About Your Knee Replacement Surgery

This guide will help you get ready for your knee replacement surgery at Memorial Sloan Kettering (MSK). It will also help you understand what to expect during your recovery.

Read through this guide at least once before your surgery and use it as a reference in the days leading up to your surgery.

Bring this guide with you every time you come to MSK, including the day of your surgery. You and your healthcare team will refer to it throughout your care.

About Your Knee Replacement Surgery

The Parts of Your Knee

Your knee is the joint in the middle of your leg. A joint is a place where 1 or more bones meet. Your knee is made up of the end of your thighbone, your kneecap, and the end of your shinbone (see Figure 1).

  • Your thighbone is the bone that goes from your knee upward, to your hip. It’s also called your femur.
  • Your kneecap is a small, triangle-shaped bone at the end of your thighbone. It’s also called your patella. Your kneecap protects your knee.
  • Your shinbone is the bone that goes from your knee downward, to your ankle. It’s also called your tibia.

The ends of these bones are covered with a layer of cartilage (protective tissue). The cartilage lets your bones glide against one another when you bend your knee.

The bones in your knee are surrounded by muscles, tendons (strong tissue that connects muscles to bones), and ligaments (bands of tough tissue).

Figure 1. The parts of your knee

Figure 1. The parts of your knee

About Your Knee Replacement Surgery

During your surgery, your surgeon will remove the tumor in your bone and the parts of your knee damaged by the tumor. Then, they will replace the parts of your knee with artificial (man-made) parts called prostheses or implants (see Figure 2). These are usually made of metal, plastic, or a combination of both.

Figure 2. An example of a prosthesis

Figure 2. An example of a prosthesis

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Before Your Surgery

The information in this section will help you get ready for your surgery. Read through this section when your surgery is scheduled and refer to it as your surgery date gets closer. It has important information about what you need to do before your surgery.

Write down your questions and be sure to ask your doctor or nurse.

Getting Ready for Your Surgery

You and your healthcare team will work together to get ready for your surgery.

Help us keep you safe during your surgery by telling us if any of the following statements apply to you, even if you aren’t sure.

  • I take a blood thinner. Some examples are aspirin, heparin, warfarin (Coumadin®), clopidogrel (Plavix®), enoxaparin (Lovenox®), dabigatran (Pradaxa®), apixaban (Eliquis®), and rivaroxaban (Xarelto®). There are others, so be sure your healthcare provider knows all the medications you’re taking.
  • I take prescription medications (medications prescribed by a healthcare provider), including patches and creams.
  • I take over-the-counter medications (medications I buy without a prescription), including patches and creams.
  • I take dietary supplements, such as herbs, vitamins, minerals, or natural or home remedies.
  • I have a pacemaker, automatic implantable cardioverter-defibrillator (AICD), or other heart device.
  • I have sleep apnea (shortness of breath while sleeping).
  • I have had a problem with anesthesia (medication to make you sleep during surgery) in the past.
  • I am allergic to certain medication(s) or materials, including latex.
  • I am not willing to receive a blood transfusion.
  • I drink alcohol.
  • I smoke.
  • I use recreational drugs.

About Drinking Alcohol

The amount of alcohol you drink can affect you during and after your surgery. It’s important to talk with your healthcare providers about how much alcohol you drink. This will help us plan your care.

  • If you stop drinking alcohol suddenly, it can cause seizures, delirium, and death. If we know you’re at risk for these complications, we can prescribe medications to help keep them from happening.
  • If you drink alcohol regularly, you may be at risk for other complications during and after your surgery. These include bleeding, infections, heart problems, and a longer hospital stay.

Here are things you can do before your surgery to keep from having problems:

  • Be honest with your healthcare providers about how much alcohol you drink.
  • Try to stop drinking alcohol once your surgery is planned. If you develop a headache, nausea (feeling like you’re going to throw up), increased anxiety, or can’t sleep after you stop drinking, tell your healthcare provider right away. These are early signs of alcohol withdrawal and can be treated.
  • Tell your healthcare provider if you can’t stop drinking.
  • Ask your healthcare provider questions about drinking and surgery. As always, all of your medical information will be kept confidential.

About Smoking

If you smoke, you can have breathing problems when you have surgery. Stopping even for a few days before surgery can help. If you smoke, your nurse will refer you to our Tobacco Treatment Program. You can also reach the program by calling 212-610-0507.

About Sleep Apnea

Sleep apnea is a common breathing disorder that causes you to stop breathing for short periods of time while sleeping. The most common type is obstructive sleep apnea (OSA). With OSA, your airway becomes completely blocked during sleep. OSA can cause serious problems during and after surgery.

Please tell us if you have sleep apnea or if you think you might have it. If you use a breathing machine (such as a CPAP machine) for sleep apnea, bring it with you the day of your surgery.

Within 30 Days of Your Surgery

Presurgical Testing (PST)

Before your surgery, you will have an appointment for presurgical testing (PST). The date, time, and location of your PST appointment will be printed on the appointment reminder from your surgeon’s office.

You can eat and take your usual medications the day of your PST appointment.

