Patient’s hospital stay normally varies from 5 to 8 days. After the surgery, surgical site pain lasts for about 24 – 48 hours. During this period pain medication is administered via several methods to keep the pain as low as possible. This allows early recovery of the patient as well as encourages him / her for faster rehabilitation. Various methods to keep the pain at bay are:
- Pain killer (Analgesic) injection around thigh after the surgery (femoral block)
- Analgesic injection delivered via electronic pump into the spine (epidural pump)
- Intra-venous analgesic drug administration
- Using analgesic patch over skin
- Oral analgesics
Leg exercises are started as soon as anesthesia wears out and leg / foot movements have regained. The post-operative exercise program is precisely scheduled and undertaken with the help of a physiotherapist.
Day 0: On the day of operation two basic exercises are started. They help to keep the muscle power of thigh & leg intact, also, avoid formation of any clots in the leg veins (DVT).
- Ankle / calf pump exercise Calf Pump Exercise (video)
- In bed static & active quadriceps strengthening exercise In bed quadriceps exercise (video)
Day 1: On the day after surgery, drain tubes are removed and a small dressing is applied. Bedside sitting and knee bending is then started if the pain levels permit. In Bed Knee Bending Exercise (video) Also, in bed straight leg raising (SLR) exercise is encouraged. Initially, an assistance is required to raise the leg but soon the patient is able to perform it without any help. SLR Exercise (video)
Epidural analgesia is gradually reduced and stopped as early as possible. This allows early regain of muscle control and co-ordination.
Day 2: First check dressing is done and fresh dressing is applied. Epidural catheter is removed from the back. Earlier exercises are continued. Standing and walking with the help of walker is commenced as soon as pain is tolerable and thigh muscle power is restored. Most knee replacement patients begin standing and walking with the help of a walking support and a physiotherapist, 3 to 4 days after surgery. The physiotherapist will teach the patient specific exercises to strengthen your muscles and restore movement in your knee for walking and other normal daily activities.
Day 3, 4, 5: Everyday, the same exercise schedule is followed and it is repeated as much as possible. Toilet training and stair climbing training is given once the patient gains confidence to undergo such activities. Once surgical wound healing is satisfactory and the patient has regained his ambulation, he / she is discharged from the hospital.
Recovery at Home
The success of the surgery depends on how well the patient follows instructions regarding home care during the first few weeks after surgery.
Wound Care: The staples will be removed about two weeks after surgery. Avoid getting the wound wet until it has thoroughly sealed and dried. A bandage may be placed over the wound to prevent irritation from clothing or support stockings.
Diet: Some loss of appetite is common for a few days after surgery. A balanced diet, often with an iron supplement, is important to promote proper tissue healing and restore muscle strength. Be sure to drink plenty of fluids.
Activity: Exercise is a critical component of home care, particularly during the first few weeks after surgery. The patient should be able to resume most normal light activities of daily living within three to six weeks following surgery. Some discomfort with activity, and at night, is common for several weeks.
Activity program should include:
- A graduated walking program initially in home and later outside.
- Walking program to slowly increase mobility and endurance.
- Resuming other normal household activities.
- Resuming sitting, standing, walking up and down stairs.
- Specific exercises several times a day to restore movement.
- Specific exercises several times a day to strengthen your leg muscles.
It is advisable to hire a physiotherapist to help with these activities at home.