Knee Replacement: Your Daily Guide to Recovery

The Cedars-Sinai Institute for Joint Replacement has developed a detailed, daily recovery guide to help you recover quickly. Your participation in the recovery program is very important. Your CSIJR team specialists will monitor your medical condition and do the things you cannot do for yourself. It is important to us to make your hospital stay and experience informative for a faster and easier recovery. Listed below are the daily guides for each day of your recovery at the hospital:

Day 1: After Surgery

Eat

  • After surgery you will start on clear liquids then advance to a regular diet
  • You need to eat. It will give you energy and help you heal.

Breathe

  • Every two hours while awake you will need to exercise your lungs (deep breathing)

The Daily Routine

  • Blood is drawn to evaluate blood count
  • The nurses will be checking your blood pressure, temperature, circulation, and movement and sensation of your leg
  • If ordered, you may have a continuous passive motion (CPM) machine on your leg. The machine will be set 0 to 30 degrees and will be on while you are in bed. This machine slowly and continuously flexes and extends your leg to keep it flexible.
  • Do your ankle pumps for circulation
  • If ordered, your "foot pumps" (booties) will be on while you are in bed. The foot pumps are to prevent blood clots.
  • Bathing and grooming are done with a nurse's assistance.

Pain Control and a Few Words about Your Medication

  • Discomfort after this procedure is normal, the pain medication may not take away all the pain, but it will make you comfortable so you can carry out necessary activities and rest.
  • You will have pain medication ordered (shots, PCA-patient controlled analgesia, or epidural)
  • If the pain medication is not working or you are nauseated Let the nurse know.
  • You will have an intravenous needle placed in your hand or arm to give you fluids and medication. You may also receive a blood transfusion.
  • Antibiotics: A few more doses to prevent infection.

Treatments

  • You may have a catheter in your bladder draining urine for the first 24 hours after surgery.
  • There may be a drain in your knee that will remove excess blood from your knee wound. The nurses may also flush blood from your drain. This is routine.
  • The doctor will remove the drain in 24 to 48 hours.

Move

  • The nurses will help you turn from side-to-side every few hours for comfort and to prevent skin problems.
  • You are on bed rest today, unless you are back from surgery before noon. In this case, a physical therapist will see you in the afternoon to start your knee exercise program and sit you up on the side of the bed (dangle your legs), as tolerated.
  • Do your thigh muscle squeezes. Hold for six seconds then release.
  • Do your buttock squeezes. Hold for six seconds then release.

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Day 2: Postoperative Day #1

Eat

  • You will be eating a regular diet. Be sure to drink plenty of liquids.
  • Eat = Energy = Healing. Everyday your appetite will improve.

Breathe

  • Every two hours while awake do your (deep breathing) exercises.

The Daily Routine

  • Bathing and grooming with the nurse's assistance.
  • Nurses will check your blood pressure and temperature every eight hours or more, if necessary. They also will check the circulation, feeling and movement of the leg on which you had surgery.
  • You need to continue on the CPM machine if ordered. It will be set 10 degrees higher.
  • The nurses will continue to turn you for comfort.
  • If you have them ordered, you should continue to wear the foot pumps while you are in bed.
  • Blood may be drawn to evaluate your blood count.
  • If you are not able to return to your own home from the hospital then a hospital social worker will see you today and work with you on plans for your discharge from the hospital.

Treatment

  • If you are tolerating liquids well, your intravenous fluids will be discontinued.
  • If you have a drain in your hip your physician may remove it. The nurses will continue to monitor the wound or dressing.
  • If you have a catheter in your bladder, it will be removed today and you will start to use the bathroom.

Pain Control and Medication

  • You should continue to take your pain medication so that you will be comfortable enough to participate in your daily activities and physical therapy program.
  • After your third dose of antibiotics, the IV will be removed. If you are on a PCA, the intravenous will be discontinued when your PCA is stopped.

Move

  • Do your ankle pump exercises.
  • Do those buttock squeezes.
  • Do those quad sets and heel slides.
  • Do those straight leg raises.
  • Do those abduction exercises.
  • Exercise those arms to get them strong.
  • Time to sit up.
  • If a physical therapist started working with you on Day 1, then they will continue with your program. Otherwise they will start your therapy today. The exercises actually help to reduce swelling which makes your hip feel better.

