tips
• A discharge planner will meet with you regarding home therapy or rehab center treatment if necessary
• You will receive a blood thinner to prevent blood clots and you will need to take as directed
• You will recieve pain medications orally as needed as well as an IV anti-inflammatory medication
• You will go home with the prescription for pain medication. GET OFF PAIN PILLS as soon as possible. Narcotics will not be refilled after 4-5 weeks postoperatively
• Please notify the staff of any issues with urinating but keep in mind that difficulty with bowel movements is normal (it could be several days before you have a bowel movement)
• You will receive instructions regarding your incision, medications, compression hose, and bathing before you leave the hospital or surgical center

1-3 Weeks After Surgery

• You should not have a dressing. If spots or drainage occur, you may cover the incision with sterile gauze and light tape (this is common)
• A brown bandage will be placed on your knee after surgery. That bandage may come off 1-2 days after surgery. Leave the clear adhesive dressing on your knee until your first postoperative appointment. We will remove the clear adhesive dressing.
• You may get your incision wet with soap and water, but do not soak it
• No hot tubs or under-water baths for 4 weeks
• Start outpatient physical therapy within a week after surgery
• If you go to a rehab center, you should not stay longer than 14 days, then start outpatient physical therapy as soon as you get home
• You may participate in activity as tolerated
• Walk multiple times a day followed by ice and elevation
• If you have a stationary bike at home, use this daily
• Fever around 100 degrees in the first week is normal
• It is common to have bowel difficulty, however, notify our office if you go several days after leaving the hospital without a bowel movement
• Some bruising, swelling and redness is normal
• Numbness, the size of two silver dollars can be expected on the lateral side (outside) of the knee after surgery.
• It is common to have some numbness around the incision
• Worrisome findings include: drainage from wound, redness that increases, shortness of breath or chest pain, fever of 102 or higher, and dramatic new leg swelling- contact Dr. Hickman's office immediately if you have any of these symptoms

3-6 Weeks After Surgery

• Many patients are walking near normal by 3-6 weeks after surgery
• It is common to be stiff and sore at the end of the day
• It is common to be stiff after sitting
• Most patients may continue taking anti-inflammatories as needed (as long as you have cleared to do so by primary care physician)
• You should need less pain medication and be completely off it by 5 weeks postoperatively
• There are no restrictions on normal activity, in fact increasing your activities as tolerated is good for your recovery
• Most patients will complete physical therapy by 6 weeks after surgery
• Worrisome findings include: drainage from wound, redness that increases, shortness of breath or chest pain, fever of 102 or higher, and dramatic new leg swelling- contact Dr. Hickman's office immediately if you have any of these symptoms

3-4 Months After Surgery

• Activity should be near normal and you may increase to heavy activities without any restrictions
• Most patients have stiffness and soreness at the end of the day

12 Months After Surgery

• Less Stiffness, however stiffness can still exist
• Sore at the end of the day
• Swelling should be near normal.
• You may always have some swelling or fullness in your operated knee.