We are here to help you before and after your surgery.
Dr. Kurtz has created lots of information to get patients ready for their knee replacement surgery.
You can read Dr. Kurtz’s knee replacement instructions below.
You can download and read his instructions in this printer-friendly PDF here.
You can read Dr. Kurtz’s knee replacement consent form here.
You can check out our curated list of Amazon products that you may want to buy.
You can watch Dr. Kurtz’s knee replacement videos.
We can call in your routine post-operative medications before your surgery when you fill out this form.
Written Knee Replacement Instructions
One and Only Rule
Don’t Fall
Avoid slippery surfaces (icy sidewalks, wet floors, slippery grass hills, etc.).
Be careful getting in and out of the shower.
Use a walker until your balance has returned to normal.
Using a walker helps prevent falls better than using a cane.
Using a cane helps prevent falls better than not using any support devices.
Ask for help from your support person when you need it.
Do not try to go to the bathroom by yourself at 2 a.m. in the dark without your walker if you have not been walking independently during the day.
Caring for your incision
When you leave the hospital, your incision will be covered with a waterproof bandage. You may immediately shower (in the hospital or at home) with the waterproof bandage on your incision.
Contact Dr. Kurtz if your incision is draining more than 72 hours after surgery or if you are changing your bandage more than once a day.
If your incision is draining or looks inflamed, please take a picture of your incision with a smartphone and email the picture to Dr. Kurtz.
Please remove your hospital bandage on post-operative day #5.
If your incision is dry, then you do not need to put another bandage on it, but you can do so if you want.
After the bandage is removed, you may shower without covering your incision. You can let water run over your incision. Do not scrub your incision.
The area around your incision may feel warm for 3–4 weeks. If there is no drainage or redness, then that is okay.
Do not submerge your incision in water for 3 weeks (bath, pool, hot tub, lake, etc.).
There is no need to apply any creams or anti-scarring agents to your incision; however, if you want to apply these types of agents, please allow your incision to completely heal and then wait one more week before applying any lotions to your incision (typically 3–4 weeks after surgery).
Bruising will often appear around your ankle a few days after surgery as gravity pulls blood from your knee down to your ankle. This is normal and not a problem.
Dr. Kurtz closes all incisions with dissolvable sutures. No staples.
Vicryl sutures hold the deep tissues together.
Monocryl sutures hold the skin edges together.
These sutures dissolve in 4-6 weeks.
Occasionally, patients will see a small piece of suture stick out of their incision around 4-6 weeks as part of the suture has dissolved, and part of the suture has not.
If this occurs, email Dr. Kurtz a picture of your incision.
You can use some tweezers to remove the piece of suture.
Activity after surgery
Knee Range of Motion
Knee range of motion (i.e. full flexion and full extension) is the most important goal during the first two months after a knee replacement.
Physical Therapy (3 times a week) will help you achieve your full range of motion, but you need to do your exercises at home each day.
Work on achieving full extension at home by elevating your leg with pillows under your ankle, not under your knee. This is the perfect time to apply ice packs to the top of your knee to add a little weight to help your knee get more extension.
Work on achieving full flexion at home by sitting in a chair, bending your knee back as far as it will go, firmly planting your foot on the ground so that your foot will not slide, and then sliding your bottom forward in the chair so that your knee is forced to flex more. Hold that position for 10 seconds and then relax by sliding back in your chair. Repeat that process 10 times every 1-2 hours while you are awake.
A stationary bike is one of the best ways to achieve full flexion. You usually need about 110 degrees of flexion to get all the way around on the bike pedal. Warm up on the bike with the bike seat as high as possible and then lower the bike seat down to force more flexion in the knee to get a full rotation.
You should elevate and ice your leg as much as possible to decrease swelling.
Walking and Standing
You can bear full weight on your knee replacement and bend your knee without restrictions unless Dr. Kurtz has told you otherwise.
Walking and strengthening muscles are not important in the first two months of recovery.
During the first two months, you should walk frequently but only for short distances.
Frequent walks can help prevent blood clots.
Only walking short distances limits the initial stress on your bone. As your bone adapts to your knee replacement, you can increase your distance.
During the day, you should change rooms or move chairs every 1 to 2 hours to help prevent blood clots.
Avoid walking for long distances. Too much walking or standing can cause more swelling, stiffness, and achy pain. You do not need to try to get extra walking in.
If you overexert yourself with too much walking or standing, you may experience increased swelling, decreased knee range of motion, and increased achy pain for a few days after the activity. With rest, this achy pain will subside in a few days.