Morning Session

  • The therapist will assess the strength in your arms and legs.
  • Determine your ability to move in bed.
  • Teach you he following exercises: 1) ankle pumps, 2) heel slides, 3) quad sets, 4) short arc quads and straight leg raises, and 5) gluteal sets.
  • Discuss proper positioning and movements you need to avoid.
  • Assist you in moving to a sitting position at the edge of the bed. If able, you will stand and sit up for 30 minutes.
  • Provide you with a sheet of written instructions with your exercises and movement precautions.

Afternoon Session

  • Assist you with the exercises that you performed in the morning session.
  • Sit up in a chair for 30 to 45 minutes.

Evening Session

  • Your nurse or care partner will assist you with your exercises.
  • If able, sit up in a chair for 30 to 45 minutes.

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Day 3: Postoperative Day #2

Eat

  • Remember EAT = ENERGY = HEAL = HAPPY KNEE

Breathe

  • Continue to do your deep breathing exercises to keep your lungs clear.

The Daily Routine and Treatments

  • Up in a chair for all meals.
  • You may use a bedside commode or the bathroom.
  • Your nurse will review your home instructions (teaching) including Fragmin (blood thinning medicine) injections (if your doctor has ordered one of them) and dressing care. Family members are encouraged to get involved.
  • An occupational therapist will see you to help with your equipment and device needs to help you in the activities of daily living (ADLs).

Pain Control and Medication

  • You should continue to take your pain medication so that you will be comfortable enough to participate in your daily activities and physical therapy program.
  • If necessary, you may be given a laxative to help you have a bowel movement.

MOVE... 25, 50,75 Feet a Little Farther

  • Each day try and get a little farther down the "street." The goal is to increase the distance you can walk while becoming more independent with your walker. You will see an improvement each day.
  • You should be sitting in a chair for all meals. You are encouraged to sit for 45 to 60 minutes in the morning and afternoon to help you regain your strength.
  • Do those buttock squeezes. Do those quad sets and heel slides.
  • Exercise your arms to make them strong to help you with your ambulating.
  • The physical therapist and nursing staff will continue your hip program.

Morning Session

  • Assist you with your exercises. You may be given additional exercises.
  • Assist you in getting in and out of bed, the chair and walking. You may advance from a walker to crutches, and the distance will be farther.

Afternoon Session

  • Assist you with your exercises
  • Assist you in getting in out of bed and walking.

Evening Session

  • Assist you with your exercises.
  • Assist you in getting out of bed and walking.

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Day 4: Postoperative Day #3

Eat

  • Regular diet and drink lots of fluids.

Breathe

  • Keep working those lungs (deep breathing).

The Daily Routine and Treatment

  • Up in the chair for all meals.
  • Into the bathroom for all activities of daily living. Ask for assistance if you need help.
  • If you have not had a bowel movement, you should ask for a laxative or enema.
  • With input from your nurse and therapist, the social worker will review the discharge criteria and help you with your plans for post-hospitalization care.
  • Your nurse will review your home instructions (teaching) including Fragmin injections (if your doctor has ordered one of them). Ask questions and eliminate the fear.

Move

  • You are encouraged to sit up for 45 to 60 minutes at a time to help you get strong.
  • The physical therapist and nursing staff will continue with your knee program.
  • Occupational therapy has handy gadgets that will be great help at home.

Morning Session

  • Review positioning and movement precautions
  • Assist you with and progress you through your exercises.

Today, your occupational therapist will discuss and assess any special equipment needs you may have related to self-care and those handy gadgets. You will also be provided with appropriate equipment (e.g., reacher, long shoe horn, etc.). You will get help with proper dressing, toileting, bathing and other self-care techniques (using appropriate movement precautions).

Afternoon Session

  • Assist you with your exercises.
  • Assist you with walking a few more feet down the street.

Evening Session

  • Do your exercises on your own.

Preparing for Discharge

  • If needed, you will be set up with home care for physical therapy and occupational therapy.
  • You will be seen by the equipment company representative to discuss any equipment needs that the therapist feels you need for home.
  • The nurse will go over your instructions for home care.

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