All In The Timing: Many Get Knee Replacement Too Late Or Too Soon
HealthDay Reporter
MONDAY, Jan. 13, 2020 — It’s a question many aging Americans face: Is it time to replace my aching knee, or should I wait?
New research suggests that for far too many patients, the procedure is done either too late or too soon.
Much of the success of knee replacement surgery for knee osteoarthritis depends on timing, but a team at Northwestern University’s Feinberg School of Medicine in Chicago found that 90% of patients who could benefit from the procedure waited too long to have it, while about 25% of patients who didn’t need it underwent the procedure too soon.
In most cases, “people are waiting and waiting to have the procedure and losing the most benefit,” said lead investigator Hassan Ghomrawi, associate professor of surgery.
“When people wait too long, two things happen,” Ghomrawi explained in a university news release. “The osteoarthritis causes deterioration of their function. Some of them wouldn’t be able to straighten out their legs, affecting their walking and mobility. When you can’t get exercise, you can start to develop other health problems such as cardiovascular problems. You may also become depressed. The overall impact can be huge.”
Nearly 1 million knee replacements are performed in the United States each year, and a large increase in that number is expected by 2030, the study authors said.
Another problem with delaying knee replacement surgery is that it’s less effective, the research team explained.
Study author Ghomrawi agreed.
Knee Replacement Pain A Year And Beyond
The goal of knee replacement surgery is to help you get back to the activities you love. Your doctor will encourage you to stay fit through activities like swimming, cycling, and even golf. This type of exercise will help you stay limber and pain-free.
On the contrary, there are certain activities that could negatively affect the prosthetic joint materials in place. Even normal use will begin to wear out the implants, but excessive weight or activity can cause your knee replacement to loosen and become painful. You may need to avoid running, jogging, high-impact exercises, and contact sports for the rest of your life following surgery.
The good news is that studies show more than 90% of total knee replacements are still functioning properly 15 years after surgery. Staying healthy and following the advice of your doctor will help you achieve these long-term benefits.
While its possible for pain to persist for a year and beyond, it shouldnt be debilitating. Scar tissue can continue to heal, as well as the muscles in your knee, but if youre suffering from ongoing pain after a year, always talk to your doctor.
When Can I Get Back To My Usual Activities
The timing for getting back to typical activities varies from person to person. The one thing that doesnt vary is the need for physical therapy to help get you there.
Heres a high-level look of the progress you can expect to see in the first three months of recovery with regular physical therapy:
- One month after surgery: Youll probably start doing low-impact, daily activities like driving, returning to work, household chores and regular errands.
- Two months after surgery: Around the seven-week mark, you can likely start enjoying low-impact physical activities again. Many of my patients love getting active by swimming, biking and taking longer walks at this point in their recovery.
- Three months after surgery: You may be able to return to high-impact physical activity like running, skiing or other activities you enjoy. Youll need to start slow and be gentle with yourself, but youll be able to work up to the level of activity you were used to.
All that said, its important to follow your post-op surgery instructions including regular follow-ups with your surgeon. Theyll let you know what youre ready for during your follow-up visits and coordinate recommendations with your physical therapist.
If youre not sure an activity will be safe on your new knee, dont hesitate to ask your surgeon or physical therapist.
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What Patients Should Consider A Total Knee Replacement
Total knee replacement surgery is considered for patients whose knee joints have been damaged by either progressive arthritis, trauma, or other rare destructive diseases of the joint. The most common reason for knee replacement in the United States is severe osteoarthritis of the knees.
Regardless of the cause of the damage to the joint, the resulting progressively increasing pain and stiffness and decreasing daily function lead the patient to consider total knee replacement. Decisions regarding whether or when to undergo knee replacement surgery are not easy. Patients should understand the risks as well as the benefits before making these decisions about knee replacement.
Here Is An Overview Of What You Can Expect During These 12 Weeks:
- Days 1 3: In the hospital, you will work with a physical therapist and occupational therapist to work on straightening and bending the knee.
- Discharge Day: Most people are discharged from the hospital within a few days. You will be sent home with specific instructions for care, medication, and therapy.
- Week 3: By the time you reach week three, you will be able to move around a little more, and the pain will be decreasing.
- Weeks 4 6: The most noticeable improvements in your knee happen during this time if you are consistent with your rehab and exercise activities.;
- Weeks 7 11: Physical therapy and rehabilitation continue. At this point, you will be working on range of motion, mobility, and strengthening the muscles.
- Week 12: You can start to return to normal activities but still need to avoid high-impact exercise .
Beyond this initial recovery time, you will notice that the pain will continue to decrease, and your function will improve.
