Knee and Hip Replacement: The 3 week Post-Op Visit

• Blood Thinners: Patients who are at low risk for developing blood clots are typically placed on aspirin 325mg once daily for 6 weeks post op. Patients with bleeding risks may be placed on baby aspirin (81mg) instead. Patients at higher risk for blood clots may be placed on more aggressive blood thinners such as Plavix, Coumadin, Xeralto, or Eliquis for varying lengths of time. A higher risk patient not on blood thinners prior to surgery will often be placed on one of these more aggressive drugs for 3 weeks or more and may have to take aspirin after this.

• TED Stockings: Studies now show that use of compression stockings do not lower the risk of blood clots. Thus their routine use has been discontinued.

• Wound Care: With a PICO wound VAC, showering is permissible immediately as long as the battery pack remains dry. The entire PICO dressing is removed on post op day 7. After this, showering can be continued as long as the wound remains clean and dry with no drainage. With a Zip-Line closure, showering is permissible 1 week post op if the wound is clean and dry. By 3 weeks post op, if there is no redness or drainage, a moisturizing cream or lotion can be applied to treat dry skin. Some patients apply vitamin E ointment in an attempt to improve scarring.

• Ambulation: You may transition off of a walker and onto a cane and then off of all ambulatory aids as tolerated.

• Range of Motion (ROM): Expected range of motion at 3 weeks post op from a Total Knee is from less than 5° short of full extension to 90° or more of flexion. Many factors are involved in meeting this goal. Patients with poor pre-op motion, patients with large girth knees, those with prior knee surgery, and those with significant preoperative deformity or bone loss might struggle to meet these early range of motion goals. Additionally, younger patients tend to form more early inflammation and scar tissue and tend to progress slower with range of motion. Regaining hip range of motion after Hip Replacement surgery is not as crucial early and naturally returns.

• Driving: The time to return to driving is a decision that each patient must make. For liability reasons, we are not able to tell you when it is “safe” to return to driving. In general, most patients return to driving 2-4 weeks after left leg surgery and 4-6 weeks after right leg surgery. You must be off all narcotic pain medicine (that’s a DUI) and have good strength/mobility.

• Pain Medication: The amount of pain medication needed varies from patient to patient. Some patients never finished their first postoperative prescription. Others seem to require pain medication much longer. Though it is our goal to keep our patients comfortable, it is well known that the sooner patients are off narcotic pain meds post op, the quicker they recover. In addition, due to the national opioid crisis, there is a great deal of governmental scrutiny and oversight of narcotic prescription usage. However, if you do need a refill at 3 weeks post op, we will be happy to provide it. We expect all patients to begin weaning off of prescription pain medicine by 6 weeks post op and to no longer need them by 12 weeks.

• Return to Work: Our motto is that “we are not the work police.” You can return to work when you think you can handle the rigors of your job. In general, this is about 4-6 weeks for sedentary jobs, and 8-12 weeks for physical jobs. We will be happy to provide a return to work note when you need it.

• Exercise/Recreational Activities: In addition to formal physical therapy, patients should initiate use of a knee friendly exercise program as soon as tolerated. This includes use of an exercise bike, progressive walking, leg lifts, and an elliptical trainer. The only restrictions regarding returning to recreational activity center around what a patient can tolerate due to soreness and swelling.

• Follow Up Appointment: If everything is going as planned, we will see you back in 12 weeks for routine check and follow-up x-rays. If there are concerns over your range of motion, functional, or wound healing, we may see you back sooner for an interval check.