What type of caregiving is my sister going to need after a knee replacement?

NelleHtur, welcome to the forum.

I found this article that might be helpful:

https://www.verywellhealth.com/caregiving-for-a-loved-one-recent-knee-surgery-4154262

I saw a lot of people in physical therapy when I went for my arm. So, definitely she will be going to physical therapy.

Welcome Nelle and thx for the link ff.

I am watching this thread as R will have a complex knee replacement in a couple of months.

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Here is some info from that same site. https://www.verywellhealth.com/total-knee-replacement-preop-exercises-2696473

You will need - loose-fitting, comfortable clothing and comfortable rubber-soled shoes with a back to leave the hospital in

In preparation for your return home after knee replacement, your surgeon will likely recommend the following:

Ensure you have someone lined up to assist you with personal care (e.g., bathing) and household chores (e.g., laundry and grocery shopping) for at least one week

Even though you will be able to go up and down stairs after surgery, consider making a temporary bedroom on the first floor if applicable (especially if you are worried about falling).

Make pathways within any crowded areas of your home.

Remove any fall hazards within your home, such as throw rugs or electrical cords lying on the floor.

Install handrails on your stairways and in your bathroom.

Rent a shower chair and raised toilet seat.

Purchase a grabber device to reach items on your own, a long-handled shoehorn, and a sock aid (a tool that helps you put socks on easily).

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Help with meals would also be good.

I see you have some of this covered. already and her husband will be there to do some things. Without complications I suspect she will do fine.

Maybe some one else with experience can chip in and suggest when you might best make the trip. I would think with an caregiver 4 hr a day for a week or two and her husband most things, if not all, will be managed.

Good luck!

Thanks Freqflyer. I knew most of that information, but I found that reminders about preparing meals ahead of time (stuff the freezer) and getting prescriptions from the Dr. before leaving the hospital were helpful..

Nelle,

Are there plans for rehab. Much of the recover depends upon the condition of the patient going in for surgery, their muscles, their weight, their general condition.

If this isn't optimum I would suggest a few weeks of rehab, or at least one. If this can be managed then you could attend some of the therapy sessions with good effect.

Sure wish the best outcome here. I had a friend who had a total knee and sailed through easily, but she was only 55, in excellent condition.

Sounds like you have a great set up. Well done!

Sounds like your sister is all geared up for discharge straight home, but her healthcare team should discuss her discharge, rehab options & exercises with her. If there are any barriers, hopefully they can be addressed early. As you are prepared to help, you may like to ask questions too. To be sure your expectations are accurate.

Sometimes factors mean a stint in inpatient rehab is suggested first. Eg if mobility is very poor, other major health issues, spouse frail or unwell, home is up multi flights of stairs etc.

Your sister may be using crutches or a frame when she gets home. A shower chair can be useful & a shower hose. A longhandled brush for back & lower legs. A little help may be needed for washing & drying lower legs. Maybe a little help putting pants/skirt on too.

Her walking & transferring to chairs should be at independent stage prior to discharge. Maybe some small assistance to get leg onto her bed? Walking outside may need supervision at first or even a wheelchair - ask the Physiotjerapist what she can do safely & if any restrictions.

Personalities vary a lot. Is your sister usually a motivated type? Likes to be independent?

My sister has many health issues but responds very well to the guidence & encouragement professionals give to regain her independence after any setback. (With family there is tendency to become an inactive lump).

Your sister is very lucky to have you in her team ☺️

My dad lived with us for a few weeks after his knee replacement. He went to PT 3 times a week, used a walker, but really did fine. No one helped with showering or anything in the bathroom, he could do that independently. I made his meals and told him coming to the table was part of his therapy, he enjoyed being told that! Sounds like you’re well set up, far more than anything I did. Dad was in his early 80’s at the time and really did well with the surgery and recovery. Hope you’ll see the same

If you are limited to one week, I think that the first week will be when she needs the most help. She's lucky you can go help her. My mom (in her mid 70s and not in very good physical condition) stayed overnight in the hospital and then went to rehab for about a week until she could do 3 stairs to get into the house and walk enough to get around the house independently with her walker. She needed help with getting her ice for her knee, putting her foot up when in her chair to help with the swelling, PT came to the house 3 times a week, etc. If she is a hard worker and will do her exercises in between PT visits that will help her recover more quickly. If everything goes well she should be able to get to the bathroom independently while still in the hospital.

