Precautions After Knee Replacement Surgery
This article outlines the necessary precautions to take after total knee replacement surgery so you dont overdo it. The medical team at the hospital and my doctor gave me several suggestions on how to avoid setbacks and how to improve my recovery.
I also learned some dos and donts through trial and error. Well discuss the dangers of falling, infection, blood clots and several other things that might impede your TKR recovery.
Hopefully my experience will make your recovery from knee replacement less painful and free from setbacks. The more you know before surgery, the better your recovery will be.
Do as much reading and researching as much as you can and get information from friends and acquaintances that have had TKR. I asked a lot of questions whenever I met someone that had previously had TKR and Im glad I did.
Everyone has a different experience with total knee replacement and recovery but I was surprised how consistent the advice was.
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How Long Will It Be Before I Feel Normal
You should be able to stop using your crutches or walking frame and resume normal leisure activities 6 weeks after surgery. However, it may take up to 3 months for pain and swelling to settle down. It can take up to a year for any leg swelling to disappear.
Your new knee will continue to recover for up to 2 years after your operation. During this time, scar tissue will heal and muscles can be restored by exercise.
Even after you have recovered, its best to avoid extreme movements or sports where theres a risk of falling, such as skiing or mountain biking. Your doctor or a physiotherapist can advise you.
Driving After A Total Knee Replacement
Hi everyone. After receiving some requests regarding driving after a total knee replacement , I thought a post here would be appropriate
The standard literature us patients are given upon preparing for a tkr recommends not driving until at least 6 weeks after surgery. I had no choice but to do it sooner, however.
The reason being is that I needed to go to physical therapy and didnt want to impose upon anyone for a lift. Besides, I like to drive and wanted to experiment as long as I didnt harm myself.
Well, I can definitely see how six weeks is an appropriate time frame if the leg you use for the accelerator is the one that had a total knee replacement.
For instance, if your bionic knee is on your right leg, youre going to have difficulty driving. There just wont be enough flexibility to operate the accelerator, in my opinion.
However, my bionic knee is on my left leg. I could operate the accelerator with no problem. There were other problems as mentioned below.
If my car was clutch-operated, there was no way I could have driven it within six weeks. Maybe after about 4-6 weeks, but even then there would have been extreme discomfort. Hey, driving a clutch might be another good recuperation exercise.
My car has an automatic transmission. I had a problem, with the following while driving after a total knee replacement. You may be the same:
- Time involved. It definitely is not a quick process. The entire process is much slower than typical.
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Why Is My Knee Throbbing After Surgery
Excessive pain in the knee following arthroscopic surgery is usually due to overactivity or spending too much time on your feet before the thigh muscles have been adequately strengthened. Excessive swelling can also cause pain in the knee. It is normal for the knee to be sore and swollen following arthroscopy.
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How Soon Will I Be Up And About
The staff will help you to get up and walk about as quickly as possible. If youve had keyhole surgery or are on an enhanced recovery programme, you may be able to walk on the same day as your operation. Generally, youll be helped to stand within 12 to 24 hours after your operation.
Walking with a frame or crutches is encouraged. Most people are able to walk independently with sticks after about a week.
During your stay in hospital, a physiotherapist will teach you exercises to help strengthen your knee. You can usually begin these the day after your operation. Its important to follow the physiotherapists advice to avoid complications or dislocation of your new joint.
Its normal to have initial discomfort while walking and exercising, and your legs and feet may be swollen.
You may be put on a passive motion machine to restore movement in your knee and leg. This support will slowly move your knee while you are in bed. It helps to decrease swelling by keeping your leg raised and helps improve your circulation.
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Characteristics Of Severe Arthritis Of The Knee
Pain
Pain is the most noticeable symptom of knee arthritis. In most patients the knee pain gradually gets worse over time but sometimes has more sudden flares where the symptoms get acutely severe. The pain is almost always worsened by weight-bearing and activity. In some patients the knee pain becomes severe enough to limit even routine daily activities.
Stiffness
Morning stiffness is present in certain types of arthritis. Patients with morning stiffness of the knee may notice some improvement in knee flexibility over the course of the day. Rheumatoid arthritis patients may experience more frequent morning stiffness than patients with osteoarthritis.