If you have considerable achy pain while lying in bed at night, you should decrease your activity the next day by standing and walking less.
Add up the cumulative minutes you spend standing and walking throughout the day. Stand and walk for less than 20 minutes each day during the first week. That means walking inside your house 4-5 times a day for 4-5 minutes (i.e. to go to the bathroom or get in the car to go to therapy). By the 4th week, you can probably stand or walk for about 60 minutes a day. By 2 months, you can probably stand or walk for 3-4 hours a day. Your endurance will increase with time.
You should avoid high impact activities like jumping, aerobics, tennis, and skiing during the first three months after your knee replacement.
Swelling
As shown on the graph below, on the day of surgery, your knee will likely have good range of motion and minimal swelling. A few days after surgery, your knee will likely have significant swelling and feel stiff (poor range of motion). Three or four days after surgery is often the most painful time in the recovery. Over the ensuing 2-3 months, your swelling will slowly diminish, and your range of motion will gradually improve.
TED or compression hoses are available by request to wear after surgery to decrease swelling. Most patients do not like to wear compression hoses, so we only provide them to patients who express a desire to wear them.
Sleeping
You may sleep on your back, side, or stomach.
If you sleep on your back, placing two or three pillows under your ankle can help with obtaining full extension, elevating the leg, and decreasing swelling.
Do not place a pillow under your knee at any time, as that position keeps your knee flexed and may cause you to develop a flexion contracture in your knee.
If you sleep on your side, you may place a pillow between your legs for comfort, but try to keep your operative leg as straight as possible.
A knee immobilizer may be worn if you are a side sleeper and have trouble getting your knee straight.
An over-the-counter or prescription sleep aid can be taken if you have difficulty falling asleep. (see medication section.)
If you are prone to insomnia, then limit your naps during the day, sit by a window during the day to help your body return to its normal circadian rhythm, and turn off all electronic devices an hour before bedtime.
Recliners/chairs
Please avoid sitting in recliners after your knee replacement. Recliners keep the knee bent 20 to 30 degrees and may cause you to develop a flexion contracture in your knee.
The ideal sitting position is to place two or three pillows under your ankle to elevate your leg and get your knee fully straight or extended. There should be nothing but air under the back of your operative knee. You need to keep your toes pointed straight up, as your leg will often want to externally rotate to allow your knee to flex. You may place additional weights on the top of your knee to assist in achieving even more extension.
Driving
You can drive when you are off narcotic medicine, able to bear full weight on your leg, and able to quickly move your foot off the gas pedal and onto the brake pedal. Dr. Kurtz does not have to release you to drive. You can determine when you are safe to resume driving. If you are in doubt about your ability to drive, then please refrain from driving.
If you want a temporary handicapped placard, please fill out this form. You can hand deliver or email your completed form to Dr. Kurtz. He will sign it and return the signed form to you. You can then take the signed form to the Tennessee county clerk to get your temporary handicap placard.
Cold Therapy
Cold therapy (i.e., an ice machine) is applied to your knee while you are in the hospital.
You can buy a cooling machine from Amazon for your recovery at home ($150).
You can buy ice packs from Amazon for your recovery at home.
You can rent a cooling machine from Game Ready ($300 for 14 days). Contact Dr. Kurtz to set this up.
Try to use cold therapy for 30 minutes on / 30 minutes off during the day for 3 weeks.
Try to use cold therapy constantly at night for the first three weeks.
Protect your skin while using cold therapy by putting a layer of clothing between the ice and your skin.
Return to work
Many patients must return to work after their knee replacement surgery.
All patients can return to work when they think they are ready.
Patients with a desk job can generally return to work 6 weeks after their surgery.
Patients with a physical job can return to work between 2-3 months after their surgery.
Many employers require the provider to send in paperwork about the employee’s absence.
Please send all workplace paperwork to Kristie.
615-963-3402 (fax)
615-963-1437 (office)
Physical Therapy
Prehab involves making one or two physical therapy visits before your surgery to learn some knee exercises and get a jump on your knee recovery.
Dr. Kurtz strongly recommends that you get some Prehab before your surgery.
Please email getPT@toa.com if you want to schedule prehab or post-operative physical therapy.
You will likely do physical therapy three times a week for four to six weeks after surgery.
You may continue physical therapy for more than six weeks if you so desire.
You will continue your home exercises for 3–4 months.