I, too, am to have my knees replaced. I’m a fat athlete - awful combination.

Consistent advice from everyone I know who has had it done: PT is critical and do your very best to power through it. Do the recovery work to the best of your ability.

A friend climbed the stairs at St Paul’s in London 6 months later! (fortunately I’ve already checked that off my list)

Sounds like you are well prepared to help your sister. Keep her spirits up and encourage her to move.

One of my friends had a spinal block instead of a general anesthetic when she had her 2nd knee done. Surgeon offered to let her see her metal before he closed her. She looked. Not sure how I’d answer. Assuming I didn’t faint.

Good luck to your sister!

The people I know who have had knee replacements are up and around in no time. I think Rehab depends on age. Most of the people I know go to offsite Therapy like Daughters Dad did. As long as you do the therapy and exercises given for home Sister should have no problem. Do not disable her. She needs to do as much as she can by herself. That means fixing herself a sandwich. The more she moves that knee the better.

My 76 yo relative recovered quickly. Spent overnight in hospital after surgery, then went home. From the start, used crutches to get around. Used an ice machine wrap-thing (that can also be rented) to ice the knee. Needed live-in help that first week, which was the worst week because of 1) the pain, 2) needing help with taking her pain meds on schedule, 3) needing someone to drive her to PT, etc. Weeks 2&3 were much better: so much so, that-while she greatly appreciated the help -she increasingly was looking forward to getting back her privacy and having her house to herself.
No walker, cane, or wheelchair. No one ever showered her, she got into the shower by herself. She had a recliner that was a good comfortable chair to sit in and do the exercises and knee bends, read, or watch tv while the ice machine was on. Her doctor was very happy with her recovery. By the middle of week 3 she was climbing a flight of maybe 8 stairs (albeit slowly) without pain, to visit another friend! By the end of week 3 she could drive by herself.

Please find out if her insurance will pay for a BREG Polar Care Cube.
These are beyond amazing for keeping swelling to a minimum & no swelling means less pain so less pain mean your apt to do more PT / ADL and progress faster and be able to rest / sleep better. Less pain also means also less pain meds needed and lets face it, they do not prescribe pain meds like it was done in the past.

The cube is basically a continuous loop ice flow cooling system that wraps around your knee with the ice water bath swirling up from the electric cooler. She will need help putting it on & taking it off at first. You (sissy) will need a separate cooler to store ice in to “feed” the cube periodically. The smaller sq Fiji water bottles fit the BREG perfectly & if you freeze them to use in the cube plus some fresh ice around them you could easily get through the day with just a single refill. Tres facil!

I had a L knee surgery mid Oct 2019 (not replacement, was both sides cartilage cleanup, backside bursa issues) & was back standing 10-14 hr days on a job late Nov. I was very very motivated. That ice cube made beyond huge difference as I used it from day 1 after surgery to keep swelling down and once working I’d lie down & slap it on and around my knee once I got home couple of hours then took it off to do exercises / shower etc and then put it back on overnight, fall asleep with it for a couple of hours then take it off and my knee was normal looking next morning. I did wear a compression sleeve (open toe to upper thigh) for almost two years when working or heavier walking or yard project days. I’m mid 60’s and definitely not a size 6!

Your Sisters replacement surgery might not have quite as much swelling but if her insurance will cover a BREG, get one. They are amazing to have & be able to use for cold therapy.

