Post-Operative Protocols & FAQ

You may typically shower 48–72 hours after surgery, once the surgical dressing is removed or changed. Keep the incision area dry and avoid submerging it in water (no baths, hot tubs, or swimming pools) until the wound is fully closed and Dr. Watts gives clearance — usually 3–4 weeks post-op.

When showering, you may let water gently run over the wound but do not scrub or apply soap directly to the incision. Pat dry gently with a clean towel and reapply your dressing as instructed.

Call the office at 905-472-3374 if you experience any of the following:

• Increasing redness, warmth, or swelling around the incision
• Wound drainage that is cloudy, foul-smelling, or increasing in amount
• Fever above 38.5°C (101.3°F)
• New or worsening pain that is not controlled by prescribed medication
• Calf pain, swelling, or redness (possible sign of deep vein thrombosis)
• Sudden shortness of breath or chest pain — call 911 immediately
• Any fall or new injury to the surgical site

The office is open Monday to Friday, 8 a.m. – 4 p.m. For urgent after-hours concerns, please go to your nearest emergency department.

Surgical site infections are uncommon but require prompt treatment. Watch for these warning signs:

• Increased redness — spreading redness beyond the incision edges
• Warmth — the area around the wound feels hot to touch
• Swelling — new or worsening swelling around the incision (not general limb swelling)
• Wound discharge — cloudy, yellow, green, or foul-smelling drainage
• Wound opening — the incision edges separating or gaps appearing
• Fever — temperature above 38.5°C, especially after the first 48 hours
• Worsening pain — pain that is increasing rather than gradually improving over time

Some redness and swelling immediately around the incision during the first few days is normal. If you are unsure, contact the Post-Surgical Wellness Clinic at 905-472-7627 ext. 3 (Mon–Fri, 11 a.m.–3 p.m.) or Dr. Watts’ office at 905-472-3374.

Yes — swelling is completely normal and expected after joint replacement surgery. It results from the body's natural inflammatory response to surgery and typically peaks around 3–5 days post-operatively.

Swelling can persist, to varying degrees, for 3–6 months after a knee replacement and up to 3 months after a hip replacement. Managing swelling effectively supports recovery:

• Apply ice (wrapped in a cloth) for 20 minutes, 3–4 times per day for at least 6 weeks
• Elevate the limb above heart level when resting
• Keep moving — walking promotes circulation and reduces swelling
• Avoid prolonged sitting with legs dependent (dangling)
• Wear compression stockings as directed

If swelling is associated with redness, warmth, fever, or calf pain (possible DVT), contact the Post-Surgical Wellness Clinic at 905-472-7627 ext. 3 (Mon–Fri, 11 a.m.–3 p.m.) or Dr. Watts’ office immediately. After hours, go to the Emergency Department.

Return to driving depends on the procedure and which side was operated on:

• Total hip replacement: Generally 3–6 weeks — when you are off narcotic medications and can reliably perform an emergency stop
• Total knee replacement (right knee): Approximately 4–6 weeks
• Total knee replacement (left knee, automatic transmission): As early as 2 weeks, with Dr. Watts' approval
• ACL reconstruction: Typically 4–6 weeks, depending on graft type and strength recovery

The key criteria are: you must be off narcotic pain medication, you must be able to perform a rapid emergency stop safely, and you must have Dr. Watts' explicit clearance. Do not drive until cleared by your surgeon.

Yes — physiotherapy is a critical component of recovery for all major orthopaedic procedures. Dr. Watts will provide a physiotherapy referral as part of your post-operative care plan.

• Total knee replacement: Begin physiotherapy within 1–2 weeks of surgery, focusing on range of motion, swelling control, and quadriceps strengthening
• Total hip replacement: A physiotherapist (often seen in hospital the day of surgery) will guide early walking and home exercises; outpatient physiotherapy typically begins within 2–4 weeks
• ACL reconstruction: Physiotherapy begins within the first week and continues for the entire 9–12 month return-to-sport timeline

OHIP covers physiotherapy for post-operative patients at certain publicly funded physiotherapy clinics. Dr. Watts' office can provide guidance on appropriate referrals.