During your appointment, you will meet with a nurse practitioner (NP) who works closely with anesthesiology staff (doctors and specialized nurses who will give you anesthesia during your surgery). Your NP will review your medical and surgical history with you. You will have tests, including an electrocardiogram (EKG) to check your heart rhythm, a chest x-ray, blood tests, and any other tests needed to plan your care. Your NP may also recommend that you see other healthcare providers.

Your NP will talk with you about which medications you should take the morning of your surgery.

It’s very helpful to bring the following things to your PST appointment:

  • A list of all the medications you’re taking, including prescription and over-the-counter medications, patches, and creams.
  • Results of any tests done outside of MSK, such as a cardiac stress test, echocardiogram, or carotid doppler study.
  • The name(s) and telephone number(s) of your doctor(s).

Identify Your Caregiver

Your caregiver plays an important role in your care. You and your caregiver will learn about your surgery from your healthcare provider. After your surgery, your caregiver should be with you when you’re given your discharge instructions so they’re able to help you care for yourself at home. Your caregiver will also need to take you home after you’re discharged from the hospital.

Complete a Health Care Proxy Form

If you haven’t already completed a Health Care Proxy form, we recommend you complete one now. A health care proxy is a legal document that identifies the person who will speak for you if you can’t communicate for yourself. The person you identify is called your health care agent. For more information about health care proxies and other advance directives, read the resource Advance Care Planning.

If you’re interested in completing a Health Care Proxy form, talk with your nurse. If you have completed one already, or if you have any other advance directives, bring them to your next appointment.

Follow a Healthy Diet

Follow a well-balanced, healthy diet before your surgery. If you need help with your diet, talk with your doctor or nurse about meeting with a clinical dietitian nutritionist.

10 Days Before Your Surgery

Buy Hibiclens® Skin Cleanser

Hibiclens skin cleanser

Hibiclens is a skin cleanser that kills germs for 24 hours after you use it (see figure). Showering with Hibiclens before your surgery will help lower your risk of infection after surgery. You can buy Hibiclens at your local pharmacy without a prescription.

7 Days Before Your Surgery

Stop Taking Herbal Remedies and Other Dietary Supplements

Stop taking herbal remedies and other dietary supplements 7 days before your surgery. If you take a multivitamin, ask your doctor or nurse if you should keep taking it. For more information, read the resource Herbal Remedies and Cancer Treatment.

Watch a Virtual Tour

This video will give you an idea of what to expect when you come to Memorial Hospital (MSK’s main hospital) on the day of your surgery.

2 Days Before Your Surgery

1 Day Before Your Surgery

Note the Time of Your Surgery

A staff member from the Admitting Office will call you after 2:00 pm the day before your surgery. If your surgery is scheduled for a Monday, they will call you on the Friday before. If you don’t get a call by 7:00 pm, please call 212-639-5014.

The staff member will tell you what time to arrive at the hospital for your surgery. They will also remind you where to go. This will be the following location:

Presurgical Center (PSC) on the 6th floor
1275 York Avenue (between East 67th and East 68th Streets)
New York, NY 10065
B elevator to 6th floor

Shower With Hibiclens

The night before your surgery, shower using Hibiclens.

  1. Use your normal shampoo to wash your hair. Rinse your head well.
  2. Use your normal soap to wash your face and genital area. Rinse your body well with warm water.
  3. Open the Hibiclens bottle. Pour some solution into your hand or a clean washcloth.
  4. Move away from the shower stream to avoid rinsing off the Hibiclens too soon.
  5. Rub the Hibiclens gently over your body from your neck to your feet. Don’t put the Hibiclens on your face or genital area.
  6. Move back into the shower stream to rinse off the Hibiclens. Use warm water.
  7. Dry yourself off with a clean towel after your shower.
  8. Don’t put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.

Sleep

Go to bed early and get a full night’s sleep.

Instructions for eating and drinking before your surgery

12 ounces of water

  • Do not eat anything after midnight the night before your surgery. This includes hard candy and gum.
  • Between midnight and up until 2 hours before your scheduled arrival time, you may drink a total of 12 ounces of water (see figure).
  • Starting 2 hours before your scheduled arrival time, do not eat or drink anything. This includes water.

The Morning of Your Surgery

Take Your Medications

If your doctor or NP told you to take certain medications the morning of your surgery, take only those medications with a sip of water. Depending on what medications you take and the surgery you’re having, this may be all, some, or none of your usual morning medications.

Shower With Hibiclens

Shower using Hibiclens just before you leave for the hospital. Use the Hibiclens the same way you did the night before.

Don’t put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.

Things to Remember

  • Wear something comfortable and loose-fitting.
  • If you wear contact lenses, wear your glasses instead. Wearing contact lenses during surgery can damage your eyes.
  • Don’t wear any metal objects. Remove all jewelry, including body piercings. The equipment used during your surgery can cause burns if it touches metal.
  • Don’t put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne.
  • Leave valuable items (such as credit cards, jewelry, and your checkbook) at home.
  • Before you’re taken into the operating room, you will need to remove your hearing aids, dentures, prosthetic device(s), wig, and religious articles.

