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    Total Knee Replacement: Caring for Yourself at Home

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    This guide provides you with precautions about sitting and moving safely and illustrations to help you perform your daily exercises.

    When you are at home, be sure to exercise your new knee as shown by your therapists.

    What is the Focus of Rehabilitation?
    The focus of our rehabilitation program at California Pacific Medical Center is to make you as independent as possible in your daily life activities. The following guidelines have been developed by therapists and your medical team to ensure your best possible recovery. It is important to follow these guidelines to experience a successful recovery from your total knee replacement surgery. If you have any questions, do not hesitate to ask the doctors, nurses, and therapists caring for you.

    Going Home

    This information will help you manage your care at home. If you have any additional questions, please ask your doctor, nurse, or therapist.

    Many patients go home 3-4 days after their surgery. You and your surgeon will decide what is best for you. Usually, you will be discharged if:

    1. You know the signs of surgical complications:

      • Increasing pain in your new knee.

      • Persistent and/or increasing pain or swelling in your calf or leg.

      • Excessive redness, heat or drainage at your surgery site.

      • Fever of 101°F or higher.
    2. You know all the medications you are taking, their purpose and possible side effects

    3. Your physical and occupational therapists have confirmed that you can perform daily activities and exercises:

      • Get in and out of bed by yourself.

      • Walk on your own at least 50 feet with your walking device.

      • Bathe and dress yourself using special tools without help.

      • Use the toilet or commode without help.

      • Stand for 10 minutes at a counter or sink to do simple tasks by yourself.

      • Be able to get in and out of the bathtub or shower safely and correctly based on your home bathtub/shower.

      • Climb up and down 12 stairs with help standing by (if you have stairs at home).

      • Be able to do your home exercise program as instructed by your therapist.

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    Activities of Daily Living

    Before you leave the hospital, you must meet the goals set by your physical and occupational therapists. They will prepare you for activities of daily living and instruct you on the best ways to move about.


    Standing
    • Move your operated leg forward and push off the arm rests of the chair to stand up.

    • Once you have your balance, reach for the walker.


    Using a Walker to Begin Walking, be sure to:
    • Move the walker first.

    • Then, move the operated leg forward.

    • Push down on your hands when you step forward with your non-operated leg.

    • Land on your heel and push off your toes when walking (a heel/toe pattern of walking). Take an equal number of steps with each foot. Make each step the same length.

    • Lean your back against the wall for support if you stop to talk with someone or if you become tired.

    • Frequent, short walks are recommended.


    Dressing
    Your occupational therapist will instruct you in the use of adaptive equipment to assist you with dressing if needed.
    • Putting on your pants: Put the operated leg into the pant leg first. Then put the non-operated leg into the other pant leg using a reacher or dressing stick.

    • Removing your pants: First, remove the non-operated leg from the pant leg. Then, remove the operated leg from the other pant leg using a reacher or dressing stick.

    • Tying your shoes: Use elastic shoelaces or slip-on shoes.
    Homemaking
    • Sit for rest breaks as needed.

    • Slide objects along the countertop rather than carrying them. Use a utility cart with wheels to transfer items to and from the table.

    • Attach a bag or basket to your walker or wear a fanny pack to carry small items.

    • Use a long-handled reacher ("grabber", "pick-up stick") to reach objects on the floor.

    • Remove all throw rugs and long electrical cords to avoid tripping in your home.

    • Watch out for slippery/wet areas on the floor.



    Bathing or Showering
    You may shower when approved by your doctor. You and your occupational therapist will discuss the correct technique to step into your shower stall or bathtub at home. We recommend that you install a hand held shower hose, which better enables you to bathe below your waist.
    • If you do not have non-skid strips glued to the floor of your shower stall or bathtub, carefully place a non-skid rubber bath mat on the floor of the stall or tub. Before starting the water, be sure that the suction cups on the underside of the mat are pushed down against the floor of the tub or stall.

    • Do not sit on the bottom of the bathtub to bathe during your recovery. Moving in and out of this position causes too much bending of your new knee.

    • Use liquid soap to avoid dropping a bar of soap.

    • A long-handled bath sponge will help in bathing below the knees.

    • During the first few showers at home, we recommend that you shower no longer than 10 minutes, using lukewarm water and keeping the bathroom well ventilated.

    • If needed, your therapist will discuss how to cover your incision for bathing.


    Climbing Up Stairs
    • Use a hand rail (if available) to climb stairs.

    • Lead with your non-operated leg, then your operated leg, and finally your crutches or cane.

    • A family member should stay one step below, standing on your operated side, when helping you climb stairs.


    Going Down Stairs
    • Use a hand rail (if available) to go down stairs.

