In this section, we will discuss a few things you need to know in regard to surgery and recovery. We will cover some common hospital protocols as well as precautions your doctor and staff will be taking to avoid complications which can result from surgery.
Surgery and recovery
When surgery is completed, you will be taken to the recovery room for a period of close observation. Your blood pressure, heart rate, respiration and body temperature will be closely monitored with special attention given to the circulation and sensation in the feet and legs. When you awaken and your condition is stabilized, you will be transferred to your room.
While protocols differ from hospital to hospital, here is a list of things you may see when you wake up:
- A large dressing applied to the surgical area
- A drain tube leading directly into the surgical area
- An IV will continue post-operatively in order to provide adequate fluids and administer antibiotics and other medications
- A catheter may have been inserted into your bladder as the side effects of medication make it difficult to urinate
- A continuous passive motion (CPM) unit may be placed on your leg to slowly and gently bend and straighten your knee, to help more quickly regain your knee range of motion
- A patient-controlled analgesia (PCA) device may be connected to your IV for pain relief
Post-operative care and precautions
As with any major surgical procedure, post-operative knee complications can occur following revision knee surgery. Below is a list of some of the complications that may occur after surgery.
Deep vein thrombosis
Deep vein thrombosis occurs when blood clots are formed in the large veins of the legs. In some cases, these clots can become dislodged from the veins, travel through the circulatory system and become stuck in critical arteries of the lungs. The following steps may be taken by you and your physician to prevent deep vein thrombosis.
- Blood-thinning medication, such as aspirin or anticoagulants
- Support stockings (TED hose)
- Foot elevation to prevent swelling
- Foot and ankle exercises to optimize blood flow
- Pneumatic devices placed on the feet to improve circulation
Infection
Infections occur in a small percentage of patients undergoing revision knee surgery. Your physician will be able to minimize the risk of infection by closely monitoring the incision and looking for any signs of redness, swelling or other indications. Always wash your hands before and after handling your incision site, especially when the sutures are still in place.
Pneumonia
A possible side effect of surgery is the development of pneumonia. The following steps may help minimize the risk.
- Deep breathing exercises: A simple analogy to illustrate proper deep breathing is to “Smell a Rose and Blow Out the Candles.” In other words, inhale slowly and deeply through your nose and exhale slowly through your mouth at a slow and controlled rate. A simple rule of thumb may be to perform these deep breathing exercises eight to 10 times every hour.
- Coughing: This activity helps to loosen the secretions in your lungs and excrete them from your pulmonary system.
- Incentive spirometer: This simple device provides visual feedback while performing deep breathing exercises. Your nurse or respiratory therapist will demonstrate the proper technique.
Incision complications
Poor healing of the incision is a fairly common complication of revision knee surgery. This is because the tissue is often scarred and thinner than when your original knee replacement was done. Previous skin incisions can make it difficult for the new incision to close properly after revision knee surgery, leading to complications. The chances of infection increase when your incision does not heal right.
Poor incision healing is more likely to occur in patients with one or more of the following factors:
- Obesity
- Prior wound healing problems
- Poor circulation
- Diabetes mellitus
- Tobacco habit
Your orthopaedic surgeon’s goal is to prevent problems with your incision. However, if problems do occur, one or more additional surgeries may be needed.
Rehabilitation after knee revision surgery
One of the most critical factors in achieving successful revision knee surgery depends upon your diligence in physical rehabilitation. You must actively participate in the rehabilitation process, working diligently on your own as well as with your physical therapists to achieve the best results.
You are typically in the hospital for three to seven days and the physical therapists will begin working with you as early as one to two days after surgery. They will teach you simple exercises that can be performed in bed to strengthen the muscles in the knee and lower extremity. These exercises may include:
- Ankle pumps: Flex and extend the ankles
- Quadricep sets: Tighten and relax the thigh muscles
- Heel slides: Flex your hip and knee. Return knee to the straight position
- Leg lifts: Raise leg six inches above the mat, keeping knee straight
- Knee extension: Place a pillow under your knee. Lift your foot off the mat
Your physical therapists will also teach you the following proper techniques. Although these activities may seem simple, you must learn to do them safely so you do not suffer other injury.
- Getting in and out of bed by yourself
- Walk down the hall using your walker or crutches
- Manage steps at home
- Bend your knee 90 degrees and straighten your knee
An occupational therapist will teach you how to safely perform activities needed in daily life and will also provide you with a list of knee precautions that are designed to protect your new knee during the first eight to 12 weeks following surgery. The occupational therapist will also instruct you in the proper use of various long-handled devices that will assist you in your daily life activities. These devices may include the following:
- A reacher to dress and pick things up off the floor
- A sock-aid to assist in putting on socks
- A long-handled sponge to wash your legs and feet
- A leg-lifting device to move the operated leg in and out of the car or bed
- An elevated toilet seat for when using the bathroom
- An elevated bathtub chair to fit in the shower or tub
Hospital discharge and home instructions
Before leaving the hospital, your doctor and staff will help you adjust to recovery in every way possible. They will show you safe techniques of simple activities like getting in and out of bed, going to the bathroom, managing steps at home, and getting in and out of the car.
Progress varies from patient to patient, so discharge instructions may vary. You will receive specific precautions from your orthopaedic surgeon, nurse and physical therapist.
- You will be using a walker or crutches to assist with walking. Ask your surgeon how much weight you can put on your operated leg
- Wear your TED hose
- Your surgeon will talk to you about when you can drive
- Continue the exercise program you learned while in the hospital
Your orthopaedic surgeon will typically see you one or more times during your outpatient visits. Depending on what is learned from your X-rays and examinations, you may start to put full weight on your leg. Most orthopaedic surgeons recommend that you have routine checkups after your revision knee surgery. How often you need to be seen varies according to your situation and what your surgeon recommends. Always consult your orthopaedic surgeon if you begin to have pain in your artificial joint or if you suspect that something is not working correctly.
Life after knee revision surgery
Once you have completed the post-operative knee rehabilitation process, you should have near-normal range of movement and adequate strength in your knee to perform most activities of daily living. Patients having revision knee surgery have successfully returned to activities such as walking, driving, swimming and stationary cycling.
However, special precautions should be taken. You should avoid high-impact activities such as running, jumping, and quick stopping and starting. Patients may also need to consider avoiding work activities that require heavy lifting, crawling and climbing. Remember to listen to what your body tells you. If you begin to have pain or swelling, contact your healthcare professional for advice.
