AMERICAN ORTHOPEDICS & SPORTS MEDICINE, PLC
Steven B. Larson, M.D., F.A.A.O.S.
740 Conference Drive, Suite 2, Goodlettsville, TN 37072
Telephone: (615) 851-2673 · Fax: (615) 851-2675
Date of surgery:____________ Arrival Time: __________
When you arrive at the hospital, check in at the Registration Desk.
Total Knee Replacement Surgery Post Operative Instructions
The following information is designed to answer some of the frequently asked
questions regarding what to expect after total knee replacement surgery and about postoperative care. These are general guidelines. If you have any questions or concerns; please
give Dr. Larson’s staff a call.
The first goal after total knee replacement surgery is to get the wound drainage to stop.
This is done by elevating the knee above the heart, ice packs to the knee (20-25 minutes on,
5-10 minutes off), resting the knee, and wearing a compression bandage such as an Ace wrap.
A draining wound increases the risk of infection.
PREVENTION OF BLOOD CLOTS, DEEP VENOUS THROMBOSIS (DVT)
Deep venous thrombosis (blood clots) may occur after surgery. To decrease the risk of
blood clots you may be given prophylaxis with Lovenox (enoxaparin), Xarelto, or Warfarin.
All of these “blood thinning” drugs tend to keep the wound draining by inhibiting clotting. If
you are discharged on Lovenox, you will take this for a total of 10 days and discontinue it on
post op day #11. Then Dr. Larson recommends that if you have no contraindications, to take
an enteric coated aspirin, 325mg tablet, twice a day until your are three months out from your
surgery.
IRON PILLS (FESO4) POST OP
Dr. Larson recommends that you take a 325mg iron tablet, twice a day, until you are
three months out from your surgery. Due to blood loss during surgery, it may take up to
three months for your low blood level (i.e. anemia) to return back to normal. It is common
for you to feel tired and fatigued after surgery until your blood level returns back to normal.
The iron pills can cause constipation. If this happens, try to take just one a day. If still
constipated, you may discontinue the iron pills. Taking a Colace capsule (docusate sodium)
two to three times a day may resolve your constipation. This is available over the counter at
any pharmacy or grocery store.
WOUND CARE
Please do not touch the surgical wound with bare fingers, do not to get the wound wet,
and do not leave the dressings off so that the wound can “air out”. Daily dressing changes
should begin on post-operative day #2. Staples will be removed in 10 -14 days post-op.
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AMERICAN ORTHOPEDICS & SPORTS MEDICINE, PLC
Steven B. Larson, M.D., F.A.A.O.S.
740 Conference Drive, Suite 2, Goodlettsville, TN 37072
Telephone: (615) 851-2673 · Fax: (615) 851-2675
PREVENTION OF WOUND INFECTIONS.
The number one cause of wound infections is patients touching the wounds with bare
fingers. Do not touch the wounds with bare fingers, do not pick at scabs or the incisions. Do
not touch the staples with your bare fingers. The number two cause of wound infections is
patients getting their wounds wet with water. Please do not do this. The number three cause
of wound infections is patients leaving the dressings off for the wounds to “air out”. Please
keep you wounds dressed at all times, except when changing the dressings of course.
The longer your wounds drain, the more chance they have of getting infected. If
drainage can get out of your knee, germs can get in and cause infection. The more swelling
you have in your knee, the longer your wounds will drain. Dr. Larson’s first goal after
surgery is to get the drainage to stop. Do this by trying to get the swelling down. Try to get
the swelling down by resting your knee, decrease your activity, ice bags to the knee, wear the
6” ace wrap, and elevate the knee above your heart. After all of the wound drainage stops for
24 hours, you may increase your activity level.
KNEE IMMOBILIZER BRACE WEAR:
You will be given a knee immobilizer brace during your preoperative history and
physical visit with Dr. Larson. Please bring this with you into the operating room. Your will
wear the brace for the first 24 hours after surgery. After the first day post op, you will only
need to wear the immobilizer brace when you out of bed. You should practice doing straight
leg raising exercises during the first 4 days after surgery. If on the fourth post-op day, you
can do a straight leg raise for 10 seconds, then you do not need to wear the knee immobilizer
brace any more. If you can not do a 10 second straight leg raise, then you leg is too weak to
support your weight. If you walk without the knee immobilizer brace on, and your knee is
too weak, your knee could get a sharp pain causing the knee to go out, or buckle. If your
knee is weak when it goes out, you could fall down causing injury such as a dislocated
kneecap or rupture tendon. Physical therapy will usually start on the first day after surgery.