    • Lead with your crutch or cane, followed by your operated leg, and finally your non-operated leg.

    • A family member should stay one step below, standing on your operated side, when helping you go down stairs.


    Getting Into a Car
    • Be sure the passenger seat is pushed all the way back.

    • Recline the seat back as far as possible.

    • With your walker in front of you, slowly back up to the car seat.

    • Sit on the car seat.

    • Swing your legs into the car.

    • When traveling, make frequent stops and get out and walk around.
    Getting Out of Car
    • Push the seat all the way back.

    • Recline the seat all the way back.

    • Lift your legs out. Place the walker up in front of you and stand up on the unaffected leg.

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    Tips for Your Recovery

    Caring for Your Knee When in Bed

    • Pump your ankles up and down 10 times every 2 hours to maintain good blood flow (circulation) to your lower legs.

    • Do not lie in bed with a pillow under your knee. This will interfere with regaining full knee mobility.
    Caring for Your Knee During the Day
    • Avoid sitting and/or standing for long periods (no more than 30 minutes in one place). Changing position frequently will increase blood flow, decrease joint stiffness, and decrease post-operative leg swelling.

    • To decrease pain, inflammation and swelling, ice can be placed on your knee for 15 - 20 minutes every hour or as tolerated.

    • Follow your home exercises program given to you by the hospital physical therapist.
    Caring for Your Knee at Home
    • Ask your doctor when:

      • You can take a shower.

      • You may start to drive and return to work.

      • Your staples will be removed, if you have staples.
    • Beginning your home exercise program:
      An important part of your recovery is following a home exercise program. When muscles are not used, they become weak and do not work as well in supporting and moving the body. Surgery can correct the knee problem, but the muscles will remain weak unless you strengthen them with regular exercise. To start the home exercise program, your therapist will teach you how to perform these exercises. Do your home exercise program as prescribed by your physical therapist.
    Caring for Your Surgical Incision
    • Keep your incision clean and dry until all the staples or stitches are removed.

    • If you have staples or stitches, they will be taken out about 10 - 14 days after your surgery. Your doctor, a nurse or therapist will remove the staples or stitches.

    • Do not apply cream or ointment to the staples or stitches unless instructed to do so by your surgeon.

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    Exercises

    Your therapist will show you how to do your exercises and will tell you how often to do them (indicated by "X" below).

    Ankle Pumps
    Bend ankles to move feet up and down, alternating feet.
    Repeat "X" times. Do "X" sessions each day.



    Quad Sets
    Slowly tighten muscles on thigh of straight leg while counting out loud to "X".
    Repeat with other leg to complete set.
    Repeat "X" times. Do "X" sessions each day.



    Gluteal Squeezes
    Squeeze buttocks muscles as tightly as possible while counting out loud to "X".
    Repeat "X" times. Do "X" sessions each day.



    Heel Slides
    Make sure bed is flat.
    Bend knee and pull heel toward buttocks.
    Hold for "X" seconds. Return. Repeat with other knee to complete set.
    Repeat "X" times. Do "X" sessions each day.



    Short Arc Quads
    Place a rolled towel under your knee. Raise the lower part of your leg until your knee is straight. Hold for "X" seconds.



    Straight Leg Raises
    Bend one leg. Keep other leg as straight as possible and tighten muscles on top of thigh.
    Slowly lift straight leg "X" inches from bed and hold "X" seconds.
    Lower it, keeping muscles tight "X" seconds. Relax.
    Repeat "X" times. Do "X" sessions per day.



    Hip Abduction
    Keep your toes pointed toward the ceiling. Move your leg out to the side as far as possible. Slowly return to the starting position and relax.



    Long Arc Quads
    Straighten operated leg and try to hold it for "X" seconds.
    Repeat "X" times. Do "X" sessions each day.



    Knee Slides
    Slowly slide your foot forward in front of you until a stretch is felt in the knee and hold for 10 seconds. Then slide your foot back as far as you can and hold for 10 seconds.
    Repeat "X" times. Do "X" sessions each day.

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    More Ways to Learn

    Visit the Community Health Resource Center at 2100 Webster Street, San Francisco, (415) 923-3155. Services include classes and written information on a wide variety of health topics.


    Produced by the Center for Patient and Community Education in association with the Department of Outcomes Management and the Communications & Marketing Department at California Pacific Medical Center. Last updated: 7/09

    Illustrations by: Troy Paiva


    Funded by: A generous donation from the Mr. and Mrs. Arthur A. Ciocca Foundation.

    Note: This information is not meant to replace any information or personal medical advice which you get directly from your doctor(s). If you have any questions about this information, such as the risks or benefits of the treatment listed, please ask your doctor(s).

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