Knee Replacement Recovery Starts Right Away In The Hospital
These days, a typical inpatient stay following knee replacement surgery lasts two days, although some patients go home the same day as surgery, and some patients may need to stay longer.
When thinking about getting back on your feet, its helpful to consider the recovery process in phases, beginning immediately after surgery. Health care teams are proactive about keeping patients comfortable for recovery by administering medications such as low-dose narcotics, nerve pain medication, and anti-inflammatory medication. From there, its all about getting your knee joint moving again.
Physical therapy starts the day of surgery and could be as minimal as dangling your feet over the side of the bed, says Dr. Parks. The remainder of your hospital stay will likely involve physical therapy focused on activities of daily living, which youll need to move around your home.
Our physical therapist sees patients the same day as surgery to get them up and walking around the nurses station, adds Dr. Courtney. Its no longer about bed rest like it used to be. Now we get patients moving a lot quicker.
Indeed, Barnes remembers that the hospital staff had her up and moving almost immediately. I started walking the day of surgery, she says.
A Physical Therapy Timeline
If youre having physical therapy in Myrtle Beach or in any of the surrounding Horry County areas we serve, you will have an individualized treatment plan tailored to your specific situation. Therefore, there may be some slight variations of this timeline. However, it should provide you with an idea of how long youll need physical therapy after a knee replacement.
Preparation For Total Knee Replacement Surgery
Patients undergoing total knee replacement surgery usually will undergo a pre-operative surgical risk assessment. When necessary, further evaluation will be performed by an internal medicine physician who specializes in pre-operative evaluation and risk-factor modification. Some patients will also be evaluated by an anesthesiologist in advance of the surgery.
Routine blood tests are performed on all pre-operative patients. Chest X-rays and electrocardiograms are obtained in patients who meet certain age and health criteria as well.
Surgeons will often spend time with the patient in advance of the surgery, making certain that all the patients questions and concerns, as well as those of the family, are answered.
The surgeons office should provide a reasonable estimate of:
- the surgeons fee
- the degree to which these should be covered by the patients insurance.
Total Knee Replacement Surgical Team
The total knee requires an experienced orthopedic surgeon and the resources of a large medical center. Some patients have complex medical needs and around surgery often require immediate access to multiple medical and surgical specialties and in-house medical, physical therapy, and social support services.
Finding an experienced surgeon to perform your total knee replacement
Some questions to consider asking your knee surgeon:
- Are you board certified in orthopedic surgery?
- Have you done a fellowship in joint replacement surgery?
- How many knee replacements do you do each year?
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Recovery Is Different For Everyone
Generally, people are pretty far along by six weeks and mostly recovered by three months after surgery. Minor aches and pains may last for a while longer.
Your recovery time will vary depending on whether you have a partial or full knee replacement. You will need to walk with a cane for at least a couple of weeks. Return to work can vary, but generally expect at least a couple of weeks.
For the first four to six weeks after surgery, therapy will focus on improving your range of motion. Many people start with muscles that are atrophied, or weakened, especially if they were limiting their activities for a long time before surgery. For them, it may take longer to recover, making it important to continue an exercise program focused on building strength.
How Can A Physical Therapist Help
The physical therapist is an integral part of the team of health care professionals who help people receiving a total knee replacement regain movement and function, and return to daily activities. Your physical therapist can help you prepare for and recover from surgery, and develop an individualized treatment program to get you moving again in the safest and most effective way possible.
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Why Would I Need Surgery
Osteoarthritis is the main reason why people go for knee replacement surgery. The age-related condition is very common and occurs when cartilage — the cushion between the knee and the bone joints — breaks down.
Other reasons include:
- Rheumatoid arthritis: Rheumatoid arthritis is when the bodyâs immune system attacks and destroys the lining of the knee.
- Deformities: People with bowed legs or âknock-kneesâ often get surgery to restore the position of the knee.
- Knee injuries: A broken bone or torn ligaments around the knee sometimes will result in arthritis that causes great pain and limits your movement.
Range Of Motion Basics After Knee Replacement Surgery
First, we need to start off by saying that everyone is different. Some people are naturally born with more flexion and extension in their knee joints, some people have complications or severe osteoarthritis degradation to overcome, some people may experience knee stiffness, and so forth. In fact, one of the best indicators of your knee range of motion after surgery is your ROM before surgery.
A completely straight, unflexed knee joint will measure 0° of flexion. A fully bent knee will max out at about a full range of motion of 135° degrees of flexion.
