Patients, surgeons, nurses, physical therapists, and home caregivers must all work together to ensure that the home recovery following outpatient knee replacement is successful.
Educating the patient and caregivers about what to expect before, during and after surgery is important. The health care team will provide education through 1-on-1 or group training, or through educational materials, such as pamphlets, smartphone apps, and videos. The patient and caregiver are responsible for:
- Using pain medications as instructed
- Doing physical therapy as instructed
- Keeping an eye out for signs of complications, such as infection
- Alerting the surgeon, his staff or the hospital of any issues or concerns in a timely manner
One study demonstrated that 84% of complications related to knee replacement surgery occur more than 24 hours after surgery.1 This means that all patients—even patients who spend a night or two in the hospital—should be vigilant after being discharged.
Controlling Pain After Knee Replacement
People considering same-day knee replacement surgery may have fear and anxiety regarding uncontrolled pain after surgery. Surgeons have learned to employ multiple pain-reducing therapies simultaneously or in sequence to help reduce post-surgical pain.
Multi-modal pain control
Using more than one type of pain treatment is called multi-modal pain control, or multi-modal pain management. Multi-modal pain control has been shown to reduce or eliminate the need for opioids and to minimize side effects related to treating pain. Multi-modal pain control is especially helpful during the first few days after knee replacement, when pain is most intense and unpredictable.
Examples of multi-modal pain control techniques include:
- Injections of local anesthetic into the affected joint tissues during knee replacement. This provides post-surgical pain relief without muscle weakness. The effects last about 12 to 24 hours.
- A peripheral nerve block that blocks pain signals to nerves in the leg. Only the specific limb on which the surgeon is operating is affected. Peripheral nerve blocks are typically administered before surgery. The effects typically last about 12 to 24 hours and may last as long as 36 hours. There may be a risk of temporary muscle weakness and some surgeons will provide a knee brace to use until the effects of the block wear off.
- NSAID’s, acetaminophen and steroid medications. For most people, these medications reliably decrease inflammation and pain.
- Opioid pain medications. Opioids, also called narcotics or painkillers, are strong pain relievers. Because of concerns about opioid addiction, misuse, abuse, as well as many adverse effects, opioids are typically prescribed for only a few days after surgery. They should only be used if the other pain treatments are not controlling pain.
Taking medications on a consistent schedule can help reduce pain after knee replacement. This fact is particularly important the first week after knee replacement.
Nausea is a common side effect of surgical anesthesia and pain medications. Anti-nausea medications can control most cases of nausea. These medications are typically given via IV during and immediately after surgery. In addition, anti-nausea pills will be prescribed to have available at home if needed. Staying well-hydrated can help as well.
Doing Physical Therapy at Home
Experts agree that physical therapy is essential to recovery after partial or total knee replacement. Physical therapy typically begins in the recovery room, where patients will be asked to stand and walk (usually with the aid of a walker) in the hours following surgery. However, there is no universally accepted physical therapy schedule prescribed to every patient.
Patients who undergo out-patient surgery will still be given specific exercises to do at home. These exercises should be done several times a day to enhance recovery and minimize the risk of deep vein thrombosis (DVT). Additionally, in-home or out-patient physical therapy, under the direction of a physical therapist, will also be prescribed.
When to Call for Help
One study2 showed that 90% of major complications occur within 4 days of knee replacement surgery. The surgical staff will teach the patient and caregivers to look for signs and symptoms of infection, deep vein thrombosis (DVT), and other complications.
In general, patients experiencing the following symptoms should call 911:
- Chest pain
- Shortness of breath
- Altered mental status or significant confusion
Other symptoms may be concerning but not an emergency. Patients experiencing the symptoms below are advised to call their surgeon’s office to decide whether an emergency room visit or follow-up office visit is necessary.
- Uncontrolled severe pain
- Significant swelling in the leg
- Copious wound drainage or wound drainage that persists beyond 3 days from surgery.
- Anything that is concerning or unusual—Communication is important
Patients considering outpatient surgery and their caregivers are advised to evaluate the pros and cons and become educated about postsurgical care responsibilities.