What to Bring

  • A pair of loose-fitting pants (such as sweat pants).
  • Sneakers that lace up. You may have some swelling in your feet. Lace-up sneakers can fit over this swelling.
  • Your breathing machine for sleep apnea (such as your CPAP machine), if you have one.
  • Your portable music player, if you choose. However, someone will need to hold it for you when you go into surgery.
  • Your incentive spirometer, if you have one.
  • Your Health Care Proxy form and other advance directives, if you have completed them.
  • Your cell phone and charger.
  • Only the money you may want for small purchases (such as a newspaper).
  • A case for your personal items (such as eyeglasses, hearing aid(s), dentures, prosthetic device(s), wig, and religious articles), if you have one.
  • The list of medications you take at home.
  • This guide. Your healthcare team will use this guide to teach you how to care for yourself after your surgery.

Where to Park

MSK's parking garage

MSK’s parking garage is located on East 66th Street between York and First Avenues. If you have questions about prices, call 212-639-2338.

To reach the garage, turn onto East 66th Street from York Avenue. The garage is located about a quarter of a block in from York Avenue, on the right-hand (north) side of the street. There’s a tunnel that you can walk through that connects the garage to the hospital.

There are also other garages located on East 69th Street between First and Second Avenues, East 67th Street between York and First Avenues, and East 65th Street between First and Second Avenues.

Once You’re in the Hospital

You will be asked to say and spell your name and birth date many times. This is for your safety. People with the same or a similar name may be having surgery on the same day.

Get Dressed for Surgery

When it’s time to change for surgery, you will get a hospital gown, robe, and nonskid socks to wear.

Meet With Your Nurse

You will meet with your nurse before surgery. Tell them the dose of any medications (including patches and creams) you took after midnight and the time you took them.

Your nurse may place an intravenous (IV) line into one of your veins, usually in your arm or hand. If your nurse doesn’t place the IV, your anesthesiologist will do it later once you’re in the operating room.

Marking Your Surgical Site

In addition to being asked your name and birth date, you may also be asked the name of your doctor, what surgery you’re having, and which side is being operated on. Your doctor or another member of your surgical team will use a marker to initial the site on your body that will be operated on. This is to make sure that all members of the surgical staff are clear about the plan for your surgery.

Meet With Your Anesthesiologist

Your anesthesiologist will:

  • Review your medical history with you.
  • Ask you if you’ve had any problems with anesthesia in the past, including nausea or pain.
  • Talk with you about your comfort and safety during your surgery.
  • Talk with you about the kind of anesthesia you will have.
  • Answer your questions about your anesthesia.

Your doctor or anesthesiologist may also talk with you about placing an epidural catheter (thin, flexible tube) in your spine (back). An epidural catheter is another way to give you pain medication after your surgery.

Get Ready for Your Surgery

Once your nurse has seen you, 1 or 2 visitors can keep you company as you wait for your surgery to start. When it’s time for your surgery, your visitor(s) will be taken to the waiting area. Your visitors should read the resource Information for Family and Friends for the Day of Surgery.

You will either walk into the operating room or be taken in on a stretcher. A member of the operating room team will help you onto the operating bed. Compression boots will be placed on your lower legs. These gently inflate and deflate to help blood flow in your legs.

Once you’re comfortable, your anesthesiologist will give you anesthesia through your IV line and you will fall asleep. You will also get fluids through your IV line during and after your surgery.

During Your Surgery

After you’re fully asleep, a breathing tube will be placed through your mouth and into your windpipe to help you breathe.

Your surgeon will clean your leg and make an incision (surgical cut) over or near your kneecap. The incision will be about 8 to 12 inches (20 to 30 centimeters) long. They will remove the damaged bone and cartilage from your knee and send it to the Pathology Department to be checked for cancer cells. Then, your surgeon will prepare your knee joint for your prostheses and attach the pieces of your artificial joint.

Once your surgery is finished, your surgeon will close your incision with staples, sutures (stitches), or Dermabond® (surgical glue). They will place a bandage over your incision.

Your breathing tube is usually taken out while you’re still in the operating room.

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After Your Surgery

The information in this section will tell you what to expect after your surgery, both during your hospital stay and after you leave the hospital. You will learn how to safely recover from your surgery.

Write down your questions and be sure to ask your doctor or nurse.

In the Post-Anesthesia Care Unit (PACU)

When you wake up after your surgery, you will be in the Post-Anesthesia Care Unit (PACU).

A nurse will be monitoring your body temperature, pulse, blood pressure, and oxygen levels. You may be getting oxygen through a thin tube that rests below your nose or a mask that covers your nose and mouth. You will also have compression boots on your lower legs.

Pain Medication

If you have an epidural catheter, you will get pain medication into your epidural space (the space in your spine just outside your spinal cord). You will be able to control your pain medication using a button called a patient-controlled analgesia (PCA) device. For more information, read the resource Patient-Controlled Analgesia (PCA).

If you don’t have an epidural catheter, you will get pain medication through your IV line.

