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Wound Dressing After Total Knee Replacement

Number Of Dressing Changes And Post

How Should I Care for My Wound After Knee Replacement Surgery?

Patients were discharged from the hospital if they met specific criteria, such as the ability to perform independent personal care, walk at least 70 m on crutches, get in and out of bed and get up from chairs and were treated with oral pain relief . The post-operative hospital stay was computed as the whole day, whereas the part less than one day was also calculated as one day. After discharge, the patient was assigned to a chat group in which the dressing was photographed and evaluated under the guidance of medical personnel. We kept track of the total number of dressing changes.

How Do You Clean Yourself After Knee Surgery

Make certain that the hard-to-reach areas are thoroughly cleaned with a long-handled sponge. To keep the floor dry and prevent slipping, use a rubber-backed bath mat. You can bathe in a shower chair if you prefer. Increase the height of your toilet by using a toilet seat with a raised rim or a toilet chair.

How Do I Manage Pain And Discomfort After Joint Replacement Surgery

Try to take your pain medication as soon as you begin to feel pain. Dont wait until the pain becomes severe. Follow the instructions on the prescription label. Remember to take your pain medication before activity and bedtime.

If you need to have stitches or staples removed and youre still taking pain medications, be sure to have a friend or family member drive you to your appointment.

Pain medication may cause nausea. If this happens, decrease the amount you are taking or stop and contact your surgeons office.

If you need additional pain medication, please contact your surgeons office. Give at least a few days advance notice before you run out of the medication. Please plan ahead, especially for holiday weekends.

Also remember:

  • You arent permitted to drive a car while taking narcotic pain medication.
  • It may take several days to have a bowel movement. Anesthesia and pain medication often cause constipation. Drink plenty of fluids and eat whole grains, fruits, and vegetables. A stool softener or laxative can help bowel function return to normal.
  • Dont hesitate to call your surgeons office with any questions or concerns.

Incision care

Walker, crutches, cane

Use your assistive devices for balance as instructed by your surgeon or therapist. By your first post-op visit with your surgeon, you may have already improved and changed from using a walker or crutches to a cane .

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When Can You Go In The Water After Knee Surgery

Because everyones recovery process varies, you should consult with your doctor before jumping into the water. After the stitches have been removed or dissolved, it is usually safe to swim for a few days following the procedure. Aside from any soreness following surgery, you should also consider any subsequent pain.

Flexion And Extension Contracture

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Contracture is a shortening of the muscle itself. So, fibrosis is something that sets up, like we talked about, as a spiderweb, and it connects bone to bone. Contracture is an actual shortening of the muscle, the tendon, because its been in a short position for so long. You know that whole use it or lose it? Thats real. That really happens. And so if you dont move that muscle, its going to contract, its going to stay short, because thats all it ever had to do. And thats why sometimes strengthening after a knee replacement takes longer, because you most likely didnt have that range of motion before surgery.

If you had a knee, and that knee was only bending to 70 degrees, then the quadriceps knew that it had to work from 70 to zero, and thats all the quadriceps had to do. And the hamstrings only pulled the knee back to 70 degrees. They didnt pull it back any further, right? So, those muscle fibers that exist after 70 degrees on either side of the joint, theyre on vacation, and they like being on vacation.

And when you ask them to start working again it takes a little bit of time for them to remember what their goal was, what their target was, what their job is.

Scar tissue and swelling after knee replacement are the biggest challenges for most patients. Do your homework and make a plan for your recovery. With a good physical therapist and the right approach to recovery you will get back to your life in no time.

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Reasons Some Incisions Dont Heal

Many medical conditions can significantly impact the stages of healing and the strength of the final scar. Some of these conditions can be prevented or at least minimized, while others may not be as easy to modify. A few of the common conditions that impact wound healing and strength include:

For these reasons, most joint replacement programs will advise people having any type of joint replacement surgery to optimize these conditions prior to surgery.

For example, ensuring proper nutrition, controlling blood sugar , managing rheumatoid drugs, weight loss, and tobacco cessation are all steps that people can take to lower their risk of wound healing complications after knee replacement surgery.

In addition, some surgeons may advise against performing knee replacement surgery in particularly high-risk individuals. While everyone wants to believe their surgery will go well and without complication, there are individuals who may be better and more safely managed with nonsurgical treatments, particularly if they are at high risk for healing complications after knee replacement surgery.

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Application Of The Dressing

Cefoxitin, a prophylactic antibiotic, was regularly administered 30 min before surgery. Tranexamic acid was given intravenously twice before exposure and wound closure. Duration the operation, all patients had a standard three-layer continuous suture approach performed in about 45° flexion of the knee. The incision was closed by two fixed residents. The articular capsule was sutured continuously with 2# absorbable knot-free unidirectional barb suture , while the subcutaneous tissue was sutured continuously with 0# absorbable knot-free bi-directional barb suture . We used 3-0 absorbable knot-free bi-directional barbed sutures in the skin .

