University of Maryland Rehabilitation & Orthopaedic Institute
410-448-2500 or 1-888-453-7626

Programs and Services

Total Joint Replacement

Total Knee Patient Pathway

We specialize in the care of patients undergoing joint replacement surgery and are dedicated to returning individuals to independent living and improved quality of life. The Patient Pathway to Healing below lists what you can expect to happen on the first three days following total knee replacement surgery.

Day 1

Activity

  • You should do ankle pumps while you are in bed.
  • Your leg will be in a CPM machine to keep your knee moving.
  • Physical therapy is twice a day. You will be out of bed and in a chair.
  • The physical therapist will help you walk with a walker or crutches.
  • Follow knee precautions with all movements.
  • Occupational therapy will assist you in the activities of daily living.

Medications

  • Your pain medications will be controlled with a PCA pump.
  • You will receive antibiotics to prevent infection.
  • You will receive blood thinners and wear antiembolism stockings to prevent blood clots.
  • Your will begin a stool softener to avoid constipation.

Breathing Exercises

  • Deep breathing using the incentive spirometer every two hours is important to prevent pneumonia.

Diet

  • You will start with clear liquids and advance to a regular diet.

Self Care

  • You can feed yourself.
  • You can bathe your face and upper body. The nurse will assist you with your legs.
  • Bring loose fitting clothes and sturdy shoes that don't slip (like tennis shoes) to use during physical therapy and when you practice dressing with the occupational therapist.

Planning Your Discharge

  • You will meet with the case manager to plan your discharge.

Day 2

Activity

  • Follow knee precautions with all movements.
  • Physical therapy is twice a day.
  • The physical therapist will help you with knee exercises and walking with a walker or crutches.
  • Occupational therapy will assist you in the activities of daily living.
  • When you are out of bed, your operative leg should be extended.
  • Your leg will be in the CPM machine while you're in bed.
  • NO PILLOWS UNDER KNEE.

Medications

  • Your pain will be managed with oral medication.
  • You will continue to receive blood thinners and wear the antiembolism stockings to prevent blood clots.
  • You will receive a stool softener to avoid constipation.

Breathing Exercises

  • Deep breathing using the incentive spirometer every two hours is important to prevent pneumonia.

Diet

  • You will be on a regular diet.

Self Care

  • You will be able to bathe yourself with help for your legs.
  • You will be out of bed to the bathroom with assistance. A bedside commode will be available if you are unable to walk to the bathroom.
  • Walking to the bathroom helps build your strength and prepare you for discharge.

Planning Your Discharge

  • Your discharge plans are finalized and will be discussed with you and your family.
  • You will work with the PT therapist, the OT therapist, and the nurse to identify equipment you will need at home. The therapists will arrange for the equipment to be delivered to your home.
  • You will plan your transportation and discuss getting in and out of a car with your therapist.
  • If you have stairs at home, the physical therapist will instruct you on how to go up and come down on crutches or with a walker.
  • If you are going to rehab, the case manager will make the arrangements for you.

Day 3

Activity

  • You will be able to get out of bed independently.
  • You will be able to walk with a walker or crutches.
  • You will receive PT and OT before discharge.
  • You will be independent with your exercise program at home.
  • NO PILLOWS UNDER YOUR KNEE.

Medications

  • Your pain will be managed with oral medication.
  • A review of the medications you are going to take at home will be included with your discharge instructions.
  • DO NOT DRINK ALCOHOLIC BEVERAGES WHILE YOU ARE TAKING PAIN MEDICATIONS.

Breathing Exercises

  • Do your deep breathing exercises every two hours while you're awake.

Diet

  • You will be on a regular diet, but to help prevent constipation eat plenty of fresh fruits and vegetables and drink several glasses of liquid daily.

Self Care

  • You will walk to the bathroom with one of the staff.
  • You will be able to dress and bathe yourself with some help for your legs.

Planning Your Discharge

  • Follow knee precautions with all movements.
  • You and your family will receive verbal and written discharge instructions.
  • The nurse will review instructions for your care at home, including care of your incision, the signs and symptoms of infection and complications of your knee surgery. The nurse will also review the sign and symptoms of blood clots in your leg.
  • The nurse will review good nutrition and its importance in wound healing.
  • Your doctor may request home care services such as visiting nurses and physical therapy.
  • If you are going to rehab, your PT and OT will continue there.