Frequently Asked Questions

Probably far less than you expect — and possibly none. About 40% of my total knee patients use zero narcotic pills. Another 45% use fewer than ten. The remaining 15% use more than ten.

Narcotics are available for breakthrough pain. They are the backup, not the structure. If you have a history of opioid dependence, or you are worried about it, say so — it changes the plan and it is not a conversation to avoid.

Yes, and it is the part patients most want to negotiate.

Patients who exceed the activity limits have more pain, more swelling, and more stiffness. This is not a soft recommendation — it is the most consistent pattern I see. The two weeks of restriction buy you a much easier six weeks after them.

You may feel good enough to do more. Feeling good is the protocol working. It is not permission.

These are two different things, and patients conflate them constantly.

Bed jail restricts walking around. It does not restrict working the knee. Starting the day after surgery you work on the knee ten minutes of every waking hour — five minutes straightening, five minutes bending — and rest in between.

It is the combination that works: frequent motion, genuine rest, and very little walking. Doing one without the others does not produce the same result.

Two weeks after surgery — not two days, which is the standard approach.

The knee needs time to quiet down first. A joint that is still acutely swollen and inflamed responds to hard work by swelling more, and then you are fighting the swelling you just created.

You are not idle during those two weeks. You are doing your own exercises ten minutes of every waking hour, and staying within your step limits. That is what makes therapy productive once it begins.

Because feeling fine is the plan working. It is not a signal to stop.

Pain is far easier to prevent than to treat. If you let it build before treating it, the nerves have already become more sensitive, and it takes considerably more medication to get comfortable again than it would have taken to stay comfortable.

The traditional method builds every knee to the same textbook geometry, which usually means releasing and rebalancing your ligaments to make them fit. Kinematic Alignment restores the alignment your knee had before arthritis wore it down, and leaves the collateral ligaments alone.

Less disruption on the way in means less to recover from.

The surgical approach is the same — the Subvastus Approach, which goes underneath the quadriceps muscle rather than cutting through the tendon.

But the Quiet Knee Protocol is three parts, not one. The approach is only part one. The medication plan and the activity restrictions are the other two, and the results depend on all three.

Because there is no single list to publish. Your plan is assembled from your history — kidney function, heart or stroke history, blood thinners, ulcers, diabetes, prior gastric bypass, seizure disorder, cancer treatment, age, and allergies all change it. A combination that is right for one patient can be unsafe for another.

You will get your own written plan before surgery. That document is the one that applies to you.

In most cases, yes — but this is one of the most important things for us to know, and it substantially shapes your plan.

Tell the office about every blood thinner you take, including aspirin you started on your own. Do not stop or change a blood thinner without being told to.

It is one of the few things you can do before surgery that measurably changes how the surgery goes. After a major operation your body breaks down its own muscle for fuel, and protein blunts that.

It matters most if you take a GLP-1 medication (Ozempic, Wegovy, Zepbound) or if you already have low muscle mass. Full details here.

If you have kidney or liver disease, talk to us before starting one.

Dr. Andrew Wickline, M.D., in upstate New York. He performs over 700 total knee replacements a year and has the lowest complication rate in the state of New York. He developed the protocol to reduce his patients' opioid use. His site is andrewwicklinemd.com.

You should stop your exercises. You should lie with your leg elevated but bent over at least three pillows to a 45° angle. You should have ice on the front and the back of your knee. Lay like this for about three to four hours and generally the bleeding will stop. If the bleeding gets worse, call Dr. Olsen's office.

If the bleeding is confined to the pad portion of the dressing, you can leave it alone. However if it is leaking under the sticky portion of the dressing, then your dressing needs to be changed. You should call Dr. Olsen's office to set up a time you can be seen.

Call the office: 952-831-8742

If you obtained the BREG ice machine from Dr. Olsen's office, or rented the NICE ice machine, generally speaking, they never get cold enough to be a major problem and can be left on at all times. However if you get a different brand of ice machine, you should put a meat thermometer underneath the ice wrap layer and check the temperature. If it is 38 to 40 degrees, it can generally be left on for extended periods of time. If it is below 36 degrees, it should only be 30 minutes on and 30 minutes off. No matter what, the first time you use the ice machine at any temperature, you should leave it on for 30 minutes and then check your skin. It should be reddish when the ice wrap is removed and it should return to normal color usually within 20 to 30 minutes. If it does not return to normal color then this is too cold for you and a 20-minute on, 20-minute off pattern is probably safest.¹

You will have a long Ace Wrap on your whole leg. Under that is a stretchy sock on the lower leg and foot. You can take off your Ace Wrap the day after surgery — this also makes getting your range of motion easier. The stretchy sock stays on, except for showers, until you have either a Reparel Leg Sleeve or some EdemaWear, which will replace the stretchy sock.

When using the Reparel sleeve, it stops at the ankle. For some people this will allow the foot to become swollen. If that occurs, you can replace the stretchy sock you had on immediately after surgery and then put the Reparel sleeve over the top of that.