TOA has physical therapy locations at:
Brentwood
Clarksville: (931) 221-4743
Franklin: (615) 823-8256
Gallatin: (615) 567-5024
Hendersonville: (615) 724-9271
Lebanon: (615) 321-0200
Murfreesboro: (615) 278-1634
One City: (615) 263-0178
Skyline: (615) 823-8816
Smyrna: (615) 278-1660
St. Thomas West: (615) 234-7221
If there is not a TOA physical therapy location near your house, then we will assist you in scheduling your therapy close to your home.
Home Exercise Program
While you are awake, you should do the following exercises every hour.
Do 10 ankle pumps. Contract your calf muscles by pointing your forefoot down (plantar flex). Hold the contraction for 5 seconds, and then relax your calf muscle for 5 seconds. Repeat 10 times.
Do 10 chair slides. Sit in a chair with your knee flexed. Keep your foot on the floor and sliding your butt forward in the chair. Holding that maximum knee flexion for 5 seconds and then relax for 5 seconds. Repeat that process 10 times.
Do 10 Quad contractions. Pretend an egg is under your straight knee, contract your quads to drive the knee down into the bed, and crush the imaginary egg. Hold that contraction for 5 seconds, and then relax for 5 seconds. Repeat 10 times.
Do 10 knee extension stretches. Put your foot up on an ottoman or coffee table. Push down on the top of your knee to force full extension. Hold for 5 seconds, and then relax for 5 seconds. Repeat 10 times.
Walk to the kitchen and set a timer for 60 minutes.
Ice your knee in between your hourly exercises for the first 3 weeks.
Diet
Eating a healthy diet with plenty of protein after surgery can promote good wound healing.
High fiber diets and drinking plenty of water can help prevent post-operative constipation.
Avoid processed foods. Food that comes in a box or bag is typically processed carbohydrates, which temporarily spike your blood sugar. An hour or two later, your blood sugar falls, and you crave more processed carbohydrates. Obtaining your necessary calories from proteins, lipids, and naturally occurring carbohydrates helps smooth out your blood sugar curve and limits the high spikes in blood sugar that can harm wound healing.
Try to eat mostly whole foods (fruits, vegetables, and proteins).
Drink mostly water and low-calorie electrolyte drinks. Avoid sugary soda drinks and excessive alcohol.
If you are diabetic, make sure to keep your blood sugars below 140 to promote good wound healing.
Avoid drinking excessive alcohol while taking narcotics, as this can increase falls.
Post-operative Medicines
Filling your post-operative prescriptions before or after your surgery
Patients can fill their post-operative prescriptions at their local pharmacy before or after their surgery.
If you want to get your medications before surgery, please fill out this form.
If you want to get your medications after surgery, then Dr. Kurtz (or the hospital’s nurse practitioner) will e-prescribe your medications to your pharmacy when you leave the hospital or surgery center.
Please confirm with Dr. Kurtz’s team your pharmacy name and location where you want your post-operative medicines called in.
Blood Thinners
If you do not have a history of blood clots, you will take aspirin (81 mg twice a day) for 4 weeks after your knee replacement.
If you have a history of blood clots (DVT, PE) or can not take aspirin, then you will take Eliquis (2.5 mg once a day) Coumadin (dose varies), or Xarelto (10mg once a day) for approximately 4 weeks.
If you were on a blood thinner before surgery, we will likely resume your normal blood thinner after surgery.
Some patients who regularly take long acting blood thinners will need to be on Lovenox for a few days before and after your surgery while they come off of their long acting blood thinners.
NSAIDs
If you are regularly taking NSAIDs before surgery, you may continue taking your NSAIDs up until the day before surgery.
If you normally tolerate NSAIDs before surgery, you can start taking them after your surgery.
Dr. Kurtz will prescribe an NSAID for you, or you can take an over-the-counter NSAID.
Patients with a history of GI bleeds, kidney problems, heart failure, or uncontrolled blood pressure should not take NSAIDs unless Dr. Kurtz or their PCP says otherwise.
NSAIDs and aspirin bind to the same receptor on platelets, so patients should not take both medications at the same time. Patients should take their aspirin and then wait at least 2 hours before taking their NSAID.
NSAIDS and aspirin should not be taken on an empty stomach.
Patients usually take over-the-counter Pepcid (famotidine, 20 mg twice a day) for one month after their surgery to prevent stomach irritation from aspirin and/or NSAIDs.
If you are taking an NSAID and develop the symptoms of a GI bleed (blood in stool, low blood pressure, extreme fatigue, anemia, abdominal pain), then please go to the ER and contact Dr. Kurtz on the way.