As a general rule, a knee flexion of about 125° will allow you to carry out most normal activities. For daily living, a minimum flexion of around 105°-110° is required. Heres the approximate range of motion flexion required for everyday activities:
- 65° to walk
- 70° pick an object off the ground
- 85° to climb up stairs
- 95° to stand from a sitting position
- 105° to tie shoelaces
- 115° to squat or sit cross-legged
- 125°+ covers most activities. However, squatting or sitting on your heel may always prove challenging.
In a study conducted with 108 total knee arthroplasty patients, the mean postoperative active flexion was 111°
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How Will I Feel The First Few Days Back From Joint Replacement Surgery
No matter how much you prepared for your homecoming, it will be an adjustment. You will likely experience anxiety and question whether you were discharged too early. This is a normal feeling, so relax and focus on your recovery.
Depending on your surgeon’s policy, you may get a call from a care coordinator. This is your opportunity to report any problems and ask any questions. You may also get a visit from the physical therapist or occupational therapist within 48 hours of discharge. Your provider will let you know what to expect and the timelines involved.
What To Expect During Recovery
Many patients considering a total knee replacement want to know how long walking again will take. Fortunately, walking with an assisted device such as a walker, cane, or crutches will begin within 24 hours of surgery. If all goes well, patients are discharged home within 2-3 days after surgery. Physical therapy can be completed at an outpatient clinic or at home. Full rehabilitation will take approximately 8 weeks.
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Returning To Activities / Sports
With knee replacement recovery time is one of the biggest healers. Over time the swelling will reduce, your muscles will get stronger and your knee should free up becoming more flexible than beforehand.
It is important to take things easy for the first few weeks but after that, you can start thinking about returning to your favorite activities. Here are some helpful tips on knee replacement recovery time:
- You can resume most activities after 6-12 weeks, for example swimming
- Some activities should be carried out with care e.g. golf dont wear shoes with spikes
- Some activities are not advised following a total knee replacement as they put too much stress on the new knee joint. These include: jogging, contact sports e.g. basketball and football, squash, badminton, jumping activities and skiing. If you are unsure, discuss things with your doctor.
Pain and swelling can take up to 3 months to settle and knee replacement recovery time continues up to 2 years after your operation.
Tips For A Smoother Recovery
Physicians and patients share their insights for safely and efficiently getting back on your feet:
If you have concerns or if youre experiencing something you dont understand, speak up. Your doctor and physical therapist will know if its normal or not. In my case I mentioned a muscle spasm issue to my physical therapist, and she got on the phone with my doctor and I ended up needing a medication change to address it. Patient Sharon Barnes
Walking is the best therapy you can do. Walking in the park or around your neighborhood is really how youll be able to get back to normal life quicker. Dr. Courtney
Ive had both done, 14 and 15 years ago. Best advice: Do your before exercises and build up your strength, then after surgery, do your exercise as soon as youre able and keep doing them to get your best range of movement. Its going to hurt, but its so worth it. Healing pain is different, its pain with an end in sight. My father-in-law told me before I had my first one done, to remember, short-term pain for the long-term gain, and that was my mantra. Patient Kathy M., via Facebook
I had bilateral knee replacements done two years ago. My advice? Build up your leg muscles before surgery. I started three months before so the muscles were in tip-top shape. It made a huge difference in making therapy so much easier. Cheryl W., via Facebook
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Here Are A Few Things You Can Expect After Knee Replacement Surgery:
- Rest and Ice: The knee will be swollen and tender, which is why you need to follow doctor suggestions for keeping the leg elevated and icing the joint.
- Medications: Not only does medication help with pain management, but it is also vital to reduce inflammation. Sometimes antibiotics are needed for preventing infection.
- Follow Up: You will have follow-up appointments to talk to your sports medicine doctor about recovery. Surgical staples or stitches will be removed during the office visit. Reach out to your doctor if you notice unusual symptoms, such as redness, fever, incision drainage, or increased pain.
- Home Modifications: You might need certain modifications to help you navigate your home. Since the knee needs to heal, you must use crutches. Some patients transition to a cane or walker as the recovery progresses. Consider using other modifications, such as handrails, a shower bench, a reaching stick, and removing loose cords and rugs that could cause a fall.
Types Of Arthritis That Affect The Knee
This broad category includes a wide variety of diagnoses including rheumatoid arthritis, lupus, gout and many others. It is important that patients with these conditions be followed by a qualified rheumatologist as there are a number of exciting new treatments that may decrease the symptoms and perhaps even slow the progression of knee joint damage.
Patients with inflammatory arthritis of the knee usually have joint damage in all three compartments and therefore are not good candidates for partial knee replacement. However, inflammatory arthritis patients who decide to have total knee replacement have an extremely high likelihood of success. These patients often experience total, or near-total, pain relief following a well-performed joint replacement.