Reparel Leg Sleeve (opens in a new tab) Sized by upper-thigh measurement.

EdemaWear (opens in a new tab) Order page and sizing guide on their site.

At first it will appear as if the ball is not getting smaller in size. It is! At first the outside layer will get bigger wrinkles and then the entire ball will get smaller.

Yes. However, make sure the dressing on your leg is completely stuck down to your skin and keep the OnQ pump and bag out of the shower.

The small ball in the center will be gone and you will see a cylinder tube without anything around it. At that point it is time to remove it. First take off all the sticky dressing holding it down. There is usually a small amount of purple glue where it goes into the leg. Just lift this from the skin. Once everything is free just pull gently. It will slip out like a wet noodle and should not hurt (it may feel a little strange but should not be painful). After that cover the area with a little gauze and tape then throw everything away. A small amount of bleeding or clear fluid at the site is normal; press on it with gauze for five minutes. Call the office if it keeps bleeding, if fluid keeps leaking, or if the area becomes red, warm, or more painful over the next few days.

Call the office: 952-831-8742

It will last 3-5 days depending on how fast you run the pump. Usually keeping it at a level of 6 works well. You can turn it up before PT and at bedtime if need be, but you don't have to.

Patients that go beyond the step count limits have more pain, swelling, and stiffness. You have to think of this activity restriction as a six-week commitment/investment in the long-term success of your knee replacement. If you push your activities too hard, you can make your knee less functional and more painful on a permanent basis. One of the main points of the Quiet Knee Protocol is to avoid the high dissatisfaction rate with the standard techniques where people are more active after surgery.²

See your step limits

The short answer is no. Strengthening exercises add a lot more inflammation to the knee and can make you swell and lose motion. You can do simple things like isometric quad sets (tightening the thigh muscles without moving the knee) but pushing on weights or lifting weights will cause more trouble. Keep working on your motion and you can start some gentle strength work at the 4 week mark.³

If you had your right knee done, you can't drive for six weeks. If you had your left knee done then you can drive when you are no longer on narcotic medications.⁴

If your knee was replaced at the Shakopee Surgery Center, Dr. Olsen may have injected a product called Zynrelef into the knee during surgery. It combines a slow-absorbing local anesthetic (bupivacaine) with a small dose of meloxicam, an anti-inflammatory, and it helps with pain relief for the first 72 hours. The mixture contains an ingredient called DMSO, and about 8% of patients notice an unusual smell from their body as the DMSO is broken down. It is harmless, though it will seem odd. It fades back to normal after about 72 hours.⁵

If it is after 5 PM and the problem seems severe, then the ER is your best bet. Another option is TRIA Urgent Care, which will have a better handle on your problem: open until 8 PM on weekdays, and on weekends 8 AM to 8 PM in Burnsville, Bloomington, Maple Grove and Woodbury (8 AM to 4 PM in Shakopee). Orthopedic expertise matters a lot when it comes to solving post-operative problems. Before 5 PM, you can call Dr Olsen's office at 952-831-8742 (TRIA). If the problem doesn't seem severe, you can send Dr. Olsen a message through HealthPartners MyChart.

Call the office: 952-831-8742 TRIA. Before 5 PM.

First of all make sure you're taking all of the prescribed protocol medications. Those that pick and choose tend to have more difficulty with pain control. Secondly if you've taken one of the narcotic pills and that was ineffective after 30 minutes and you took a second one, then you should contact Dr. Olsen to get some assistance with your pain management. A common mistake that patients make is to try and live their normal lives immediately after a major surgery like this and doing so will definitely increase your pain. Make sure you are resting, icing, and for knee surgery elevating frequently to diminish swelling, inflammation, and pain.

Yes, you can take all of your regular medications at the same time as the medications on the protocol. Dr. Olsen has reviewed all of your medications and there are no significant interactions. If there are you have had your protocol adjusted accordingly.

No. Your wound should be left alone until Dr. Olsen's assistant takes off the dressing at your first post-operative visit. After that time standard soap and water is fine but you should not apply any creams or ointments to the wound. Vitamin E applied to a wound too soon can make things much worse.⁶

Yes you can shower after your surgery. However you should be cautious about the possibility of passing out when you first get in the shower the first couple of days after surgery. Your internal body fluid balance is affected after surgery and if you get immediately into warm water the day after surgery, you can easily pass out. Therefore you should drink at least 2 liters (about half a gallon) of water over a couple of hours prior to getting into the shower the first two days after surgery. Usually after that it's not as big of an issue.⁷

No. Some patients will find this app helpful and others will not. It is totally up to you. You can use the printed medication sheets that Dr. Olsen gave you on the day of surgery if you would just like to do it that way.

You should send Dr. Olsen a message on the HealthPartners MyChart webpage.

Log in to HealthPartners MyChart to leave a message for Dr. Olsen (opens in a new tab)