Swelling and warmth
Patients with arthritis sometimes will notice swelling and warmth of the knee. If the swelling and warmth are excessive and are associated with severe pain, inability to bend the knee, and difficulty with weight-bearing, those signs might represent an infection. Such severe symptoms require immediate medical attention. Joint infection of the knee is discussed below.
Location
The knee joint has three compartments that can be involved with arthritis . Most patients have both symptoms and findings on X-rays that suggest involvement of two or more of these compartments for example, pain on the lateral side and beneath the kneecap . Patients who have arthritis in two or all three compartments, and who decide to get surgery, most often will undergo total knee replacement .
Taking A Road Trip In A Car After Knee Replacement
My first big trip took place 9 weeks after TKR. Every 45 minutes or so I would stop and get out of the car to walk.
I shared driving with my wife and let her drive the portion of the trip that took us through Los Angeles. We always try and drive through Los Angeles on Sunday morning but the traffic in LA can be bad at any time due to an accident and I did not want to be driving in stop and go traffic braking constantly with my right leg.
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When Can You Drive After Surgery
You should not drive on the day of your outpatient surgical procedure. Most hospitals will require that a family member or friend is present at discharge to drive you home. Studies have shown that a person usually has some form of motor deficit following general anaesthesia for 24 hours following a procedure driving should therefore not be undertaken until at least this time. Furthermore, some strong pain relieving medications can remain in the body for extended time periods and most people should not return to driving until at least 24 hours after this pain relieving medication has stopped.
Most patients do not drive until after their first post-operative visit , although some patients may return to driving before this point. When considering a return to driving, it is important to consider the following points:
- Coordination and reflexes may be slightly impaired for several weeks after surgery.
- You must recover adequate muscle control for braking and accelerating before you try to drive.
Listed below are typical times after surgery when patients resume driving. Please note that this is a rough guide only, as each patient is different.
- Simple knee arthroscopy 1 week
- ACL reconstruction 4-6 weeks
- Periacetabular osteotomy 8-12 weeks
Should I Tell My Dentist That Ive Had A Knee Replacement
After a knee replacement, pay particular attention to infections anywhere on the body, and deal with them immediately. Pay special attention to tooth decay and mouth infections, as these may be a cause of infection in joint replacement.
If you need to visit your dentist, tell them you have had a joint replacement and give them a copy of the current advice from the Arthroplasty Society of Australia, which outlines recommendations for mouth care after joint replacement surgery.
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Getting Cleared To Drive After Tkr Surgery
Before driving youll want to consult with your doctor. My doctor did not give me a timeline on when I could drive. He told me that when I felt like I was ready that I should take short drives around the neighborhood . I had surgery on my right knee, which of course is the leg you use most to accelerate and break with.
If I had a front bench seat I think I would have been able to drive earlier using my left leg while propping my right leg up on the seat. Years ago when I broke my right leg I drove left-footed with my right leg on the bench seat for several months using a car with an automatic transmission.
After taking a short drive in the neighborhood, I began driving myself to physical therapy appointments on week five post-surgery. I also drove on short errands. It was nice to be self-sufficient again, but for any driving over 20 minutes it was nice to let someone else take the wheel.
Learn What To Expect And How To Prepare From The Doctors Who Perform This Operation Every Day And The Patients Who Have Been Through Knee Surgery Successfully
If your knee arthritis has gotten so bad that your medication and physical therapy are no longer enough to keep the pain at bay or prevent mobility issues, it is a good time to consider knee replacement surgery. The procedure has come a long way from the extended hospital stays, bed rest, and narcotics-based pain relief of the past.
Fifteen to 20 years ago we told patients to wait until they could no longer take the pain of osteoarthritis to consider surgery, but thats not the case anymore, says P. Maxwell Courtney, MD, assistant professor of orthopaedic surgery at the Rothman Orthopaedic Institute at Thomas Jefferson University Hospital in Philadelphia. With todays advances, minimally invasive techniques, and accelerated rehab and recovery protocols, we now tell patients if the pain is limiting your daily activities and youve exhausted conservative options like injections and physical therapy its time to consider surgery.
That was certainly the case for Sharon Barnes, a teacher from Maine whose pain got so bad she couldnt sleep. My doctor said I had osteoarthritis in both knees it was literally bone on bone, she remembers. We did hyaluronic acid injections, and that got me about a year then didnt work as well. Thats when we started discussing surgery.
