Install Fall Prevention Equipment
While you wont be walking much right after your knee surgery, its inevitable that youll need to move around your house. Walking is an essential part of your recovery.
A loss of balance and a need for space can increase the risk of a fall. Apart from decluttering, other preventive measures include:
- installing a handrail in the bathtub or shower and next to the toilet
- having a bath mat ready to prevent slipping
Take A Pain Pill Or Tylenol Substitute Before Exercises
Early on I always took a pain pill 30 minutes before my in-home therapy session. Once I weaned myself off the pain medicine, I took a Tylenol pill.
I continued to take a Tylenol pill before my off-site therapy sessions too. Taking the medication made it easier for me to do my rehab, especially the range of motion exercises.
Have Any Necessary Items
Tissue, lip balm, lotion, lens cleaners, and medication need to be within easy reach of where you are sitting.
I had my TV remotes, my fan remote and my fireplace remote nearby within easy reach. I also had a laptop computer and a kindle next to my chair.
Make sure your phone is within easy reach to answer phone calls, texts and to access emails easily.
If your thermostat has a remote keep it handy especially during hot or cold weather.
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Three To Six Weeks After Your Knee Replacement
As you gain strength, youll rely lessor not at allon assistive devices such as canes.
Often, at this point, more low-impact activities may be introduced into your exercise regimen. In addition to walking, this includes swimming or riding a stationary bike.
Many of the exercises above will continue. Knee bends will concentrate on the goal of bending your knee to 120 degrees.
At this point, many are able to complete basic household chores and slowly get back to daily activities. If you have an office job or a job that doesnt require heavy lifting or climbing, you may be able to return to work.
Life After Knee Surgery
As a Physical Therapist, Ive seen firsthand the significant improvements in people following a knee replacement. However, there is no surgeon or PT out there who can 100% guarantee success. There certainly are risks following a surgery and this should be discussed with your doctor. But just as important, you should discuss the expected outcomes with your physician.
Returning to activities such as walking, golf, bowling, swimming, light dancing, and even light tennis is usually encouraged. However, ask your doctor about suggested timeframes for these activities.
Knee replacements have come a long way in the past 20 years and the technology continues to improve. Set your expectations appropriately with your physician and therapist. Heres to hoping your life after knee surgery is full of enjoyment and activity!
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Wound Care And Infection Prevention
- Wash your hands with soap and water before handling your wound to prevent infection.
- If your wound is bleeding, apply pressure using clean dressing or gauze for about 5 minutes until the bleeding stops.
- You can then wash the incision gently with water and gently tap it dry with a clean towel before putting on a new dressing.
- Do not scrub or scratch the wound.
- Never pull out sutures. These will either be removed by your physician or absorbed by your body.
You must also know how to look out for signs of infection like the following:
- Redness
If you see these signs and symptoms, call your doctor immediately.
What Should I Expect
Its important to note that everyone has different pain level tolerances, and no two cases are the same because our knees are complex joints. Knees are the second-largest joints in the body, after the hip joints. As such, a knee replacement is a complicated surgery that involves balancing ligaments, cutting into the bones of the knee joint, and replacing parts of the knee joint with artificial parts. The manipulation of the knee joint to place the parts leads to the pain after the procedure. Postoperative pain after knee replacement surgery is related to the healing, stretching, bending, and rotating that the knee must do after surgery.
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Setting The Right Expectations
Before we dive straight into wound care and the various therapies and exercises that come after a knee replacement surgery, it’s important to set the right expectations.A knee replacement surgery is a major surgical procedure that involves the removal of the damaged bones and cartilage that make up your knee joint. Once these parts are removed, metal and plastic components are inserted in their place.The surgery has two variations: total knee replacement, where the entire knee joint is replaced, and partial knee replacement, where only a single component of the knee joint is fixed. In this article, well be talking mostly about total knee replacement, since its more commonly done.The surgery can last up to two hours long and the patient can stay in the hospital for two to five days.While 97% of total knee replacement surgeries are successful, the road to recovery is quite long. Prognosis also depends on the individual’s age, weight, and general health status prior to the surgery. Studies show that people who are healthier and are active prior to surgery recover much faster than people who arent. A pre-operative consultation with your primary healthcare provider and surgeon will give you a general idea of how long your recovery time will be.
- Able to use assistive devices – you can use canes or crutches immediately after the surgery up to 2 weeks post-op, depending on your progress.
Dont Forget The Scar Cream
Use scar cream and an aloe based lotion often. I always applied it first thing in the morning as well as before and after my 3 exercise sessions.
It is inexpensive and ensures the scar is hydrated, making it more comfortable to bend especially during my range of motion exercises. At my age, I wasnt as worried about the cosmetic appearance of the scar, but if you are concerned, apply the scar cream often.
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How Long Will I Be On Pain Medication After My Knee Replacement Surgery
Every patient experiences recovery from a knee replacement surgery differentially and as such, everyone will require pain medication at different intervals and for different amounts of time. There is no standard approach to this, although generally we do expect patients to be weaned off their narcotic analgesics within 2 to 3 weeks of the surgery and by 6 weeks after the surgery should only be requiring occasional Tylenol or a less potent analgesic to control their pain.