I worked as a Secretary for a Visiting Nurse Assoc. We did what Medicare did not pay for. The Nurses were RNs. I would get many calls where the person didn't know what was going to happen after a hospital visit. My answer was "you need to wait for discharge" The doctor determines then what kind of care you will need. I know its kind of last minute but thats when the doctor knows what the patient will need. Rehab, in home or just go to a local PT facility.

With this knee replacement. When the doctor went over the procedure did he not tell your sister what to expect? What type of PT, OT she would receive? How long the doctor felt recovery should take. IMO this should have been discussed at her appt.

Actually, I think your all set. It all will depend on how hard your sister works. You know the saying, no pain no gain.

If you can go with her to a doctor's appointment.
Ask her doctor many of these questions.
Ask your sister if a PT can come to her house and assess it for any other safety items that should be added.
I would strongly suggest that she have towel bars replaced with Grab Bars. At least towel bars that are near a shower or tub. It is instinctual to grab onto them as we exit a tub or shower.
If the raised toilet seat does not have handles to allow her to help raise herself you might want to get one that does. (Or when I broke my knee I placed a walker backwards over the toilet so I could use the handles on the walker to push myself up)
If her shower has a glass door I would also remove that. Put a shower curtain up with a tension rod. The glass doors have bars to hang towels on and again the instinct is to grab the bar. Also if she looses her balance and falls she may fall through the glass door.
Get a good pair of non slip shower shoes so she is less apt to fall or slip in the shower or in the tub.

There are suction temporary bars. If she has a tub, there is a bar you can get that fits onto the side.

https://www.amazon.com/Bathtub-Butizone-Medical-Adjustable-Handrail/dp/B089M1X6M1/ref=asc_df_B089M1X6M1/?tag=hyprod-20&linkCode=df0&hvadid=563617515022&hvpos=&hvnetw=g&hvrand=3453114567712212928&hvpone=&hvptwo=&hvqmt=&hvdev=m&hvdvcmdl=&hvlocint=&hvlocphy=9003829&hvtargid=pla-1643445342454&psc=1&gclid=CjwKCAjwrJ-hBhB7EiwAuyBVXcZsXA4SRxQZs3zW4bl8VeYS8mpZ6MIhFucIPKOe9wvosyQ5H_E6zxoC5msQAvD_BwE

I had 2 full knee replacements (one at a time) in 2017. I was 66 at the time. I was placed in a program which provided a 3 ring binder of information about the process, what to expect, and exercises. My husband and I attended a class before the surgery and started doing the exercises 6 weeks before surgery to strengthen the muscles that were important for success. He was my main support in the weeks following each surgery. My 2 sisters also took turns coming over in the mornings to help my dress and fix breakfast. I wouldn't really have needed them, but the company and their beautiful breakfasts were definitely mood lifters.

I found that the first few days were the time when I most needed the heavy duty pain relievers. After that I was able to get by with OTC pain relievers (aspirin is best for me). I did continue to use the opioids for my PT sessions 3 times each week. I think it is most important to do the exercises and PT as recommended. The only thing I REALLY needed after the surgery was a driver to/from PT sessions. However, having people around for part of the day was lots of fun.

I opted to minimize shower use and make generous use of sponge baths and partial showers (I have a seat and hand-held shower attachment.) In that early week just after surgery it is really important to keep the dressings dry and there is more than enough to do keeping the knee elevated and iced to keep the swelling down.

For your sister, a lot depends on her overall health prior to surgery and her willingness to move around. A number of friends and relatives have had this procedure. It seems that those who are more willing to exercise and put up with a certain amount of low level pain in the process of recovering end up with better results. Personal encouragement is probably the most important thing you can do for your sister. Although full recovery takes months, early progress should be quite rapid. With help from my husband and sisters I actually enjoyed the recovery process. The first surgery (April) was a bit scary, but by the time it was time for the second surgery (August) I was really looking forward to all the things I would be able to do again. Those first weeks were something my sisters and I looked forward to as a celebration of the bigger life we would have together when I was no longer limping along dragging those uncooperative legs.

