Knee Replacement Home Instructions

Michael E. Higgins, M.D.


1. ICE:

• Ice will help decrease pain and swelling. If you are not moving from point A to point B for the first 1-2 weeks after surgery, place ice on your thigh. A bag of ice wrapped in a bath towel works well or any other ice wrap you may have is fine. Keep the ice on and replace the ice when it melts. If your thigh is too cold, take a break.


• Tylenol (Acetaminophen): Take 1000mg every 8 hrs. This is a mild pain reliever that works in two ways. First it relieves pain on its own. Second it makes other pain medications work better, because it is synergistic. This is the pain medicine you should cut back on last.

• Ultram (Tramadol): Take 1-2 pills every 8 hours (3 times daily). This is a moderate strength non-narcotic pain medication that is also synergistic with other pain medications. This is the pain medication you should cut back on second.

• Oxycodone (Roxicodone): Take 1-2 pills every 4 hours as needed. This is a strong narcotic pain medicine, and these pills that are meant for pain relief after major surgery like knee replacement. This is the pain medication you should cut back on first.

• Mobic (Meloxicam): Take once daily for 30-60 days as prescribed. This is an anti-inflammatory medication that some patients are given after surgery. After hip replacement it helps decrease pain and inflammation and also helps to decrease the chance of bone developing in muscles around the hip after surgery (heterotypic ossification).


You will be placed on a blood thinner after surgery to decrease the risk of blood clots and pulmonary embolism associated with surgery. You will be placed on Asprin, Lovenox or Xarelto depending on your risk factors, and you should take that medication as instructed. Blood thinners are usually prescribed for 30 days after surgery.


Pain medications can cause nausea. A prescription for nausea medicine, either Phenergan or Zofran, will be provided to be taken as needed


Swelling and bruising are normal after surgery. Your thigh, knee, calf, ankle, and foot will swell after surgery. Normal daily activity causes swelling and this swelling should decrease with rest, ice, and elevation (the swelling may not completely go away in the first several months after surgery). If you experience swelling that does not go down with rest and continues to increase despite rest, ice and elevation over a period of 36-48 hours, please call my office to have the swelling evaluated. Bruising varies in severity from patient to patient and is typically noted on the thigh and then later in the calf and/or ankle. While not all patients develop bruising after joint replacement surgery, it can be severe in some patients and that is normal.


The pain medications taken after surgery can cause constipation. To avoid constipation adhere to the following protocol until your bowel habits normalize.

• Stool softener Colace or similar medication will may be prescribed. They can be purchased over the counter as well.

• Milk of Magnesia (30 ml) may be taken once or twice a day and is available over the counter

• Prune juice or Prunes can be helpful

• Magnesium Citrate is a powerful laxative that is available over the counter if the above have not provided relief within 48hrs.


• Your knee dressing is called an Aquacel dressing and is an antimicrobial dressing impregnated with silver. This dressing can be kept on for 5-7 days. You will be given a replacement dressing and can change it about a week after surgery.

• It is normal to have a small amount of drainage from your incision which will show on the white part of the dressing. If there is some spotting it is ok to leave the dressing in place. If the entire white portion is red then change the dressing. If the incision is draining more than a drop or two call my office to have your incision evaluated.


• The most important part of your rehab in the first 2-3 weeks is to bend your knee and straighten out your knee to regain your range of motion. I cannot emphasize this enough! The sooner you get your knee moving the easier it will be to bend and the longer you wait the harder it will be. I recommend you move your knee from the most you can straighten it out to the most you can bend it every 15-20 minutes while you are awake. If you do this your rehab will go well. Your Physical Therapist will give you a home exercise routine to work on as well.


• You may begin showering 48 hrs after surgery as long as your incision(s) are dry/not draining. If your incision is bleeding or draining do not shower and call my office to have the incision evaluated.


• In order to drive after surgery you need to be able to control your vehicle and should not be under the influence of narcotic pain medications as they impair judgment. Some patients are ready to drive 1-2 weeks after surgery. Others need 2-3 months. When you feel ready to drive go to an empty parking lot and practice to ensure you are ready.


• You should take antibiotics before any dental procedures for the rest of your life. The reason is that bacteria in your mouth can enter the blood stream with dental procedures (including routine cleanings) and attach to your artificial joint causing an infection that would likely require removal of the artificial joint prolonged IV antibiotics and then another surgery to replace the artificial joint. This is a controversial topic because for any one person undergoing dental work the risk of an infection in an artificial joint is very low. While the risk of this happening is small, an infected joint replacement is a devastating complication that we want to avoid. The antibiotics should be taken an hour before your dental procedures. If your dentist is not comfortable prescribing the antibiotics I am happy to provide the prescription. Just call my office or ask at a follow up visit.

• Keflex 1000mg or 2000mg is the antibiotic typically used although Amoxicillin or Clindamycin are acceptable alternatives.