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Knee Replacement Recovery Timeline
Most patients are discharged one day after surgery. On your discharge day, you may be able to stand and walk out of your hospital room, or you may need assistance with walking, which is completely normal. In the weeks following, most patients gradually expand their physical abilities. Every case is unique. Your surgeon and your physical therapist will coordinate to progress you as quickly as possible. Although everyone progressed at a different pace based on numerous factors, some common timeframes are:
- 3 weeks after surgery: At this point, you should be able to walk for more than 10 minutes at a time, without a walker or crutches. Your physical therapist may challenge you to go on longer walks and stop using an assistive device like a cane.
- 6 weeks after surgery: Between weeks 4 and 6, you may be able to start driving again, if your doctor clears you.
- 12 weeks after surgery: Typical physical therapy programs last for up to 12 weeks. At this point, you should be able to walk for several blocks at a time and may even be able to pick up hobbies like swimming and cycling. As your therapy program ends around the 12-week mark, stick with your walking schedule and gradually challenge yourself to walk further and longer.
- One year after surgery: You will continue to make progress for an entire year after knee replacement. By this time, your knee should reach its full strength and you should be able to return to most activities.
Can Rehabilitation Be Done At Home
All patients are given a set of home exercises to do between supervised physical therapy sessions and the home exercises make up an important part of the recovery process. However, supervised therapy–which is best done in an outpatient physical therapy studio–is extremely helpful and those patients who are able to attend outpatient therapy are encouraged to do so.
For patients who are unable to attend outpatient physical therapy, home physical therapy is arranged.
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What Are The Risks And Complications Of Revision Knee Replacement
Any surgery can have potential complications. The complexity of revision joint surgery increases the chance of surgical complications, which include but are not limited to:
- wound drainage
- damage to nerves or blood vessels
- intra-operative fractures
- pulmonary embolism
Infection, bleeding, damage to nerves or blood vessels, and intra-operative fractures can be minimized by using antibiotics before and after surgery, employing sterile surgical techniques and utilizing well-planned surgical exposures. Patients who are obese are particularly at increased risk of infection and wound drainage issues post operatively.
Similar to primary knee replacement, some mild swelling of the knee or ankle may be present after surgery for as long as three to six months. Swelling can be treated by elevating the leg, applying an ice pack, and wearing compression stockings.
Prior medical conditions, such as heart and lung complications or stroke conditions, can be aggravated by a revision procedure. These conditions may also develop in patients after revision surgery. Very rarely, death can occur. The decision to perform revision joint surgery is made when the benefits of pain relief and functional improvement outweigh the risk of potential complications.
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Helping You To Make A Speedy Recovery After A Total Knee Replacement
Your insurance company should be informed about your operation. Some companies will not insure drivers for a number of weeks after surgery, so its important to check what your policy says. Normally, it is safest to avoid driving for 8 weeks after a knee replacement. Discuss this with your insurance provider.
Driving An exercise
Before resuming driving, you should be free from the sedative effects of any painkillers you may be taking. You should be comfortable in the driving position and able to safely control your car, including freely performing an emergency stop. After 6 weeks, you might want to test your fitness to drive, though discuss this with your physiotherapist first. Do this in a safe place without putting the key in the ignition. Simply sit in the driving seat and practise putting your feet down on the pedals. Again, build up gradually. If you feel pain, stop immediately. If you feel sore afterwards, you may need to wait a day or two and try again. Only when you can put enough pressure on the pedals to do an emergency stop without feeling any reluctance or inhibition should you think about driving again.
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Under What Conditions Should I Seek Medical Advice Post
Any condition which is new or out of the ordinary for your total knee is worth at least a phone call, an office visit, or possibly a trip to the Emergency Room. Prolonged fever greater than 102 degrees, increasing or worsening pain in your knee, increasing or worsening redness in your knee, increasing or smelly drainage from your incision, worsening calf pain and swelling, chest pain and shortness of breath are all conditions which warrant immediate medical advice.
Types Of Arthritis That Affect The Knee
Inflammatory arthritis
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
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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When Can I Resume To My Normal Leisure Activities
During the first six weeks after your surgery, we recommend limiting your activities to walking with support, gentle swimming in the shallow end once you have been given permission to get the wound wet. We recommend you refrain from exercises such as pilates, golf and social tennis until three months after the date of your surgery. If you are enthusiastic about a particular sport, please seek instructions from A/Prof Walter.
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