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Elevation After Knee Replacement
Elevating your knee above the heart level helps reduce the swelling after knee surgery and help you control the fluid build up in your lower legs.
Having a right knee wedge can make your life much more comfortable. However, you can manage with regular pillows as well.
How to elevate knee after knee replacement surgery. query into the web comes out with a mixed result, which can confuse you.;
It is not rocket science, and the whole aim of elevating your knee is to reduce swelling. Just stack three or four pillows so that your knee is above heart level.;
Also, avoid dangling your feet and keep your legs above heart level position for a longer time.
How Long Were You Using The Walker: How Is Your Endurance
Finally, when considering getting rid of your walker think about your endurance. The walker will also help you save energy when you walk. If you are exhausted each time you walk without the walker then you still need the walker. You want to conserve your energy when you need to because if you are walking and get tired and cant sit and rest you risk falling or limping. Neither of those is good. You dont want to fall and hurt yourself, and you dont want to be walking around with a limp because as discussed above that can lead to a lifetime of limping. You can increase your endurance by doing exercises repeatedly to increase your cardiovascular endurance. Work with your physical therapist to find out ways to increase your endurance to get rid of the walker soon.
What other questions do you have about arthritis and your knee replacement? Email me at
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Knee Replacement Pain After Three Months
Swelling and bruising can continue for three months or more following knee replacement surgery. However, it varies from patient to patient and depends on the condition you were in before surgery. Many patients are back to their activities without the pain they had before surgery by this stage of recovery.
If you find that any movement or activity is still exceedingly painful after three months, you may be experiencing chronic pain. Chronic pain is defined as pain persisting for three months or longer. Its a condition that affects roughly 20% of knee replacement surgery patients. It can develop and increase in intensity in the weeks and months following surgery. This can have a huge impact on your overall quality of life. Talk to your doctor for help.
How Can I Prepare My Home For Recovery
If you live in a multiple-story house, prepare a bed and space on the ground floor so that you can avoid the stairs when you first return.
Make sure the house is free of obstructions and hazards, including power cords, area rugs, clutter, and furniture. Focus on pathways, hallways, and other places you are likely to walk through.
Make sure that:
- a grab bar is available in the tub or shower
You may also require a bath or shower seat.
Some surgeons recommend using a CPM machine in the hospital as well as at home while lying in bed.
A CPM machine helps increase knee motion during the first few weeks after surgery.
It can:
- slow the development of scar tissue
- help you maximize your early range of motion following your operation
If you are sent home with a CPM machine you should use it exactly as prescribed.
Your doctor will prescribe any mobility equipment that you will need, such as a walker, crutches, or a cane.
Whats Next For Hip Or Knee Replacement
Well need more studies like this one in the future to know whether results of knee or hip replacement are getting better over time. Such studies will help doctors and their patients to have realistic expectations. In the meantime, I think anyone considering joint replacement surgery should discuss this new study with their surgeon and ask some basic questions about risks, recovery time, and how long your replaced joint is likely to last.
Follow me on Twitter @RobShmerling
What About Pain Six Months After Knee Replacement
Chronic pain in total knee replacement patients can last from three to six months. This also when the pain severity plateaus, which means that it reaches its peak and doesn’t worsen.
However, some patients still report feeling pain even;six months after the procedure. In many of those who do, the chronic pain usually lasts between one and two years. However, some patients can experience pain that lasts for three years or even longer.
Follow Your Recommended Exercise Regimen
Your doctor and physical therapist will create a progressive exercise regimen for you. This means that you’ll have specific activities to follow for each “phase” of your recovery.
For instance, you may try bending your knees 90 degrees a week after the surgery. Don’t worry if you still can’t; what’s vital is that you attempt to and that you do it slowly. Within seven to 10 days, you should also be able to fully extend and straighten out your knee.
A month after your surgery, your doctor or PT may already allow you to take long walks. They may also likely recommend reducing your reliance on your crutches or cane. However, you should still avoid crouching or squatting at this point.
So long as you stick to your exercise plan, you should be able to do more of your usual daily activities within a month. Pain, stiffness, and discomfort should also have improved significantly at this point.
Technical Details Of Total Knee Replacement
Total knee replacement surgery begins by performing a sterile preparation of the skin over the knee to prevent infection. This is followed by inflation of a tourniquet to prevent blood loss during the operation.
Next, a well-positioned skin incision–typically 6-7 in length though this varies with the patients size and the complexity of the knee problem–is made down the front of the knee and the knee joint is inspected.