Drainage Tubes

You will have 1 or 2 drainage tubes in your leg. Your nurse will give you information about the exact tubes and drains that you have. They may include:

  • Jackson-Pratt® (JP) drains near your incision. These drain fluid from around your incision. They will be taken out when your incision stops draining. This is usually 2 to 3 days after your surgery.
  • ReliaVac® drains near your incision. These drain fluid from around your incision. They will be removed 2 to 3 days after your surgery.

Visitors

Your visitors can see you briefly in the PACU, usually within 90 minutes after you arrive there. A member of the nursing staff will explain the guidelines to them.

Moving to Your Hospital Room

Most people stay in the PACU overnight. After your stay in the PACU, you will be taken to your hospital room.

In Your Hospital Room

The length of time you’re in the hospital after your surgery depends on your recovery. Some people are discharged from the hospital after 3 to 4 days, while other people stay longer.

When you’re taken to your hospital room, you will meet one of the nurses who will care for you and teach you how to care for yourself while you’re recovering from your surgery.

Read the resource Call! Don't Fall! to learn about what you can do to stay safe and keep from falling while you’re in the hospital.

Managing Your Pain

You will have some pain after your surgery.

  • If you have an epidural catheter, you will get pain medication into your epidural space. You will be able to control your medication using a PCA device.
  • If you don’t have an epidural catheter, you will get pain medication in your IV line.
  • Once you’re able to eat normal food, you will get oral pain medication (medication you swallow).

Your doctor and nurse will ask you about your pain often and give you medication as needed. If your pain isn’t relieved, tell your doctor or nurse. It’s important to control your pain so you can use your incentive spirometer and move around. Controlling your pain will help you recover better.

You will be given a prescription for pain medication before you leave the hospital. Talk with your doctor or nurse about possible side effects and when you should start switching to over-the-counter pain medications.

Exercising and Physical Therapy

Moving around will help lower your risk for blood clots and pneumonia. Your nurse, physical therapist, and occupational therapist will help you until you’re able to move around on your own.

Your physical therapy will start the day after surgery. This is a very important part of your recovery. Your surgeon and physical therapist will plan your therapy based on your needs. They will help you:

  • Build strength in your knee and leg.
  • Get in and out of bed.
  • Transfer to your chair.
  • Walk with your assistive device, such as a walker, crutches, or cane.
  • Do the exercises in the “Exercises After Your Surgery” section of this guide.

Continuous Passive Motion (CPM) Machine

You may be on a machine called a Continuous Passive Motion (CPM) (see Figure 3). A CPM machine is used to exercise your leg after knee replacement surgery. It will help you bend and extend your leg. Your physical therapist will show you how to use your CPM machine. You will need to use your CPM machine for about 1 to 3 weeks after your surgery.

You may also go home with your CPM machine. Your case manager will arrange for your CPM to be delivered to your home.

Figure 3. A CPM machine

Figure 3. A CPM machine

Knee Immobilizer

You will also have a splint called a knee immobilizer around your knee. The knee immobilizer protects your knee and keeps it from moving while it heals. Your doctor will give you more information about when to wear your knee immobilizer.

Exercising Your Lungs

It’s important to exercise your lungs so they expand fully. This helps prevent pneumonia.

  • Use your incentive spirometer 10 times every hour you’re awake. For more information, read the resource How to Use Your Incentive Spirometer.
  • Do coughing and deep breathing exercises. A member of your care team will teach you how to do these exercises.

When using your incentive spirometer or doing other breathing exercises, it may help to hold a pillow or blanket against your incision. This will keep your leg muscles from moving as much so you have less pain.

Eating and Drinking

You will gradually start eating your normal diet again when you’re ready. Your doctor or nurse will give you more information. Eating a balanced diet high in protein will help you heal after surgery. Your diet should include a healthy protein source at each meal, as well as fruits, vegetables, and whole grains. For more tips on increasing the calories and protein in your diet, read the resource Eating Well During and After Your Cancer Treatment.

If you have questions about your diet, ask to see a clinical dietitian nutritionist.

Your Drainage Tubes and Incisions

You will probably have some discharge and tenderness around your incision or around your drains. Your nurses will show and tell you what’s normal and expected. They will also help you start learning how to care for your drains, tubes, and incisions.

Your drainage tubes will be removed 2 to 3 days after your surgery. Removing them won’t hurt, and you won’t need anesthesia. You won’t go home with any tubes or drains.

If you have staples in any of your incisions, they may be taken out before you leave the hospital. If you go home with sutures in your incisions, they will be removed at your first appointment after surgery. This is usually 2 to 3 weeks after surgery.

If you go home with Steri-Strips or Dermabond on your incisions, they will loosen and fall or peel off by themselves. If they haven’t fallen off within 10 days, you can take them off.

Leaving the Hospital

By the time you’re ready to leave the hospital, your incision will have started to heal. Before you leave the hospital, look at your incision with your nurse and caregiver. Knowing what your incision looks like will help you notice any changes later.

At Home

Read the resource What You Can Do to Avoid Falling to learn about what you can do to stay safe and keep from falling at home and during your appointments at MSK.

Managing Your Pain

People have pain or discomfort for different lengths of time. You may still have some pain when you go home and will probably be taking pain medication. Some people have soreness, tightness, or muscle aches around their incision for 6 months or longer. This doesn’t mean that something is wrong.

