Total Knee Replacement: The 3 Week Post Op Visit

TOTAL KNEE REPLACEMENT: THE 3 WEEK POST OP VISIT

• Staples: Out at 14 days’ post op
• Blood thinners: Patients who are at low risk for developing blood clots are typically placed on 325 mg (regular) Aspirin once daily till 6 weeks post op. Patients with bleeding risks may be place on a baby Aspirin (81 mg) instead. Patients at higher risk for blood clots may be placed on more aggressive blood thinners such as Plavix, Coumadin, Xarelto, 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 and follow that up with 3 weeks of regular (325 mg) aspirin.
• TED stockings: Studies now show that use of compression stockings does not lower the risk of blood clots. Thus their routine use has been discontinued.
• Wound care: Showering is permissible one-week post op if the wound is clean & 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: May transition off walker and onto a cane and then off all ambulatory aids as tolerated.
• Physical Therapy: Most patients are ready to transition from home to outpatient therapy. A therapy prescription will be provided.
• Range of Motion (ROM): Expected range of motion at 3 weeks post op is from less than 5 degrees’ flexion contracture to over 90 degrees 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 pre op deformity or bone loss might struggle to meet these early ROM goals.
• Driving: Due to liability issues, we recommend no driving for the first 4 weeks post op for right knee surgery. Driving is permitted at 2 weeks post op for left knee surgery if you are off narcotic pain medication and sufficient mobility has been achieved.
• Pain Medication: The amount of pain medicine needed varies from patient to patient. Some never finish the first post op script. 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 government 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 be off prescription pain medications prior to 12 weeks post op, and ideally sooner.
• 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 at about 6 weeks for sedentary jobs, and 3 months 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 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 a routine check and follow up x-rays. If there are range of motion, functional, or wound concerns we may see you back sooner for an interval check.