Modern joint replacements are designed to last 20–30 years in the majority of patients. Published registry data from countries including Canada, Australia, and the UK demonstrate:

• Total knee replacement: Approximately 82–85% of implants remain functioning at 20 years
• Total hip replacement: Over 80% survivorship at 20 years for most implant systems

Implant longevity is influenced by patient factors (age, weight, activity level) and implant choice. Dr. Watts uses the Stryker Triathlon (knee — cemented or uncemented) and Trident cup with Accolade II or Insignia stem and ceramic heads (hip), all of which have excellent published survivorship data.

High-impact activities (running, impact sports) accelerate implant wear. Following Dr. Watts' activity guidelines and maintaining a healthy weight optimizes implant longevity.

Yes — kneeling is possible after total knee replacement, though it takes time and practice. Most patients find they are able to kneel after 3 months as strength and confidence improve.

It is common to feel some discomfort or pressure at the front of the knee when kneeling, which may relate to scar tissue or skin sensitivity rather than the implant itself. This often improves with time.

Tips for kneeling after TKA:

• Use a padded surface or kneeling pad
• Lead with your non-operated leg when going down
• Practice gradually — short periods first, working up to sustained kneeling
• If in doubt, ask Dr. Watts or your physiotherapist for guidance specific to your recovery

The direct anterior approach (DAA) — sometimes called the "bikini incision" approach — is a muscle-sparing technique for total hip replacement that accesses the hip joint through a natural interval (plane) between muscles rather than cutting through or detaching them.

Advantages compared to traditional approaches:

• No major muscles are detached from bone — reducing post-operative pain and accelerating recovery
• Inherent hip stability due to preserved soft tissues — hip precautions (dislocation precautions) are not required in most patients
• Many patients are eligible for day surgery and go home the same day
• Earlier functional recovery and return to independence compared to traditional posterior or lateral approaches
• The incision is closed with all internal absorbable sutures — no staples or clips, and no post-operative suture removal appointment required, giving a clean cosmetic finish

Not all patients are candidates for the direct anterior approach — Dr. Watts will assess your anatomy and medical history to determine the optimal surgical plan.

Because Dr. Watts uses the direct anterior approach, most patients do not require traditional hip precautions (restrictions on crossing legs, bending past 90°, or rotating the hip inward). This is one of the significant advantages of this technique.

General activity guidelines post-THA:

• Walking: Begin on the day of surgery with a walker; progress to cane over 4–6 weeks
• No driving: 3–6 weeks (right hip) until off narcotics and able to perform emergency stop
• No heavy lifting: 3 months — nothing over 10–15 lbs
• No straight leg raises: 3 months — protects the hip during healing
• Activity: Most patients can return to virtually all activities by 3 months, including sports and recreational activities, with Dr. Watts’ clearance

Always follow Dr. Watts’ individualized instructions — your specific restrictions may differ. For post-operative questions, contact the Post-Surgical Wellness Clinic at 905-472-7627 ext. 3 (Mon–Fri, 11 a.m.–3 p.m.).

Dr. Watts uses a multimodal analgesia approach to control pain effectively while minimizing opioid use. A typical pain management plan may include:

• Scheduled acetaminophen (Tylenol): The cornerstone of post-operative pain management — taken regularly for the first 2–4 weeks
• Anti-inflammatory medication (NSAID): Such as celecoxib or naproxen — if safe for the patient, used to reduce inflammation and pain
• Short-course opioid: A limited supply of oxycodone or hydromorphone for breakthrough pain in the first 1–2 weeks; doses are tapered as soon as tolerated
• Gabapentin or pregabalin: Used in some protocols for nerve-related pain, particularly around arthroscopic procedures
• Topical agents: Ice and elevation are effective non-pharmacological tools and are strongly encouraged

You will be provided a written prescription plan at discharge. Do not drive, operate machinery, or drink alcohol while taking opioid medication. If pain is not adequately controlled, contact the office rather than taking extra doses independently.