Follow the guidelines below to help manage your pain at home.

  • Take your medications as directed and as needed.
  • Call your doctor if the medication prescribed for you doesn’t ease your pain.
  • Don’t drive or drink alcohol while you’re taking prescription pain medication.
  • As your incision heals, you will have less pain and need less pain medication. An over-the-counter pain reliever such as acetaminophen (Tylenol®) or ibuprofen (Advil®) will ease aches and discomfort.
    • Follow your doctor or nurse’s instructions for stopping your prescription pain medication.
    • Don’t take more acetaminophen than the amount directed on the bottle or as instructed by your doctor or nurse. Taking too much acetaminophen can harm your liver.
  • Pain medication should help you resume your normal activities. Take enough medication to do your exercises comfortably. However, it’s normal for your pain to increase a little as you start to be more active.
  • Keep track of when you take your pain medication. It works best 30 to 45 minutes after you take it. Taking it when your pain first begins is better than waiting for the pain to get worse.

Pain medication may cause constipation (having fewer bowel movements than what’s normal for you).

Managing Constipation

Talk with your nurse about how to manage constipation. You can also follow the guidelines below.

  • Go to the bathroom at the same time every day. Your body will get used to going at that time. But, if you feel like you need to go, don’t put it off.
  • Try to use the bathroom 5 to 15 minutes after meals. After breakfast is a good time to move your bowels. The reflexes in your colon are strongest at this time.
  • Exercise, if you can. Walking is an excellent form of exercise.
  • Drink 8 to 10 (8-ounce) glasses (2 liters) of liquids daily, if you can. Drink water, juices (such as prune juice), soups, ice cream shakes, and other drinks that don’t have caffeine. Drinks with caffeine, such as coffee and soda, pull fluid out of your body.
  • Slowly increase the fiber in your diet to 25 to 35 grams per day. If you have an ostomy or have had recent bowel surgery, check with your doctor or nurse before making any changes in your diet. Foods high in fiber include:
    • Bran
    • Whole-grain cereals and breads
    • Unpeeled fruits and vegetables
    • Mixed green salads
    • Apricots, figs, and raisins
  • Both over-the-counter and prescription medications are available to treat constipation. Try one of the following over-the-counter medications first.
    • Docusate sodium (Colace®): This is a stool softener (medication that makes your bowel movements softer) that causes few side effects. Don’t take it with mineral oil.
    • Polyethylene glycol (MiraLAX®): This is a laxative (medication that causes bowel movements) that causes few side effects. Take it with 8 ounces (1 cup) of a liquid.
    • Senna (Senokot®): This is a stimulant laxative, which can cause cramping. It’s best to take it at bedtime.

Follow the instructions on the label or from your healthcare provider.

For more information, read the resource Constipation.

Swelling in your legs

You may have some swelling in your legs after your surgery. To help with this, raise your legs above your chest. You can do this by lying down and resting your legs on pillows. If the swelling doesn’t go down after 4 hours, call your doctor.

Caring for Your Incision

Change your bandages at least once a day, or more often if they become wet with drainage. If there’s more than a small amount of drainage on any of your bandages, contact your doctor’s office to tell them.

You can stop covering your incision with a bandage after your first appointment after surgery. This is usually 2 to 3 weeks after surgery.

It’s normal for the skin below your incisions to feel numb. This happens because some of the nerves were cut. The numbness will go away over time.

Check your incision every day for any signs of infection. Call your doctor’s office if you have:

  • A fever of 100.4° F (38° C) or higher.
  • Redness, swelling or a smell from your incision.
  • Drainage that looks like pus (thick, milky, bloody, or green).
  • Chills.

Caring for Your Prosthesis

If you’re going to have any procedure that might cause bleeding, tell your doctor or dentist that you have a knee prosthesis. You may need to take an antibiotic. If you get an infection, it may infect your new knee joint. For more information, read our resource Preventing an Infection in Your Bone or Joint Replacement Prosthesis.

Showering

You can shower after your sutures are removed, which is usually 2 to 3 weeks after your surgery. Until then, you can take sponge baths or shower with your incision covered with a plastic bag or a waterproof dressing (such as AquaGuard®), which you can get from your local pharmacy. Remember, it’s important to keep your incisions dry.

After your sutures are removed and you begin showering without a waterproof dressing, remove your bandages and use soap to gently wash your incision. Pat the area dry with a clean towel after showering. Leave your incision uncovered unless there’s drainage. If you still have drainage, put a new bandage on your incision after your shower. Call your doctor if you have new drainage.

Don’t place your incision completely underwater, such as to take tub baths, swim in a pool, or soak in a hot tub, until all your scabs are gone and your skin is fully healed.

Physical Activity and Exercise

  • It’s normal to have less energy than usual after your surgery. Recovery time is different for each person. Increase your activities each day as much as you can. Always balance activity periods with rest periods. Rest is an important part of your recovery.
  • If you have a CPM machine and your doctor wants you to use it at home, your case manager will arrange for it to be sent to your home. If you need help at home, the case manager will help to set that up for you.
  • Don’t sit with your legs dangling for more than one hour at a time. For every hour that you’re sitting, stand­ing, or walking, spend 1 hour lying down with your feet raised above the level of your heart. You can rest your feet on a pillow to do this.
  • Continue to do the exercises in the “Exercises After Your Surgery” at home until your doctor tells you that you may stop.