Next, specialized alignment rods and cutting jigs are used to remove enough bone from the end of the femur , the top of the tibia , and the underside of the patella to allow placement of the joint replacement implants. Proper sizing and alignment of the implants, as well as balancing of the knee ligaments, all are critical for normal post-operative function and good pain relief. Again, these steps are complex and considerable experience in total knee replacement is required in order to make sure they are done reliably, case after case. Provisional implant components are placed without bone cement to make sure they fit well against the bones and are well aligned. At this time, good function–including full flexion , extension , and ligament balance–is verified.
Finally, the bone is cleaned using saline solution and the joint replacement components are cemented into place using polymethylmethacrylate bone cement. The surgical incision is closed using stitches and staples.
Anesthetic
Length of total knee replacement surgery
Pain and pain management
Looking For Alternatives To Total Knee Replacements
We’re also funding research which is investigating alternative approaches to total knee replacement. For example, total knee replacement is not recommended for many young people. This study aims to develop a new method called ToKa®, which uses images of;the patient’s joint and specially designed software to design a patient specific implant that will be made via 3D printing. If successful, this technique could prevent osteoarthritis patients from needing total joint replacement.
Dont Wait Too Long To Have Knee Replacement Surgery
Summit Orthopedics knee expert Dane Hansen, D.O., explains why you shouldnt wait to have your knee replaced.
A recent article in the Journal of Bone & Joint Surgery found that about 90 percent of people wait longer than necessary to have knee replacement surgery, often waiting two years or more beyond the point at which they are considered a reasonable candidate for the procedure, Dr. Hansen said.
The reluctance is understandableknee replacement surgery is a significant procedure, and the recovery period can be tough. People who need to work full time, or who dont have enough help at home, may want to put off surgery until they cant stand the pain and stiffness anymore. But according to Dr. Hansen, that is not the best idea for your health and quality of life.
Research suggests that preoperative function predicts postoperative function, Dr. Hansen said. In other words, the worse off you are before surgery, the less likely you are to have an excellent outcome over the long term.
How Long Does It Take To Walk After A Knee Replacement
Most patients progress to a straight cane, walker or crutches within two or three days after surgery. As the days progress, the distance and frequency of walking will increase.
Patients are usually able to drive a car within three to six weeks after surgery and resume all other normal activities by or before six weeks. Complete recuperation and return to full strength and mobility may take up to four months. However, in many cases, patients are significantly more mobile one month after surgery than they were before they had their knee replacement
Bob Hit The Rewind Button And Look What Happened
Within 6 months, Bob was no longer diabetic. He had lost 3o pounds. His feet no longer swelled so he had no need of the water pill. He no longer needed meds for COPD because his pulse ox stayed in the mid to high 90s.
Most significantly his pain was now only 3 out of 10 and controlled by over the counter Advil.
This is an example of hyperalgesia. Bobs pain was being made worse on opioids and causing a host of other downstream issues. I realize that this is anecdotal but I share this story a lot because most people have never heard of anyone getting off their medications and showing improvement in a number of conditions that most people think of as chronic.
If you are facing knee replacement surgery and are currently on opioids, think twice about proceeding without first investigating whether the pain pills themselves may be causing increased pain sensitivity. Create a plan with your doctor.
If you are opioid naïve going into surgery, use them wisely for the purpose of gaining your range of motion back and feeling tolerable in the first two weeks. Sparing opioid use with attempts to gut it out will result in a longer knee replacement recovery and overall longer use of the pain medicines.
How Long Does The Pain Last After A Knee Replacement
Over 90% of patients who have knee replacement surgery experience a significant improvement in their pain and mobility. But remember that this is a major surgery, which means that it takes time to recover after going under the knife.
It often takes three months to return to normal activities and six months to 1 year before your knee is strong and resilient.
Do I Need Physical Therapy
Many patients are sent to physical therapy after knee arthroscopy, and this is usually decided at the first post-operative visit. Some patients regain motion very quickly and have minimal swelling and therapy may not be necessary for them. Or, they may only have to go once or twice to learn a home program. Your surgeon will decide what is best for you.
How Long Does Knee Replacement Surgery Take
Wanting to learn more about how long knee replacement surgery takes to perform? Ill share my surgery time when I had TKR.
My actual knee replacement surgery took approximately 2 hours and 45 minutes to perform. This included falling asleep just before surgery and when I woke up.
However, the process for TKR Surgery actually begins the night before your surgery. After dinner you are no longer able to eat or drink liquids.
You also have been given a bathing kit with directions. Thenight before you go to bed, you are instructed to thoroughly wash your body withthe soap and washcloths that they provide.
The next morning you are instructed to bathe again exactlylike the night before. Then, you are off to the hospital.
If everything goes well, expect to be home the next day.Below Ill share a few more details of my experience.