Narcotic Pain Medicine
Most patients will take tramadol (Ultram), hydrocodone (Norco), or oxycodone (Percocet) for a few weeks after surgery.
For the first 1-2 weeks after surgery, patients will typically take narcotic pain medicine 2-4 times a day.
After 1-2 weeks, patients should decrease their narcotic pain medicine to just 1-2 times a day (right before physical therapy and bedtime).
Narcotic medicine can cause nausea, vomiting, constipation, and loss of appetite.
All narcotic refills require an electronic signature from Dr. Kurtz.
If you need a refill, please email Dr. Kurtz
Non-narcotic pain medicines
In addition to taking narcotic pain medicine, many patients will also take non-narcotic pain medicines to help control their pain and limit their use of narcotics.
Tylenol (i.e. acetaminophen) can be taken every 6-8 hours.
Patients should not take more than 4 grams of Tylenol (acetaminophen) a day.
Percocet (oxycodone/acetaminophen) and Norco (hydrocodone/acetaminophen) have 325 mg of acetaminophen in each tablet, so you must include the acetaminophen in your narcotic tablets when calculating your total daily acetaminophen usage.
Prednisone (i.e. steroids, Medrol dose pack) can help with swelling, inflammation, range of motion, and pain control.
Side effects of prednisone include increased appetite, blood sugar, and activity.
Diabetics must be careful when taking prednisone.
Prednisone requires a prescription, so contact Dr. Kurtz if you want him to prescribe it.
Neurontin (Gabapentin) can help with nerve pain.
Neurontin works on the Gaba receptors in nerves to decrease nerve inflammation.
Side effects of Neurontin include drowsiness and not feeling like yourself.
Neurontin requires a prescription, so contact Dr. Kurtz if you want him to prescribe it.
NSAIDS are helpful adjuncts to pain control as discussed above.
Toradol is a strong NSAID can help with post-operative pain.
It is administered as an injection into the muscle in clinic.
It is usually given through your IV during your hospital stay.
Voltaren Gel is a topical ointment that can be applied to the sides of your knee. Do not put it directly on your incision for the first 3 weeks.
Lidocaine patches (Salonpas) can be applied to the sides of your knee to help with nerve pain.
Stool Softeners
Most stool softeners are available over the counter. If you are prone to constipation, it is helpful to start taking them a day or two before your surgery and continue as long as you are taking narcotic pain medicine.
Sleep aids
Some patients benefit from taking a sleep aid.
Dr. Kurtz recommends trying an over-the-counter sleep aid before trying a prescription sleep aid.
Over-the-counter sleep aids
Prescription Sleep Aids
Ambien
Lunesta
Restoril
If you feel like you need a prescription sleep aid, please email Dr. Kurtz, and he will consider prescribing a few tablets to get you back to your normal circadian rhythm.
Disposing of un-used narcotics
Leaving un-used narcotics in your medicine cabinet can be dangerous and lead to an inadvertent narcotic overdose by another individual.
After you have fully recovered from your knee surgery and no longer need pain medicine, it is advisable to dispose of your unused narcotics in an eco-friendly manner.
Dr. Kurtz recommends placing the un-used pills in a small plastic bag, adding some fluid (coke, coffee grounds, etc.) to the bag, and throwing the bag away in the trash.
Things to watch out for
Falls
Falls are the most common complication after surgery.
About one in every 50 patients will have a fall after knee replacement surgery.
About a third of falls cause serious bodily harm that may require hospitalization and/or another surgery.
Fall prevention includes:
Use your walker until your balance has returned to normal.
Ask your support person for help when needed.
Improve the lighting in your bedroom and bathroom.
Removing all cords and loose rugs from the floor.
Do not walk your large dog on a leash until your strength has returned to normal.
Avoid small bathrooms that cannot accommodate a walker.
Infection
All patients get IV antibiotics (Ancef or Vancomycin) before and after their surgery.
If you are at high risk for infection (diabetes, immune-compromised, smoker, or obese), then Dr. Kurtz may send you home from the hospital with an oral antibiotic (Keflex) for a week.
Please ask about an oral antibiotic at home if you feel like your immune system is weakened.
The rate of infection after a knee replacement is about 1 in 400.
If a patient were to get a post-operative infection, the earliest the knee infection would present would be four or five days after surgery. Most infections don’t present until two or four weeks after surgery.
Infections usually present as persistent drainage from the incision, redness around the incision, and/or a body temperature above 101.5.
A low-grade temperature (100.5 and lower) is common for 4-5 days after surgery, especially if you had a general anesthetic.