Driving

Your doctor will tell you when you can start driving again. Don’t drive while you’re taking prescription pain medication that may make you drowsy. 

Going Back to Work

The time it takes to return to work depends on the type of work you do, the type of surgery you had, and how fast your body heals. Ask your doctor when you will be able to return to work.

Traveling

Don’t travel by airplane until your doctor says it’s okay. Talk with your doctor before taking any long trips after your surgery.

Managing Your Feelings

After surgery for a serious illness, you may have new and upsetting feelings. Many people say they felt weepy, sad, worried, nervous, irritable, and angry at one time or another. You may find that you can’t control some of these feelings. If this happens, it’s a good idea to seek emotional support.

The first step in coping is to talk about how you feel. Family and friends can help. Your nurse, doctor, and social worker can reassure, support, and guide you. It’s always a good idea to let these professionals know how you, your family, and your friends are feeling emotionally. Many resources are available to you and your family. Whether you’re in the hospital or at home, the nurses, doctors, and social workers are here to help you and your family and friends handle the emotional aspects of your illness.

Using MyMSK

MyMSK (my.mskcc.org) is your MSK patient portal account. You can use MyMSK to send and receive messages from your healthcare team, view your test results, see your appointment dates and times, and more.

If you don’t already have a MyMSK account, you can sign up by going to my.mskcc.org. For more information about signing up for a MyMSK account, watch our video How to Enroll in the Patient Portal: MyMSK. You can also contact the MyMSK Help Desk by emailing mymsk@mskcc.org or calling 800-248-0593.

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Contact Your Doctor or Nurse If:

  • A fever of 100.4 °F (38 °C) or higher
  • Pain that doesn’t get better with pain medication
  • Chills
  • Shortness of breath
  • Bleeding that won’t stop
  • Redness, drainage, swelling, or a smell from your incisions
  • Swelling in your legs that doesn’t get better after you raise your legs for 4 hours
  • Any problems you didn’t expect
  • Any questions or concerns

You can contact your doctor’s office Monday through Friday from 9:00 am to 5:00 pm.

After 5:00 pm, during the weekend, and on holidays, call 212-639-2000 and ask to speak to the doctor on call for your doctor.

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Exercises After Your Surgery

After your surgery, you will need to do exercises to build strength in your knee and leg. Your physical therapist will show you how to do each exercise. They will also tell you when to start each one. You won’t be able to do all of these exercises right away. You will slowly add exercises to your therapy during your hospital stay and when you go home.

Not all knee replacement surgeries are done the same way. If you have a CPM machine or if your knee must stay in 1 position to heal, you won’t be able to do the exercises in this section. Your physical therapist will plan your therapy based on your needs.

Exercise tips

  • Dress comfortably. You should wear clothing that won’t limit your movements. You can wear a hospital gown, pajamas, or athletic clothing.
  • You can do these exercises while you’re in bed. Support your head and shoulders on 1 or more pillows. Make sure you’re comfortable.
  • Breathe in through your nose and out through your mouth. Do the exercise movements when you breathe out.
  • Don’t hold your breath while doing any of these exercises. Count out loud during the exercises to keep your breaths evenly paced.
  • Stop any exercise that causes you pain or discomfort and tell your physical therapist which exercises are hurting you. You can continue to do the other exercises.

Exercises

Do not do any of the exercises in this section without talking with your doctor and physical therapist.

Ankle Pumps

  1. Lie on your back with your head and shoulders supported on pillows. You can also do this exercise while sitting.
  2. Point your toes up toward your nose (see Figure 1). You can do this with both feet at the same time.
  3. Then, point them toward the floor.
  4. Repeat 10 times.

Do this exercise every hour that you’re awake.

Figure 1. Ankle pumps

Figure 1. Ankle pumps

Quad sets

  1. Lie on your back with your head and shoulders supported on pillows.
  2. Straighten your legs as much as you can.
  3. Push the backs of your knees down into the bed while tightening the muscles on the top of your thighs (see Figure 2).
  4. Hold the position and count out loud to 5.
  5. Relax.
  6. Repeat 10 times.

Do this exercise every hour that you’re awake.

Figure 2. Quad sets

Figure 2. Quad sets

Glute sets

  1. Lie on your back with your head and shoulders supported on pillows.
  2. Straighten your legs as much as you can.
  3. Squeeze your buttock muscles together tightly (see Figure 3).
  4. Hold the position and count out loud to 5.
  5. Relax your buttocks.
  6. Repeat 10 times.

Do this exercise every hour that you’re awake.

Figure 3. Glute sets

Figure 3. Glute sets

Knee bends

Don’t do this exercise if you have a CPM machine. If you have a CPM machine, the machine will bend your knee for you.

  1. Lie on your back with your head and shoulders supported on pillows.
  2. Slowly bend your operated leg (leg you had surgery on), sliding your heel toward your buttocks (see Figure 4).
  3. Gently slide your heel away from your buttocks until your knee is resting on the bed.
  4. Repeat 10 times.