PHYSICAL THERAPY/REHABILATATION POST OP
Physical therapy will begin the first day after surgery. Usually on the first day, you
will sit in a bedside chair for a couple of hours. On the second Postop day, you will work
with therapist assistance with a walker out to the hallway of your hospital room. On the third
post-op day, you will walk with the therapist out to the nurse’s station. If you have stairs to
climb at home, please tell the therapist to teach you stair climbing. You will usually be
discharged to home on your third post operative day. You may continue therapy at home or
at a rehab facility for the next three weeks. Clinic physical therapy is usually started about 4
weeks postoperatively and is continued for six weeks. Clinic physical therapy usually ends
about two months post op. On your last visit to physical therapy, you will be instructed on a
home exercise program to do until you have 0-120 degrees range of motion of your knee, full
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AMERICAN ORTHOPEDICS & SPORTS MEDICINE, PLC
Steven B. Larson, M.D., F.A.A.O.S.
740 Conference Drive, Suite 2, Goodlettsville, TN 37072
Telephone: (615) 851-2673 · Fax: (615) 851-2675
strength, and good functioning of your knee.
A Continuous Passive Motion (CPM) machine will be ordered for you by Dr. Larson
for you to use during the first 3 weeks after surgery. If you go home from the hospital, either
the discharge planning social worker or your home physical therapist will be responsible for
seeing that you get the CPM machine. If you go to a rehab facility, the rehab facility will
provide it for your. Your will start the CPM machine in the hospital on your second post op
day, after your wound drain has been pulled by the nurses and the nurses have done the first
dressing change. At the time of your first dressing change, the nurses will apply a thigh high
white TED hose stocking. Dr. Larson likes this to help decrease swelling in the whole lower
extremity. Dr. Larson recommends wearing the TED hose stocking for six weeks.
HOSPITAL DISCHARGE PLANNING
A hospital social worker/discharge planner will meet with you the next day after surgery
to assist you with your return to home or transfer to a rehab facility. If you will be going
home after surgery, the social worker will try to arrange for home physical therapy for about
3 weeks. They can order for you a home walker, a raised toilet seat, a home Continuous
Passive Motion (CPM) machine, and home health nursing. They can also assist you with
making sure that your blood clot preventative medicine (Lovenox or Xarelto) will be
available at your pharmacy when you are discharged from the hospital. The blood clot
preventative medicine [usually Lovenox (enoxaparin) or Xarelto] should be picked up within
24 hours of being discharged from the hospital. These medicines may not be carried by your
pharmacy and your pharmacy may have to special order these at the guidance from the social
worker.
POSSIBLE RISKS, COMPLICATIONS, AND ADVERSE REACTIONS
There are risks, benefits, alternatives to any surgery, and possible complications.
Complications may include, but are not limited to: infection, bleeding, need for blood
transfusion, risk of blood transfusion adverse reaction, risk of AIDS, risk of hepatitis,
stiffness, arthrofibrosis, frozen knee syndrome, contractures, need for reoperation, need for
manipulation under anesthesia, need for surgical lysis of adhesions, need for surgical patella
lateral releases, anesthetic complications, death, coma, stroke, heart attack, heart failure,
cardiac arrhythmias, cardiogenic shock, blood clots, pulmonary embolism, kidney damage,
kidney failure, liver damage or liver failure from anesthesia, atelectasis, aspiration,
pneumonia, pneumothorax (collapsed lung), wound healing problems, ugly scars, keloid
scars, draining scars, overlapping skin edges, skin necrosis, hematoma, seroma, wound
dehiscence, stitch abscesses, hemarthrosis, patellar fracture, quadriceps tendon rupture,
patellar tendon rupture, femur fracture, tibia fracture, loosening of implants, extravasation of
cement, malposition of components, patellar tracking problems, patella subluxation or
dislocation, patellar tilt, maltracking of the patella, use of tourniquet, blisters, swelling,
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AMERICAN ORTHOPEDICS & SPORTS MEDICINE, PLC
Steven B. Larson, M.D., F.A.A.O.S.
740 Conference Drive, Suite 2, Goodlettsville, TN 37072
Telephone: (615) 851-2673 · Fax: (615) 851-2675
ecchymosis, compartment syndrome, paresthesias, neuroma formation, neuritis formation,
thromboemboli, damage to blood vessels and nerves, numbness, paralysis, loss of function of
the lower extremity, loss of the lower extremity, continued pain, reflex sympathetic
dystrophy, malignant hyperthermia, negative pressure pulmonary edema, need for ligament
balancing, need for additional incisions, limb length inequality. There are also possible
complications that unforeseen and unmentioned at this time.
POST OPERATIVE NUMBNESS OR FALLING ASLEEP FEELING IN LOWER
LEG
Dr. Larson will use a tourniquet around your upper thigh to decrease blood loss during
surgery. This also helps for him to see what he is doing during the surgery by stopping the
bleeding. The longer the tourniquet is used, the more your lower leg will feel like it has
fallen asleep during surgery. It not uncommon for this falling asleep feeling to last for a few
days. It can sometimes take over 3 weeks for all of the falling asleep feeling to resolve.
