Last updated: 11/24/2009

Aftercare following knee replacement surgery begins while the patient is still in the hospital. Most patients will remain there for five to 10 days after the operation. During this period the patient will be given fluids and antibiotic medications...

intravenously to prevent infection. Medications for pain will be given every three to four hours, or through a device known as a PCA (patient-controlled anesthesia). The PCA is a small pump that delivers a dose of medication into the IV when the patient pushes a button. To get the lungs back to normal functioning, a respiratory therapist will ask the patient to cough several times a day or breathe into blow bottles.

Aftercare during the hospital stay is also intended to lower the risk of a venous thromboembolism (VTE), or blood clot in the deep veins of the leg. Prevention of VTE involves medications to thin the blood; exercises for the feet and ankles while lying in bed; and wearing thromboembolic deterrent (TED) or deep vein thrombosis (DVT) stockings. TED stockings are made of nylon (usually white) and may be knee-length or thigh-length; they help to reduce the risk of a blood clot forming in the leg vein by putting mild pressure on the veins.

Physical therapy is also begun during the patient's hospital stay, often on the second day after the operation. The physical therapist will introduce the patient to using a cane or crutches and explain how to manage such activities as getting out of bed or showering without dislocating the new prosthesis. In most cases the patient will spend some time each day on a continuous passive motion (CPM) machine, which is a device that repeatedly bends and straightens the leg while the patient is lying in bed. In addition to increasing the patient's level of physical activity each day, the physical therapist will help the patient select special equipment for recovery at home. Commonly recommended devices include tongs or reachers for picking up objects without bending too far; a sock cone and special shoehorn; and bathing equipment.

Following discharge from the hospital, the patient may go to a skilled nursing facility, rehabilitation center, or home. Patients who have had bilateral knee replacement are unlikely to be sent directly home. Ongoing physical therapy is the most important part of recovery for the first four to five months following surgery. Most HMOs in the United States allow home visits by a home health aide, visiting nurse, and physical therapist for three to four weeks after surgery. Some hospitals allow patients to borrow a CPM machine for use at home for a few weeks. The physical therapist will monitor the patient's progress as well as suggest specific exercises to improve strength and range of motion. After the home visits, the patient is encouraged to take up other forms of low-impact physical activity in addition to the exercises; swimming, walking, and pedaling a stationary bicycle are all good ways to speed recovery. The patient may take a mild medication for pain (usually aspirin or ibuprofen) 30–45 minutes before an exercise session if needed.

The patient will be instructed to notify his or her dentist about the knee replacement so that extra precautions can be taken against infection resulting from bacteria getting into the bloodstream during dental work. Some surgeons ask patients to notify them whenever the dentist schedules a tooth extraction, root canal, or periodontal work.