Do this exercise every hour that you’re awake.

Figure 4. Knee bends

Figure 4. Knee bends

Flexion and extension (bending and straightening) in sitting

  1. Sit in a chair or at the edge of your bed. Let your knee bend as much as you can without hurting yourself.
  2. Hook the ankle of the unoperated leg (leg you didn’t have surgery on) under your operated leg (see Figure 5).
  3. Lift your unoperated leg slowly to gently help straighten your operated leg.
  4. Lower your legs slowly until the operated knee is bent as much as possible again.
  5. Relax your legs.
  6. Repeat 10 times.

Do this exercise every hour that you’re awake.

Figure 5. Flexion and extension

Figure 5. Flexion and extension

Straight leg raises

  1. Lie on your back with your head and shoulders supported on pillows.
  2. Bend your unoperated leg and place your foot flat on the bed (see Figure 6).
  3. Keeping your operated leg straight, lift it from the bed until your knees are even with each other (see Figure 7). This will be hard to do at first but will get easier with time.
  4. Slowly lower your leg onto the bed and relax.
  5. Repeat 10 times.

Do this exercise 5 times throughout your day.

Figure 6. Bending your leg

Figure 6. Bending your leg

Figure 7. Lifting your leg

Figure 7. Lifting your leg

Short arc quads

  1. Lie on your back with your head and shoulders supported on pillows.
  2. Place a rolled towel or pillow under your operated knee so that it’s slightly bent.
  3. Straighten 1 of your legs by lifting your heel and pressing the back of your knee into the towel (see Figure 8).
  4. Hold the position and count out loud to 5.
  5. Gently lower your leg.
  6. Repeat 10 times.
  7. Repeat with your other leg.

Do this exercise every hour that you’re awake.

Figure 8. Short arc quads

Figure 8. Short arc quads

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Support Services

This section contains a list of support services that may help you get ready for your surgery and recover safely.

Write down your questions and be sure to ask your doctor or nurse.

    MSK Support Services

    Anesthesia
    212-639-6840
    Call if you have questions about anesthesia.

    Blood Donor Room
    212-639-7643
    Call for more information if you’re interested in donating blood or platelets.

    Bobst International Center
    888-675-7722
    MSK welcomes patients from around the world. If you’re an international patient, call for help arranging your care.

    Chaplaincy Service
    212-639-5982
    At MSK, our chaplains are available to listen, help support family members, pray, contact community clergy or faith groups, or simply be a comforting companion and a spiritual presence. Anyone can request spiritual support, regardless of formal religious affiliation. The interfaith chapel is located near the main lobby of Memorial Hospital and is open 24 hours a day. If you have an emergency, please call the hospital operator and ask for the chaplain on call.

    Counseling Center
    646-888-0200
    Many people find that counseling helps them. We provide counseling for individuals, couples, families, and groups, as well as medications to help if you feel anxious or depressed. To make an appointment, ask your healthcare provider for a referral or call the number above.

    Food Pantry Program
    646-888-8055
    The food pantry program provides food to people in need during their cancer treatment. For more information, talk with your healthcare provider or call the number above.

    Integrative Medicine Service
    646-888-0800
    Integrative Medicine Service offers many services to complement (go along with) traditional medical care, including music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy.

    Look Good Feel Better Program
    www.lookgoodfeelbetter.org
    800-395-LOOK (800-395-5665)
    This program offers workshops to learn things you can do to help you feel better about your appearance. For more information or to sign up for a workshop, call the number above or visit the program’s website.

    MSK Library
    library.mskcc.org
    212-639-7439
    You can visit our library website or speak with the library reference staff to find more information about your specific cancer type. You can also visit LibGuides on MSK’s library website at libguides.mskcc.org.

    Patient and Caregiver Education
    www.mskcc.org/pe
    Visit the Patient and Caregiver Education website to search our virtual library. There, you can find written educational resources, videos, and online programs.

    Patient and Caregiver Support Program
    212-639-5007
    You may find it comforting to speak with a cancer survivor or caregiver who has been through a similar treatment. Through our Patient and Caregiver Support Program, you’re able to speak with former patients and caregivers. These conversations may take place in person, over the phone, or through email.

    Patient Billing
    646-227-3378
    Call if you have questions about preauthorization with your insurance company. This is also called preapproval.

    Patient Representative Office
    212-639-7202
    Call if you have questions about the Health Care Proxy form or if you have concerns about your care.

    Perioperative Nurse Liaison
    212-639-5935
    Call if you have questions about MSK releasing any information while you’re having surgery.

    Private Duty Nursing Office
    212-639-6892
    You may request private nurses or companions. Call for more information.

    Resources for Life After Cancer (RLAC) Program
    646-888-8106
    At MSK, care doesn’t end after active treatment. The RLAC Program is for patients and their families who have finished treatment. This program has many services, including seminars, workshops, support groups, counseling on life after treatment, and help with insurance and employment issues.

    Sexual Health Programs
    Cancer and cancer treatments can have an impact on your sexual health. MSK’s Sexual Health Programs can help you take action and address sexual health issues before, during, or after your treatment.