The new dressing system was used as follows in the intervention group:

1. After suturing the surgical incision, thoroughly deiodinase the skin of 10 cm around the incision with 75% alcohol.

2. Fold the calcium alginate dressing into three layers in the long axis direction and keep it slightly longer than the notch 1 cm.

3. Based on the length of the incision, 3 to 4 pieces of IV3000 film were selected when the knee flexion was about 45°, Following that, glue the middle one first and then the film from the distal end to the proximal end. The two ends of the films were roughly 4 cm longer than the incision and the overlap between the two films was about 1 cm in length. There were no air bubbles between the films and the skin, thus they adhered to the skin.

Figure 2. The appearances of wound dressings .

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Number Of Dressing Changes

Every time a dressing is changed, there is a potential risk for introducing pathogens into the wound, which can subsequently lead to SSI or periprosthetic joint infection . Wound dressings keep the wound near core body temperature, which increases the rate of miotic cell division and leukocyte activity that is necessary for wound healing. When a dressing is changed, it takes 3-4 hours for the cellular activity of the wound to resume. Hence, episodic cooling associated with dressing changes should be avoided as much as possible . Also, fewer dressing changes protects the wound from repeated exposure to pathogens in the surrounding air.

Abuzakuk et al. demonstrated that there were less dressing changes for hydrofiber dressings within the first five postoperative days compared to the use of a central pad group. They theorized that leaving the hydrofiber dressing undisturbed for a longer period of time could help prevent wound infections.

When To Call Your Surgeon

Total Knee Replacement – DERMABOND PRINEO Wound Drainage | ETHICON
  • a temperature of 101.6 F or higher
  • a sudden increase in drainage, draining lasting more than five days after your surgery, or drainage that is yellow in color or foul-smelling
  • severe discomfort, fatigue or pain
  • severe swelling that does not improve each day
  • blisters around your incision
  • any change in movement such as new weakness, firmness in your calf muscle or inability to move as usual
  • any questions or concerns

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Recovery Time For Minimally Invasive Surgery Vs Major Surgery

After minimally invasive surgeries such as keyhole surgery, a typical patient is able to resume normal activities within three weeks. Following major surgeries, such as kidney removal to combat cancer, the recovery time can range between 12 and 24 weeks. While you may stay in the hospital for a few days following surgery, you should be able to leave the hospital the day or the following day.

What To Do When An Incision Doesn’t Heal

If you have a non-healing wound, you need to involve your surgeon as soon as possible. If the surgical incision is draining more than 72 hours after surgery, people should either remain in the hospital for observation or have very close out-patient follow up to ensure the wound does continue to heal.

In situations where the drainage is declining, and there is no other sign of infection, these wounds can slowly heal. However, they do require close follow-up as a change in direction should signal more aggressive intervention.

Often physical therapy will be limited in these patients, and bending the knee beyond about 45 degrees may be held for a few days. Bending the knee increases the pressure on the tissues around the scar, and also can lower the oxygenation of those tissues. Keeping the leg straight can help dry an incision in some instances.

Blood-thinning medications can also contribute to a draining wound, and for this reason, sometimes anticoagulation will be held for a period of time in someone who has a persistently draining surgical incision.

If a wound is draining beyond one week after surgery, surgery should be undertaken to ensure there is no sign of a deeper infection and to prevent infection from becoming a problem. There is no role for the administration of antibiotic treatment in the absence of surgical treatment for this type of problem.

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Removing Your Dressing After Knee Surgery

After knee surgery, it is important to remove the dressing in a timely manner to allow the wound to begin the healing process. The dressing should be removed within 24-48 hours after surgery, unless otherwise directed by your surgeon. Once the dressing is removed, you should clean the wound with soap and water.

After you leave the hospital, you can shower and wear a waterproof dressing. Allow the dressing to soak in water for a few minutes before rinsing the area with a soft cloth. Dry the paper with a towel after it has been gently patted down. The patient or joint coach may remove the clear mesh dressing after 21 days.

It is possible to remove the bandages 2-3 days after surgery, but only to remove the sterilants. If you have any wounds that need to be covered, you should apply a small sterile dressing and wait for your appointment. When showering, it is critical to ensure that your wounds are kept dry. To relieve pain and swelling, apply ice to your knee at least once a week.

Getting Sleep After Knee Replacement Surgery

Smith &  Nephew Replicare Hydrocolloid Wound Dressing

Knee pain and stiffness can make getting sleep challenging. Higher doses of pain medication, or stronger pain medications, may be needed at night in order to sleep.