Now, 6 years later, I am still thrilled with my new knees and the ability to walk MILES if I want to, and to bend those knees into a squat when I need to. I think if you talk to your sister about some things she will be able to do with you in a few months you will both be able to see the early challenges as steps to a great future. It worked for me and I hope it works for you as well.

Could be:

Coordinating PT appts (watch PT so possibly caregiver can do / support how to do). Get handouts.
- Create a 'check off' list of when PT done and how many reps
- Good to show to PT and MD as needed

Getting ice (in the freezer - lots of it)
- Is a bigger job than perhaps one considers. Ice is heavy. Stuff the refrigerator freezer with as many packages as possible.
- Getting the ice machine set up
- insure plugs / extension cords (available) easy to manage.
BE CAREFUL WITH PLUGS AND WATER / ICE machine
- Have lots of clean large towels available

Caregiver maturity:
- Ability to / Encouragement to do exercises and take meds as directed.
- Being on time
- Checking in with you or person in need by phone = good communication

Prepare meals
- buy micro-waveable foods if appropriate.
- salads, not much physical activity so eat healthy: SALADS ! split pea soup, fruit salads? (no mac and cheese...)

Helping with pillows on the bed / help walking

Someone patient and understanding how a person may respond when in 'pain'

Flow with the needs - important as you really do not know what might come up.

Someone dependable / ask for references / experience - CALL REFERENCES

- how much notice needed if emergency?
- Availability
* Consider timing needed and if a.m. and p.m. person(s) needed.

Go to store, i.e., prescriptions refills ?
Possible visits to MD (take person)

Have back-up(s) care givers.

From what I remember doing this (ice, ice ice... encouragement to do exercises and icing).

Diversion ... DVDs? Books? TV? music?

You mention two weeks. What about needs after two weeks?

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P.S. I read this below and want to high-light as it could be very useful.
Ask MD / PT about this ahead of time. (And thank you for person who
recommended this.)

Please find out if her insurance will pay for a BREG Polar Care Cube. 
These are beyond amazing for keeping swelling to a minimum & no swelling means less pain so less pain mean your apt to do more PT / ADL and progress faster and be able to rest / sleep better. Less pain also means also less pain meds needed and lets face it, they do not prescribe pain meds like it was done in the past.

The cube is basically a continuous loop ice flow cooling system that wraps around your knee with the ice water bath swirling up from the electric cooler. She will need help putting it on & taking it off at first. You (sissy) will need a separate cooler to store ice in to “feed” the cube periodically. The smaller sq Fiji water bottles fit the BREG perfectly & if you freeze them to use in the cube plus some fresh ice around them you could easily get through the day with just a single refill.

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Sounds like you have A LOT OF THIS MANAGED READY TO GO ALREADY.
Good work! Hope this helps.

Gena / Touch Matters

I don't know if your sister has other health problems that would complicate her situation but recovery from knee replacement surgery isn't so bad, as long as she goes to in person rehab directly from the hospital. I've, had 2 replacements on one knee and rehab is extremely important. Rehab usually lasts for 21-28 days. Once I got home it was not a big deal. I could care for myself. Good luck and don't be too concerned.

NelleHtur: I would only suggest rehabilitation after the knee replacement surgery.

If there is a way to go to rehab for a short time right after surgery - she'll get daily exercise to get her on over the pain and keep it moving. If that's not possible, call the medical equipment company to make sure the equipment is going to be there on the day she is released. That movement really helps, as I'm told. It's better than doing some exercise, then laying down to rest ---- then you have to move it again after no movement. I've been told it's like trying to break apart a rusty nut and bolt.

The people I knew about, were up and moving same day at hospital. The rehab for this is not for sissy's, so if sister is prone to not exert herself, better idea to try and push the rehab in-patient a short time. As her sister, she probably won't let you tell her to exercise if she doesn't want to and may do more for medical staff.