If an infection were to occur in the first 4-6 weeks, Dr. Kurtz would wash out your knee, put you on IV antibiotics for 6 weeks, and then oral antibiotics for months.
If an infection were to occur months after your surgery, then Dr. Kurtz may have to remove the implants, put you on IV antibiotics, implant a new knee in 2 months, and keep you on oral antibiotics for months.
Blood Clots
Blood clots (DVT) can cause calf pain with stretching, swelling, and tenderness to palpation in the calf. Unfortunately, calf pain and swelling are very common after knee replacements, for obvious reasons.
If a patient suspects they have a DVT, they should contact us so we can order a doppler ultrasound.
Chest pain or difficulty breathing could represent a pulmonary embolus and should be evaluated in the emergency room as soon as possible.
Constipation / Post op ileus
Multiple factors can slow down your bowels after surgery.
Not eating on the day of your surgery.
Anesthesia and narcotic medications.
Decreased activity and bed rest.
Most patients do not have a bowel movement for 2–3 days after surgery.
If you have not had a bowel movement in 3–4 days, your belly gets distended, or you develop nausea and vomiting, then you may have a post op ileus.
If you are constipated (post op ileus) then,
Drink water.
Limit your food intake and only eat soft food.
Move around as much as possible.
Take one or more of the stool softeners listed above.
If you feel nauseated, contact Dr. Kurtz and go to the hospital. You would likely be admitted and have an NG tube placed in your stomach to suck out the contents until your bowels wake up.
Urinary Retention
Some elderly men are prone to urinary retention after surgery because of their enlarged prostate.
If you are concerned about urinary retention, Dr. Kurtz can start you on Flomax a few days before surgery and continue the Flomax for a week or so after surgery.
Blistering
Swelling can cause blistering around your knee.
When blistering occurs, it usually starts around postoperative day #3-4.
Blistering can occur when severe swelling stretches the skin and separates the epidermis from the dermis.
Shear stress on the skin from adherent dressings can increase the likelihood of blistering.
If blistering appears,
Remove any bandages that are adherent to your skin. (i.e. the waterproof bandage.)
Send Dr. Kurtz a picture of the blister via email or Get Well.
Elevate your leg as much as possible to decrease the swelling.
Do not pop or rupture the blister. The blisters will rupture on their own in a few days. You want the skin that covers the blister to cover the area for as long as possible.
You may wrap your leg in an ACE wrap to help decrease the swelling. Start at the foot and wrap up to the thigh.
These blisters may take 3–4 weeks to heal.
Equipment for home
You will likely use a walker and/or cane for the first one to two weeks after your knee replacement. TOA and/or the hospital can provide you with a walker if you need one. If TOA provides you with these products, then TOA will bill your insurance.
Amazon has many products that can be helpful during your knee replacement recovery. Products bought on Amazon are self-pay and not billed to your insurance company.
cane,
Check out our detailed list of curated Amazon products for knee surgery.
Post op clinic appointment
Patients can schedule a clinic visit anytime with our online appointment scheduling:
Post-operative patients are welcome to come into the clinic anytime. Dr. Kurtz is in clinic on Mondays, Wednesdays, or Fridays.
Just call or email us ahead of time, so we know you are coming.
If you need to be seen on a Tuesday or Thursday, we will make arrangements for you to be seen by one of Dr. Kurtz’s colleagues.
The routine post-operative appointment is scheduled for 4 weeks after surgery. We will take an x-ray of your knee replacement and give you a copy of the x-ray.
Helpful Videos
Please check out our extensive list of educational videos related to knee replacements.
Can I go home on the day of surgery?
Lateral numbness
Kneeling
Activities
Pain medicine
Concerns
Driving
Leg Discoloration
Swelling and stiffness
Travel after surgery
Knee replacements make noise
Follow up visits
Post op wound care
Drive, work, and travel
How to optimize your knee recovery
Watch Dr. Kurtz perform a knee replacement
Meet the Team
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Katie Vanhooser
Physician Assistant
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Kristie Sheperd
Medical Assistant
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Hayley Bailey
Surgery Scheduler
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Will Kurtz
Orthopedic Surgeon
Thank you for reading this material. Our team is here to help you with your recovery. If you have questions, we will provide you with the answers. Maintaining a positive attitude and staying engaged in your recovery are the best ways to ensure a great outcome.
Best wishes for a speedy recovery,
Will Kurtz, M.D.
Hip and Knee Replacement Surgeon
Tennessee Orthopaedic Alliance