POST OPERATIVE PAIN MANAGEMENT
Post-operative pain management will usually include Patient Controlled Analgesia
(PCA). This is wear your can hit a button every 10 minutes and it will inject some Morphine
or hydromorphone (Dilaudid) into your IV fluids. This is usually used for about 48 hours
post operatively, and then oral narcotic pain medicines such as Oxycodone or Hydrocodone
are usually prescribed. Most patients will need narcotic pain medicines for about 6 weeks
postoperatively. This varies widely depending on a patient’s pain tolerance.
PROGNOSIS
As with any surgery, there is the possibility of being made permanently worse,
possibility of needing reoperation, and possibility that surgery is of no benefit at all. About
90% of patients who have total knee replacement are satisfied with their surgery results at
one year out from surgery. About 5% need reoperation due to stiffness. About 4% are no
better off than they were before surgery.
POST OPERATIVE LUNG AND BREATHING ISSUES
It is common in the first 3 days postoperatively after general anesthesia, that mucous
can collect in the lungs and that the very small lung spaces (alveoli) can collapse. This is
called atelectasis. It is very common after total knee replacement surgery. To treat this the
you are encouraged to take deep breaths at least every hour and to cough. The hospital will
give you an incentive spirometer device to practice your breating on. Try to clear the
mucous out by coughing and deep breathing. If a fever develops in the first three days, it is
most likely due to the lungs. Then deep breathing and coughing should be done every 10-15
minutes while awake.
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AMERICAN ORTHOPEDICS & SPORTS MEDICINE, PLC
Steven B. Larson, M.D., F.A.A.O.S.
740 Conference Drive, Suite 2, Goodlettsville, TN 37072
Telephone: (615) 851-2673 · Fax: (615) 851-2675
POST OPERATIVE PAIN
It is common that on average about half of the post-operative pain will be gone in
about six weeks. About 70% of the surgical pain is usually gone at about 12 weeks. About
90% of the pain is gone in about 6 months. On average, all of the surgical pain is often gone
at about one year. About half the people will have all of their pain gone before one year, and
the other half will take longer than a year for all of the pain to go away. About 10% of
patients will not have all of the pain go away. This is usually due to synovitis from the
osteoarthritis which for some reason does not heal up and go away.
Pain medication can often cause drowsiness. Therefore, we advise you not to drive or
operate machinery. If you experience constipation as a side effect of your pain medication,
you may use over the counter Milk of Magnesia as directed on the bottle for relief. Two
tablespoons of Milk of Magnesia at bedtime (30 ml) usually helps with having a bowel
movement the next morning.
We are unable to call in prescriptions after office hours and on the weekends. If you
need a refill, please call your Dr. Larson’s office early in the day so that your prescription can
be filled reviewed by Dr. Larson prior to close of business each day. Someone from Dr.
Larson’s office will call you when the refill prescription has been approved by Dr. Larson
and called in to your pharmacy by Dr. Larson’s staff.
*It is not possible to be “pain free”, but we want you to be comfortable. If despite ice,
rest, elevation, and taking your pain medicine, you have severe, persistent pain, please notify
Dr. Larson.
POST OPERATIVE DRIVING
Tennessee State Law does not allow you to drive if your knee surgery impairs your
driving. It is up to you to decide when you can safely operate a motor vehicle. Driving will
not mess up your knee surgery, but your knee surgery might mess up your driving. It is also
illegal to drive in Tennessee if your pain medicine impairs your driving. Meperidine,
Oxydocone, Hydrocodone, and Phenargan can all impair your driving. You can not safely
drive if you have a knee immobilizer on your right knee. You can not drive safely if your car
has a clutch and you have a knee immobilizer on either knee. If your are unsure whether you
can drive safely or not, do not drive.
POST OPERATIVE LOOSENING OF IMPLANTS.
The parts to your artificial knee are called implants. These three implants are glued to
the bones usual a special cement. Eventually the cement will become loose if you live long
enough. The loosening rate is about 1% per year for the first 10 years, then 5-10% a year
after 10 years. Most patients are expected to have loose implants requiring a revision total
knee replacement within 30 years of the initial primary total knee replacement.
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AMERICAN ORTHOPEDICS & SPORTS MEDICINE, PLC
Steven B. Larson, M.D., F.A.A.O.S.
740 Conference Drive, Suite 2, Goodlettsville, TN 37072
Telephone: (615) 851-2673 · Fax: (615) 851-2675
COMMUNICATION:
If you have any problems related to your surgery, contact Dr. Larson or his staff right
away. There is always a doctor on call after hours and on weekends. You can page Dr.
Larson at 615-761-0188 if you have an emergency that can’t wait until the next business day.
FURTHER QUESTIONS
If you have any further questions, please call Dr. Larson’s office during business hours.
We will try to get back to you within 24-48 hours. How soon we get back to you also
depends on Dr. Larson’s busy surgery schedule. Note that Dr. Larson is only in the
Goodlettsville office on Mondays, Tuesdays, and Thursdays, to respond to your questions.
Dr. Larson’s medical office phone number is 615-851-2673.
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