Osteoarthritis is also called OA or degenerative joint disease. OA patients represent the large majority of arthritis sufferers. OA may affect multiple joints or it may be localized to the involved knee. Activity limitations due to pain are the hallmarks of this disease.
OA patients who have symptoms limited to one compartment of the knee sometimes are good candidates for minimally-invasive partial knee replacement .
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What Is Average Non
Walking has become the rage of the human population over the last few years. Many opinions have been expressed about how far the average human being should walk. The consensus seems to be about 10,000 steps a day, and 3,000 should be at a brisk pace.
Studies show that the average mans stride length is 2.5 feet per step while a womans stride length is 2.2 feet per step.
10,000 steps per day translate into:
Men:4.73 miles per day.Men walk, on average, about 3 miles per hour at a normal pace and about 4 miles per hour at a brisk pace.7,000 normal-paced steps at 3 miles per hour is 3.31 mile 3,000 brisk-paced steps at 4 miles per hour is 1.42 miles
Women:4.17 miles per day.Interestingly, women also walk, on average, about 3 miles per hour at a normal pace and about 4 miles per hour at a brisk pace. They just take more steps to cover the same distance but the speed is pretty much the same as for men.7,000 normal-paced steps at 3 miles per hour is 2.92 miles 3,000 brisk-paced steps at 4 miles per hour is 1.25 miles
EVERYTHING CHANGES PAST THE AGE OF 60 YEARS OLD!!!!!
Studies show the average number of steps a senior citizen should be achieving should be 5,500 steps but can go as low as 1,200 steps daily for patients with complications , however, the senior citizen should try to increase those 5,500 steps to as close to 10,000 steps as they can tolerate.
And after a Total Knee Replacement surgery, things come to a grinding halt for about 3 weeks!!!!!
How To Effectively Use Opioids After Knee Replacement
My advice, which I offer in more detail in my book, is simply this. The first two weeks you will experience a great deal of chemical pain, which is related to the molecules that rush into the area in an acute injury and bone pain, pain that is caused by cutting the ends of the long bones. Most people in order to feel comfortable will need some type of opioid during this time to get them through. Opioids have some well known side effects like nausea in limited cases, constipation quite frequently and well lets just call it brain fog.
Constipation can usually be managed effectively with a preemptive strategy, taking in plenty of water, taking over the counter prescriptions for constipation before you get constipated and paying attention to the types of food you eat. Consuming lots of cheese and meat, which are tough to digest, will exacerbate the problem.
I recommend taking the opioids after knee replacement during this two week time periodat the prescribed levels on a time managed program and work your tail off on your range of motion, the hardest task to complete following a knee replacement.
Since you need to be on the pain medicine secondary to the chemical and bone pain, use it to your advantage and knock out the hardest task out right at the start. Most of my patients can get off of narcotics after the week two if they follow the program and transition to over the counter medications allowing them to drive and return to work sooner than average.
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Exercise And Physical Activity
The final phase of recovery, as Dr. Parks considers it, is returning to exercises and extra activities, including hiking and biking. It typically takes eight to 12 weeks to get to this phase, he says.
In terms of full knee replacement recovery, patients generally need a year to completely heal and regain total function.
After a couple of years, you forget that youve even had knee surgery, says Barnes, who would go on to have her left knee replaced a year after the surgery on her right. Before surgery I couldnt garden. Now I walk, snow shoe, and climb ladders. I do what I want and dont have pain.
You Will Be Encouraged To Start Moving And Walking
Your providers will encourage you to start moving and walking.
You will be helped out of bed to a chair on the day of surgery. You may even try to walk if you feel up to it.
You will work with specialists to get moving again and to learn to take care of yourself.
- A physical therapist will teach you exercises and how to use a walker or crutches.
- An occupational therapist will teach people who have had hip replacement how to safely perform daily activities.
All of this takes a lot of hard work on your part. But the effort will pay off in the form of a faster recovery and better results.
After knee replacement, some surgeons recommend using a continuous passive motion machine while you are in bed. The CPM bends your knee for you. Over time, the rate and amount of bending will increase. If you are using this machine, always keep your leg in the CPM when you are in bed. It may help speed your recovery and reduce pain, bleeding, and risk of infection.
You will learn the proper positions for your legs and knees. Make sure you follow these guidelines. Improper positioning can injure your new hip or knee joint.
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Physical Therapy Is Key
Physical therapy after knee replacement surgery is vital. At HSS, we have a program that allows patients to do PT virtually at home. A therapist gives you exercises to do and is able to watch you do them and give you feedback via video call. HSS offered this option even before the COVID-19 pandemic, but now weve ramped it up and its great. If you prefer to meet with a physical therapist in person, you can do that.