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After a Total Knee Replacement Operation Going home advice by physiotherapist Shirley-Ann Walters MC

Many people have a lot of questions, especially in the first week home after a Total Knee Replacement operation. It is good to plan in advance as far as possible before going into hospital, and then review things again once you are at home.

Initially

You are likely to feel very tired, you have probably had quite a long anaesthetic, strong pain relief, and the process of getting home. It is important to gently look after yourself whilst prioritising your home exercises which are essential to a good recovery. You probably will need someone to stay with you at first if you live alone. Listen to your body. Rest as you need to, on the bed with your leg raised for short spells if necessary as you did in hospital. It is also important to sit up in a chair too, with the knee bent, alternating with straight, and walk around frequently to keep your circulation going and use your muscles.


Visitors

Do you want, and can you cope with visitors? It might be a good idea to spread them out so that they do not overtire you, and this can be planned in advance. Are they coming for your benefit, or their own in some way? You will be rehabilitating for some weeks and they don’t all have to see you at once. Arrange visitors around your exercises or continue anyway.


Pain relief

You will need enough pain relief as prescribed to you in order to do your exercises and walking practice without pain being the limiting factor. People commonly say “I don’t like taking too many tablets - it is not natural” which it isn’t, but nor is surgery, and it is an essential part of the over-all procedure in order that you keep moving and make the best recovery overall. If you under-medicate and experience more pain, it can waste precious days of progress and loose you range of movement. Stopping or reducing pain relief too soon is one of the most common mistakes made following knee replacement.


Sitting

Arrange to use a chair that is at a suitable height and access for you to get up and down from, with solid arms if needed. Have a table nearby so that you can reach the things you need.

Do not put your leg(s) up on a footstall for long periods, you probably did not do this in hospital for good reason. Sit with you leg down and gently bend and straighten it frequently, sometimes sitting at the edge of your seat and allow your leg to sink down into a fully straight position. If you have swelling it is important to have a lie down on the bed with your feet higher than you heart for a while, a few times a day. (water drains down hill J )


Walking about

Move around little and often and gradually increase this as your muscles gain strength and you improve confidence. Use both walking aids you have been given (sticks or crutches) until you can walk with one, or none without any limping, and you may need them even then when going outside or in crowds for a bit longer. Focus on the quality rather than the quantity of your walking and build it up steadily each day.


Exercises

Make sure you are increasing your range of bending and straightening movement at the knee every day. This is as important as the strengthening exercises you have been given in hospital. Find a good routine to do the exercises a few times a day or as you were advised to. You might time them for after your painkillers for best advantage. Some people find it helps to do either bending or straightening alternately on the hour, to spread it out.


Rest

Rest when you need or feel to. Be active when you feel to, as much as you can.


Ice

Once your wound has healed, you may have been advised to use cold on your leg, such as a gel pack, a bag of frozen peas well wrapped in a towel, or a cuff and ice bucket regime. Check you skin regularly for redness as ice can burn and make sure you can feel the coldness so you can tell if it gets too much, it is not meant to be severe. Be gentle with yourself about it, but regular, and once the sutures are out and the skin is fully healed you can massage it gently with a moisturising cream or olive oil.


When can I do this or that?

There maybe rules by the surgeon to be followed about when you are allowed to drive, or remove your pressure stockings so you may need help with these simple things in the early stages. Take notice of the trends in your recovery, as if you have your own line graph, and this will help you anticipate when you are ready for new things, like a trip out in the car such as to have your hair done or visit a local shop. Bigger shopping trips or outings will take longer. It can be inspiring to have something to look forward to that you enjoy.


How much should I be doing?

There will be good days and maybe days when you feel you have done a little too much the day before, learn from them, but your body will gradually get used to your activity again.


Stairs

Use your un-operated leg up first going up, operated leg down going down – in order to use the strongest leg to do the work. Eventually you may return to alternate legs again as you regain your strength and confidence, usually going up with the operated side recovers faster than going down leading with the other, where the operated leg has to do the lowering work under control.


Longer–term

The first 6-12 weeks following a Total Knee Replacement is the most intensive period of recovery, but you may still look back after 6 or 12 months and see that you have continued to progress considerably, so be patient with yourself.


Shirley-Ann Walters Grad Dip Phys MCSP

Lightwater Physiotherapy

07876 654321

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