Post Op Total Knee Replacement – Occupational Therapy on the Rehab Unit

by Pauline on April 25, 2010

As I mentioned in previous posts, every day on the rehab unit I received 2 to 4 hours of combined therapies which really helped prepare me to go home.  My greatest joy was when I got to take a shower for the first time with the occupational therapist on about post op day 6. I should note here that normally if you have staples to your knee incisions which is more common with this surgery, they don’t let you get the wounds wet until later. My wounds were glued by my surgeon which I was told is far less painful than having staples removed later and gives a “cleaner” appearance to your incisions vs. the “railroad track” look from having staples put in. The nursing assistant also helped me as the bathroom in my room functioned as a shower too with a drain in the floor and angled slightly, so towels and blankets had to be put at the doorway to keep water from running out the door. Inside the bathroom was a bench and hand held shower device so they got all my things ready as my husband arrived that afternoon. He had not seen me walk yet with therapy since he visited later in the day and was anxious about my trying to get myself out of bed and to the bathroom for a shower. “Shouldn’t you wait for someone?” he asked. I told him they will be coming and I know what I’m doing as I quickly began throwing off the “sweats” I had on with great anticipation of bathing “properly”. It was good for him to see that I actually could walk with a walker to the bathroom as the occupational therapist arrived to assist me. As I sat on the shower bench in the bathroom, what an absolute joy it was to have hot water and soap running all over my body after so many days of being in bed only allowed “sponge bathing”. I shampooed my hair too and felt like a new woman! The nurse assistant remarked, as several folks did later, that they enjoyed visiting my room as it smelled so good with my floral body splash compared to to other patient rooms they entered. I had brought “dry shampoo” and spray on body cleanser (you can buy in Walgreens) to the hospital but was told by my friend how the dry shampoo really doesn’t clean your hair properly and leaves a residue so I waited to take this shower/shampoo properly and it was well worth it! I also had purchased a small electric razor to shave my legs but was very careful not to get near my knee incisions. Also, with being on a blood thinner Coumadin you run the risk with a disposable razor of cutting yourself and bleeding so an electric razor was the way to go until later.  The occupational therapists provided me a long handled sponge which was great to wash your legs and back with that you cannot reach by yourself initially. They also suggested I order a few items to help me such as elastic shoelaces you don’t have to tie or untie so you can slip your sneakers on/off easily, a plastic sock device that helps you slip your socks on, a leg lifter that looks like a dog leash to help you pull your leg in/out of bed until you can do it by yourself, a raised toilet seat and frame with handles that attaches over your toilet (absolutely necessary), and a seat cushion which gives you more height and comfort in chairs, and a “grabber”/reacher tool that lets you pick stuff up off the floor and also use to help get your clothes on too. I did purchase most of these items through a medical supply store (Mark Drugs who I called and provided a credit card to and were very helpful and price competitive) which delivered them ahead of time to my home. You can get the grabber device in Walgreens too for $10 and I had that as well as some elastic shoelaces already at home which my husband brought into the rehab unit for me to work with the therapist on. It is good to let the therapists advise you first on what you will need for going home depending on your progress and assistive devices needs. I happened to have some items already at home from a previous back surgery purchasing some ahead of my hospitalization being a proactive nurse but you don’t necessarily have to do this. For example, I was told that some patients just use and old dog leash which can work as a “leg lifter” if you want to save some money and not buy one. Insurance does NOT pay for any of these items so be aware of this before you purchase anything as the costs add up. I also had a toilet paper device before I had surgery, basically a long handled roll with clip that you can attach your toilet paper to so you can reach behind you to clean off and easily dispose but that didn’t work too well. I found per the therapist that if you have difficulty reaching behind you on the toilet to clean yourself, standing up and bending slightly over you can do this more easily. Women, as some of us may know, tend to bend our knees when on the toilet to “clean up” but your knees are swollen and don’t bend as much initially after this surgery so you have to adapt until you are able to bend your knees more comfortably with time. Baby wipes or diaper wipes are great too after you use the toilet paper so you can clean up better. You are not allowed to take a tub bath until much later when the surgeon clears you–usually about 6 weeks post op due to your incisions they don’t want “soaked’ risking infection. I was lucky to have a shower at home with a built in seat and hand held shower head. If you don’t have this at home they recommend you get a shower bench or seat from the medical supply store. My sister had given me a car handle device that inserts in your car door to help you push off getting out of the car but I didn’t need that after all. On Thursday, post op day 9 the therapist arranged with my husband to take me out to the parking lot in a wheelchair to practice getting me in/out of our SUV for going home the next day. If I could not get in/out of our car they would arrange for transportation possibly in a Medicar van but that would be private pay and we live an hour away from the hospital. It was nice to get outside in the sunshine again but getting into the SUV proved to be quite painful. We put the passenger seat back as far as it would go. I had to go into the passenger side using my walker, going “butt” first while pulling myself with the above door handle to get my body over as close to the driver’s side, before swinging my leg inside. I’m 5’9″ so clearing the door with my legs was painful since I could not bend my legs completely yet but I managed. We figured the SUV would be better for me as it is higher seating with more leg room. A regular car may be too low since you cannot get your legs under you initially after this surgery and you might not be able to get in/out safely, if at all. I did get better at getting in/out of our SUV after we got home with going to outpatient therapy and doctor appts. I had much practice and my pain improved.

The occupational therapist also worked with me in their kitchen on how to open/close cabinet doors and the refrigerator door safely, get to the stove and stand at the sink safely while using a walker. All of this was helpful and was building my confidence for going home too. I continued to sweat a lot and need ice packs to my knees after therapy sessions which I had heard was not uncommon after this surgery.

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