Discharge Instructions & Physical Therapy Protocol for Unicompartmental Knee Replacement

Recovery after knee surgery entails controlling swelling and discomfort, healing, return of range-of-motion of the knee joint, regaining strength in the muscles around the knee joint, and a gradual return to activities.  The following instructions are intended as a guide to help you achieve these individual goals and recover as quickly as possible after your knee surgery.

Comfort

• Elevation - Elevate your knee and ankle above the level of your heart.  The best position is lying down with two pillows lengthwise under your entire leg.  This should be done for the first several days after surgery
• Swelling - A cooling device may be provided to control swelling and discomfort by slowing the circulation in your knee.  Initially, this can be used continuously for the first 3 days, (while the initial post-op dressing is on). After 3 days, the cooling device should be applied 3 times a day for 10-minute intervals. If a cooling device is not provided at the time of surgery, place crushed ice in a plastic bag over your knee for no more than 20 minutes, three (3) times a day. Compression stockings worn on both legs will also reduce swelling and decrease the risk of blood clots. These should be used for 6 weeks following your surgery
• Pain Medication - Take medications as prescribed, but only as often as necessary. Avoid alcohol and driving if you are taking pain medication
• Antibiotic Medication - If an antibiotic has been prescribed, start taking the day of discharge from the hospital. Continue taking until the prescription is finished
• Blood Thinning Medication - Take Aspirin 325mg once a day for 6 weeks after surgery to help prevent a blood clot from forming
• Driving - Driving is not permitted until seen by your doctor at your first postoperative visit. Generally driving an automatic vehicle is allowed 2 weeks after Left Unicompartmental Knee Replacement and 6 weeks after Right Unicompartmental Knee Replacement

Activities

• Range-of-Motion - Move your knee through range of motion as tolerated. This must be done while sitting or lying down
• Exercises - These help prevent complications such as blood clotting in your legs.  Point and flex your foot and wiggle your toes. Thigh muscle tightening exercises should begin the day of surgery and should be done for 10 to 15 minutes, 3 times a day, for the first few weeks after surgery
• CPM - (Continuous Passive Motion Machine) - A Continuous Passive Motion (CPM) machine should be started the day after your surgery. This machine will be set at 30°. Motion on the machine should be increased at 10-15° per day or as much as tolerated, to a maximum of 90° within two weeks. The machine should be used 6 hours per day (i.e. 2 hours in the morning, 2 hours in the afternoon and 2 hours in the evening). Use of the machine will continue until Dr. Forsythe discontinues (approximately 2 weeks). DO NOT WEAR COOLING DEVICE WHILE USING CPM MACHINE
• Weightbearing Status - You are allowed to put all of your weight on your operative leg. Do this within the limits of pain. Two crutches or a walker should be used until directed to discontinue by Dr. Forsythe
• Physical Therapy - PT begins in the hospital the day after your surgery and continues once you are home. You should call the physical therapist of your choice for an appointment. A prescription for physical therapy, along with physical therapy instructions (included in this packet) must be taken to the therapist at your first visit. Depending on your ability to ambulate, you may have a home therapist arranged for you by the hospital prior to discharge. You should begin outpatient Physical Therapy as soon as possible
• Athletic Activities - Athletic activities, such as swimming, bicycling, jogging, running and stop-and-go sports, should be avoided until allowed by your doctor
• Return to Work - Return to work as soon as possible.  Your ability to work depends on a number of factors - your level of discomfort and how much demand your job puts on your knees.  If you have any questions, please call your doctor
• Antibiotic Prophylaxis - Having a Unicompartmental Joint Replacement requires you to take antibiotics prior to all future procedures that may cause bleeding. These include
  • Dental cleaning
  • Dental procedures
  • Surgical procedures
  • Colonoscopies or Endoscopies
  • Notify your physician or dentist prior to any procedure so antibiotic treatment can be starte

Wound Care

• Once home from the hospital, change your dressing daily by applying sterile 4x4's with tape and reapply the compression stockings. The steri-strips and sutures will be removed at your first postoperative visit
• Tub bathing, swimming, and soaking of the knee should be avoided until allowed by your doctor - Usually 2 - 3 weeks after your surgery
• You may shower 5 days after surgery, after the initial dressing has been removed.  Cover the wound with plastic wrap while showering. Extreme caution and care should be taken when showering. Use of a shower chair is strongly recommended

Call your physician if

• Pain in your knee persists or worsens in the first few days after surgery
• Excessive redness or drainage of cloudy or bloody material from the wounds (Clear red tinted fluid and some mild drainage should be expected). Drainage of any kind 5 days after surgery should be reported to the doctor
• You have a temperature elevation greater than 101°
• You have pain, swelling or redness in your calf
• You have numbness or weakness in your leg or foot
• You experience excessive bleeding while taking the Aspirin to prevent blood clots

Return to the office

• Your first return to our office should be 2 weeks after your surgery.  Call your Dr. Forsythe’s office to make an appointment for this first post-operative visit.

Rehabilitation Guidelines for Unicompartmental Knee Replacement

GENERAL CONSIDERATIONS

• All times are to be considered approximate, with actual progression based upon clinical presentation
• Patients are full weightbearing with the use of crutches, a walker or a cane to assist walking until they are able to demonstrate good walking mechanics
• Early emphasis is on achieving full extension equal to the opposite leg as soon as able
• No passive or active flexion range-of-motion greater than 90° for the first two weeks
• No two-legged biking or flexion exercises for at least two weeks.  Well-leg biking is fine
• Regular manual treatment should be conducted to the patella and all incisions so they remain mobile
• Early exercises should focus on recruitment of the vastus medialis obliquus (VMO)
• No resisted leg extension machines (isotonic or isokinetic) at any point in the rehab process

WEEK 1

• Goal is to allow the medial arthrotomy to heal and decrease swelling
• Icing, elevation, and aggressive edema control (i.e., circumferential massage, compressive wraps)
• Straight leg raise exercises (standing and seated), passive and active ROM exercises
• Okay to gently bend knee < 90° 1-2 times per day
• Initiate quadricep/adduction/gluteal sets; gait training, balance/proprioception exercises
• Well-leg cycling and upper body conditioning
• Soft tissue treatments and gentle mobilization to the posterior musculature, patella, and incisions to avoid flexion or patella contracture

WEEKS 2 - 4

• Physician visit 10 - 14 days post-op for suture removal and check-up
• Continue with home program, progress flexion range-of-motion, gait training, soft tissue treatments, and balance/proprioception exercises
• Incorporate functional exercises as able (i.e., seated/standing marching, hamstring carpet drags, hip/gluteal exercises, and Core stabilization exercises)
• Aerobic exercise as tolerated (i.e., bilateral stationary cycling as able, UBE, pool workouts once incisions are healed)

WEEKS 4 - 6

• Physician visit 4 - 6 weeks post-op
• Increase the intensity of functional exercises (i.e., progress to walking outside, introducing weight machines as able)
• Continue balance/proprioception exercises (i.e., heel-to-toe walking, assisted single leg balance)
• Slow-to-normal walking without a limp

WEEKS 6 - 8

• Add lateral training exercises (i.e., lateral steps, lateral step-ups, step-overs) as able
• Incorporate single leg exercises as able (eccentric focus early on)
• Patients should be walking without a limp and range-of-motion should be ≤ 10° extension and ≥ 110° flexion

WEEKS 8 - 12

• Begin to incorporate activity specific training (i.e., household chores, gardening, sporting activities).
• Low impact activities until after Week 12.
• Patients should be weaned into a home/gym program with emphasis on their particular activity/sport