    • Our Female Sexual Medicine and Women’s Health Program helps women who are dealing with cancer-related sexual health challenges, including premature menopause and fertility issues. For more information, or to make an appointment, call 646-888-5076.
    • Our Male Sexual and Reproductive Medicine Program helps men who are dealing with cancer-related sexual health challenges, including erectile dysfunction. For more information, or to make an appointment, call 646-888-6024.

    Social Work
    212-639-7020
    Social workers help patients, family, and friends deal with issues that are common for cancer patients. They provide individual counseling and support groups throughout the course of treatment, and can help you communicate with children and other family members. Our social workers can also help refer you to community agencies and programs, as well as financial resources if you’re eligible.

    Tobacco Treatment Program
    212-610-0507
    If you want to quit smoking, MSK has specialists who can help. Call for more information.

    Virtual Programs
    www.mskcc.org/vp
    MSK’s Virtual Programs offer online education and support for patients and caregivers, even when you can’t come to MSK in person. Through live, interactive sessions, you can learn about your diagnosis, what to expect during treatment, and how to prepare for the various stages of your cancer care. Sessions are confidential, free, and led by expert clinical staff. If you’re interested in joining a Virtual Program, visit our website at www.mskcc.org/vp for more information.

    For more online information, visit the Cancer Types section of www.mskcc.org.

    External Support Services

    Access-A-Ride
    web.mta.info/nyct/paratran/guide.htm
    877-337-2017
    In New York City, the MTA offers a shared ride, door-to-door service for people with disabilities who can’t take the public bus or subway.

    Air Charity Network
    www.aircharitynetwork.org
    877-621-7177
    Provides travel to treatment centers.

    American Cancer Society (ACS)
    www.cancer.org
    800-ACS-2345 (800-227-2345)
    Offers a variety of information and services, including Hope Lodge, a free place for patients and caregivers to stay during cancer treatment.

    Cancer and Careers
    www.cancerandcareers.org
    A resource for education, tools, and events for employees with cancer.

    CancerCare
    www.cancercare.org
    800-813-4673
    275 Seventh Avenue (Between West 25th & 26th Streets)
    New York, NY 10001
    Provides counseling, support groups, educational workshops, publications, and financial assistance.

    Cancer Support Community
    www.cancersupportcommunity.org
    Provides support and education to people affected by cancer.

    Caregiver Action Network
    www.caregiveraction.org
    800-896-3650
    Provides education and support for people who care for loved ones with a chronic illness or disability.

    Corporate Angel Network
    www.corpangelnetwork.org
    866-328-1313
    Offers free travel to treatment across the country using empty seats on corporate jets.

    Gilda’s Club
    www.gildasclubnyc.org
    212-647-9700
    A place where men, women, and children living with cancer find social and emotional support through networking, workshops, lectures, and social activities.

    Good Days
    www.mygooddays.org
    877-968-7233
    Offers financial assistance to pay for copayments during treatment. Patients must have medical insurance, meet the income criteria, and be prescribed medication that’s part of the Good Days formulary.

    Healthwell Foundation
    www.healthwellfoundation.org
    800-675-8416
    Provides financial assistance to cover copayments, health care premiums, and deductibles for certain medications and therapies.

    Joe’s House
    www.joeshouse.org
    877-563-7468
    Provides a list of places to stay near treatment centers for people with cancer and their families.

    LGBT Cancer Project
    http://lgbtcancer.com/
    Provides support and advocacy for the LGBT community, including online support groups and a database of LGBT-friendly clinical trials.

    LIVESTRONG Fertility
    www.livestrong.org/we-can-help/fertility-services
    855-744-7777
    Provides reproductive information and support to cancer patients and survivors whose medical treatments have risks associated with infertility.

    National Cancer Institute
    www.cancer.gov
    800-4-CANCER (800-422-6237)

    National Cancer Legal Services Network
    www.nclsn.org
    Free cancer legal advocacy program.

    National LGBT Cancer Network
    www.cancer-network.org
    Provides education, training, and advocacy for LGBT cancer survivors and those at risk.

    Needy Meds
    www.needymeds.org
    Lists Patient Assistance Programs for brand and generic name medications.

    NYRx
    www.nyrxplan.com
    Provides prescription benefits to eligible employees and retirees of public sector employers in New York State.

    Partnership for Prescription Assistance
    www.pparx.org
    888-477-2669
    Helps qualifying patients without prescription drug coverage get free or low-cost medications.

    Patient Access Network Foundation
    www.panfoundation.org
    866-316-7263
    Provides assistance with copayments for patients with insurance.

    Patient Advocate Foundation
    www.patientadvocate.org
    800-532-5274
    Provides access to care, financial assistance, insurance assistance, job retention assistance, and access to the national underinsured resource directory.

    RxHope
    www.rxhope.com
    877-267-0517
    Provides assistance to help people get medications that they have trouble affording.

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    Educational Resources

    This section contains the educational resources that were referred to throughout this guide. These resources will help you get ready for your surgery and recover safely after surgery.

    Write down your questions and be sure to ask your doctor or nurse.

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