TOTAL KNEE REPLACEMENT
INTRODUCTION
These instructions were designed to provide you with information about your upcoming knee
replacement. It contains important instructions for you to follow before the surgery, after the
surgery while in the hospital, and after the surgery while at home.
Knee replacement surgery requires the participation of the patient as well as the medical team.
To ensure a long-lasting successful result, all the guidelines reviewed in this booklet need to be
followed.
The joint replacement program at Kaiser Permanente has been carefully developed in the sincere
hope that your new prosthetic joint will offer you long-lasting pain relief and improved mobility.
By the time you return home, you will be familiar with precautions and exercises which protect
your new knee and encourage stability and healing. Your surgeon, physical therapists, and
nurses will instruct and assist you in learning these precautions and exercises.
SPECIAL INFORMATION
Joint replacements can become infected at any time after the surgery – from the first
postoperative day to many years down the line. You can take the following steps to help prevent
infection:
 Take antibiotics before dental procedures – see information on the back of
your wallet card.
 See your primary doctor right away for any suspected urinary tract infections.
 Look for signs of infection in the knee including increasing pain, redness,
or swelling.
 After surgery, if you have any instances of shortness of breath, chest pain, upper back
pain or any hot, red spots anywhere on your leg, please seek medical attention
immediately.
Your new joint replacement may trigger airport metal detectors. We will give you a card that
verifies that you have had a knee replacement.
Keep in mind that your new knee replacement is a mechanical device. While normal walking is
never a problem, running or jumping puts an abnormal amount of stress on the knee replacement
and can cause loosening.
BEFORE SURGERY
 Stop all aspirin and/or anti-inflammatory medications like Motrin, Advil, Indocin, Feldene,
Naprosyn, Vioxx, Celebrex, Salsalate, Relafen, and Clinoril two weeks before surgery. Use
Tylenol as your only pain medication.
 If you are taking any blood thinners like Coumadin or Plavix or Persantine, speak to your
medical doctor about their use before surgery. These medications are usually stopped one to
two weeks prior to surgery.
 Continue to take all of your regular medications like pills for your high blood pressure, your
heart, or your diabetes.
 Take a shower the morning of surgery.
 Report any serious upper respiratory illness or any infection (urinary and tooth especially) to
your doctor if they are present in the two weeks prior to surgery.
 Be sure to arrange for added assistance at home when you are discharged from the hospital.
 Donate one of blood to the Blood Bank if your doctor feels you are medically able to do this.
 Do not drink or eat anything after midnight the night before surgery. Your surgeon or
anesthesiologist may instruct you to take some of your regular medications with a sip of
water on the morning of surgery.
 Remove the following: makeup, nail polish, hairpins, jewelry (wedding rings may be taped
to the finger), hairpieces. Eyeglasses, contact lenses, and hearing aids will have to be
removed just prior to surgery.
 You will be admitted to the hospital on the day of surgery. Your clothes and toiletries you
pack will be kept for you by the hospital staff. Please leave any valuables with a relative or
friend.
AFTER SURGERY
 You will be mostly in bed for the first 24 hours. You will be out of bed and into a chair on
the first day after surgery.
 There will be tubes in the knee that drain excess blood.
 There will probably be a catheter in your bladder.
 You may require a blood transfusion. Your own blood will be given if you have donated
some.
 Medications to expect:
a. The regular medications you took prior to surgery, except for
anti-inflammatory medications
b. A blood thinner.
c. Intravenous antibiotics for the first 48 hours.
d. Pain medication – Usually given through an epidural (back) catheter, or by Patient
Controlled Analgesia Pump, or by mouth.
 Blood samples will be drawn from you daily so your surgeon can determine if you need a
blood transfusion or any adjustment in your medications.
 Use the special breathing machine and breathing exercise to clear your lungs to prevent
pneumonia. The most common cause of a fever in the first few days after surgery is
atelectasis or partially collapsed lungs from anesthesia and lack of activity.
 Wear compression stockings at all times. You may also be asked to wear special pneumatic
boots that constantly squeeze your calves to pump blood towards your heart. These help
prevent blood clots.
 Do bedside exercises as directed by the physical therapist.
 Physical therapy will start early in your hospital stay. When you have satisfactorily met the
goals of therapy as defined by your doctor, you will be able to go home.
 You will need to use a walker, crutches, or a cane for approximately six weeks.
HOME EXERCISES AFTER TOTAL KNEE REPLACEMENT
DO EACH EXERCISE TWICE A DAY
These exercises may cause some discomfort. If pain increases with exercise, discontinue the
exercises and contact your surgeon or physical therapist.
AT HOME AFTER SURGERY
 Follow all instructions of the physical therapist. You will be given information concerning
exercises and precautions. The home therapist will see you 2-3 times a week or as necessary
for the first month. After the first month, if the therapist feels it is necessary, you will come
into the medical center for your physical therapy. Many patients do not need physical
therapy after the first month.
 No shower or bath for two weeks; sponge bathe only; keep the dressing dry.
 Do not drive for six weeks.
 Do not plan airplane travel for approximately two months.
 Do not have a dental cleaning for 3-6 months after surgery. You will need to take antibiotics
for any dental treatments.
 You may walk unlimited distances following the weight-bearing instructions given by your
surgeon.
 You will be given a prescription for pain pills to take by mouth as needed. Call the office
nurse for refills before you are out of pills.
 Wear the compression stockings for one month after surgery. The stockings should not pinch
or constrict any part of your leg
 At two weeks the Home Health Nurse or Physical Therapist will remove staples or sutures.
You may shower 24 hours after those are removed.
Coumadin: A blood thinner you will take for three weeks after surgery. A home health person
will take blood samples 2-3 times weekly while you are on Coumadin. Do not take any aspirin
or anti-inflammatory drug while on Coumadin.
Iron/Vitamins: Continue iron tablets for one month after surgery. Continue multivitamins
indefinitely.
Bowel Movements may be difficult while you are taking iron or pain medication. Be sure to take
the stool softener regularly. To avoid constipation, drink lots of fluids: water, juices, herbal teas.
Avoid ginseng and ginkgo while on Coumadin.
Diet: Protein is important. Even if your appetite is poor, try to eat small, nutritious meals
frequently. Avoid heavy fats or “fast foods.”
IMPORTANT DATES:
Blood Donation:
First Unit
Second Unit
Third Unit (only if requested)
Preoperative appointment with your surgeon:
_________
_________
_________
_________
Preoperative appointment with your medical doctor: _________
Date of surgery:
_________
Time of arrival at hospital:
_________
First office visit:
_________
ROUTINE OFFICE VISITS AFTER SURGERY
An x-ray will be done at each visit.
Four weeks
Three months
Six months
One year
Two years
Five years, then every five years or sooner if you have pain