It can be dangerous, even life-threatening, to take sleep medications and pain medications together. Only take sleep medications if approved by the overseeing surgeon.

Initially, getting in and out of bed can be awkward and painful. Over the first two weeks, it will get easier and less painful.

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How To Spot A Problem With An Incision

The signs to look out for when inspecting an incision suspected of having a healing problem include:

  • Persistent or worsening drainage from the incision
  • Grey or dusky tissues around the incision
  • Broken sutures or skin staples that have come out of the scar area

The most common signs of a wound healing problem are persistent or worsening drainage after surgery. It is normal for a surgical wound to have some drainage immediately following surgery, but drainage beyond 72 hours after wound closure is not considered normal.

While some spotting on a bandage after 72 hours may not be a cause for concern, more than 2 centimeters of drainage on a gauze bandage is not considered normal and should be monitored by your surgeon.

Your surgeon will need to determine if the drainage is coming from around the incision or from deeper around the knee replacement implant. In addition, he or she will need to determine if the drainage shows signs of infection. If the drainage is from the deeper part of the wound or potentially infectious, then surgery will likely be necessary for treatment.

Reasons Some Incisions Don’t Heal

Many medical conditions can significantly impact the stages of healing and the strength of the final scar. Some of these conditions can be prevented or at least minimized, while others may not be as easy to modify. A few of the common conditions that impact wound healing and strength include:

For these reasons, most joint replacement programs will advise people having any type of joint replacement surgery to optimize these conditions prior to surgery.

For example, ensuring proper nutrition, controlling blood sugar , managing rheumatoid drugs, weight loss, and tobacco cessation are all steps that people can take to lower their risk of wound healing complications after knee replacement surgery.

In addition, some surgeons may advise against performing knee replacement surgery in particularly high-risk individuals. While everyone wants to believe their surgery will go well and without complication, there are individuals who may be better and more safely managed with nonsurgical treatments, particularly if they are at high risk for healing complications after knee replacement surgery.

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Permeability And Absorptive Capacity Of Dressing

Scientists have long believed that wounds should be kept dry in order to promote healing and formation of scar tissue. However, recent studies have demonstrated that moisture enhances the wound healing process and protects nerve endings from exposure and drying out. Wound exudate contains cells and growth factors that create the moist environment necessary for wound healing, but its accumulation can result in peri-wound blister formation. An ideal dressing should absorb the excess amount of exudate, but maintain a moist environment for wound healing .

To date, however, we still do not know exactly how much exudate a wound needs. As the wound heals further, the amount of exudate produced gradually decreases to zero. Maintenance of the ideal moist environment for TJA incisions depend upon two properties of the dressing: absorptive capacity and permeability.

Foam dressings are another type of dressing used after TJA. In a study by Thomas and Young , fluid handling properties were compared between two types of foam dressings: Allevyn Adhesive , with an intelligent polyurethane film backing layer and ActivHeal® Foam Island with a standard backing film. The study revealed that the Allevyn Adhesive was significantly more permeable than the ActivHeal® Foam Island, which could potentially reduce the number of dressing changes. However, both dressings were similar with regards to the rate of moisture vapour transmission and absorbency.

Wear Loose Comfortable Clothes

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As I mentioned above, you will have staples in your knee for about 12 days. Short pants or athletic shorts make it easy to dress and also keeps the fabric from long pants off the wound.

Even after the staples have been removed long pants especially denim can cause discomfort. If you have to wear long pants, I recommend thin fabric or zippered pants that are specially made for post-surgery . Check out my article on what to wear after TKR.

This is another good reason to plan your surgery and recovery during warmer weather when less clothing is necessary.

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Caring For Your Wound After Surgery

The patient is then told to remove the dressing every other day, unless otherwise ordered by the doctor or nurse. If the dressing becomes wet, it must be changed. Following surgery, it is critical that the wound be kept clean and dry. It is necessary to drain and rinsed the wound with clean water to remove any liquid that accumulates on the wound. If the wound is not scrubbed, the patient can bathe after it has healed. It is a good idea to change the adhesive bandages on a regular basis.

Important Signs And Symptoms:

If any of the following signs and symptoms occur, you should contact Dr. Kiritsis office. Please be advised if a problem arises which you feel requires immediate medical attention or you are unable to contact Dr. Kiritsis office you should seek immediate medical attention at the emergency department or other health care facility you have access to.

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Common Symptoms After Surgery

Your incision will be swollen, bruised and may be red after surgery. These symptoms are common and part of the healing process. The following symptoms are also common after surgery:

  • temperature below 101.6 F
  • warmth or numbness around your incision
  • spotty drainage, red or clear in color, lasting for one to five days

It is important to monitor your symptoms every day to make sure your incision is healing properly.

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