With that being said, there are a number of different factors that can affect a persons ability to tolerate pain medication or indeed their ability to have the pain medication kill their pain. As such, each medication regimen will be tailored to the individual. It is important to regularly communicate with your surgeon or healthcare provider regarding your experience of the pain and your current pain medication regimen, so that it can be altered to suit you and your needs.
Pain After Total Knee Replacement
You will experience some postsurgical pain in the area that has been operated on after your knee replacement. This is normal and you will be prescribed medications by your surgeon to attempt to control your pain and bring it within tolerable levels. It is important to remember that, at this stage, it is unrealistic to expect that there will be no pain and so a small amount of soreness in and around the knee is normal. It will take one to two weeks for the postsurgical pain to dissipate however, this does not indicate that the knee has fully healed.
There will be some discomfort in the knee up to around 6 weeks following the surgery and in some patients, this may even persist up to 3 months following the surgery. The pain is caused by a number of factors including the muscles around the knee recovering from the surgery and regaining strength that they have lost as a result of the surgery, as well as other tissues around the knee healing and getting used to the new biomechanics of the knee joint.
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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
How Long Will I Need Pain Medication After Total Knee Replacement
Pain, swelling, and bruising are all normal after knee replacement surgery, both for partial and total knee replacements. Youll be sent home with oral pain medications after your surgery, which youll take for several weeks after your surgery.
The most commonly prescribed pain medications after knee replacement surgery include prescription-strength naproxen sodium, ibuprofen, and acetaminophen. If those commonly used pain relievers dont provide enough relief, your doctor can prescribe something stronger, such as hydrocodone or an opioid pain killer. Narcotics are addictive pain relievers and can be taken safely after surgery but the duration of these drugs if chosen for use, should be limited as much as possible. Please speak with your physician prior to surgery in regards to the pain protocols that will be used postoperatively
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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.
Sitting Unsupported Knee Bends
While sitting at bedside or in a chair with your thigh supported, bend your knee as far as you can until your foot rests on the floor. With your foot lightly resting on the floor, slide your upper body forward in the chair to increase your knee bend. Hold for 5 to 10 seconds. Straighten your knee fully.
Repeat several times until your leg feels fatigued or until you can completely bend your knee.
Sitting unsupported knee bend
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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 .
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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What Not To Do After A Knee Replacement
As previously mentioned, removing the dressings too early or before you are instructed to do so by your healthcare provider will increase the risk of developing an infection. This is important to avoid and as such leaving your dressings and following the postoperative care instructions that you are given is essential.
Trying to do too much too quickly is a common scenario particularly in younger patients. Recovery from the knee replacement is a slow process and many patients want to be back to a baseline level of activity within a few weeks of the surgery. This is simply not possible and we would encourage you to be patient and consistent with your exercises and rehabilitation protocols. Regular communication with your surgeon or healthcare provider if you have any concerns will be able to reassure you of your progress through the process of recovering.
Avoid trying to enter into sporting activity too quickly. Although it does frustrate patients when find they are unable to perform their sports as quickly as they want after the surgery, it can also put you at risk of developing an injury around tissues that are still in the process of healing. This can cause problematic injuries such as disruptions to your extensor mechanism of your knee and even periprosthetic fractures. These are major injuries that usually require surgical intervention and should be avoided at all costs.
Different Types Of Surgery
There are 5 main types of knee replacement surgery:
- Total knee replacement. This is the most common form. Your surgeon replaces the surfaces of the thigh bone and shin bone that connects to the knee.
- Partial knee replacement. If arthritis affects only one side of your knee, this surgery may be a possibility. However, itâs only right for you if you have strong knee ligaments and the rest of the cartilage in the knee is normal. Partial knee replacement can be performed through a smaller cut than is needed for total knee replacement.
- Patellofemoral replacement. This replaces only the under-surface of the kneecap and the groove the kneecap sits in. This can be very effective for people with chronic kneecap arthritis.
- Complex knee replacement. This procedure may be needed if you have very severe arthritis or if youâve already had two or three knee replacement surgeries.
- Cartilage restoration: Sometimes when the knee only has an isolated area of injury or wear this area can be replaced with a living cartilage graft or cells which grow into cartilage.
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Knee Replacement Recovery At Home And Outpatient Therapy
It would be nice if a knee replacement was like getting a new car part installed and away you go. The surgery is just the beginning of the knee rehabilitation process.
Swelling, stiffness, and strength are necessary to improve in order to decrease pain and progress therapy to higher level activities. They will be the primary focus of therapy early on to set up the patient for successful rehabilitation. It will take time for the knee tissues to heal and gradual loading to improve strength and flexibility.
Whats It Like To Recover From A Knee Replacement
As soon as you wake up from knee replacement surgery, your rehabilitation can begin. Patients are encouraged to begin walking with a walker, crutches, or a cane on the same day that their surgery occurred. Within three to six weeks after total knee arthroplasty, you will gradually resume many of your normal activities, but not all until you are released from a doctors care.
Your physical therapist will help you learn to safely use the new joint and will go over all of the aftercare necessary to recover successfully from the surgery. They will help you use a continuous passive motion machine, to gently move the joint to speed the healing process. Youll also learn to change your bandage, and practice how to get to and from the bathroom. Your physical therapist will also teach you the exercises necessary to help you regain the full range of motion in your new joint.
Typically, you will return home as long as you have a support system in place to help care for you during the rehabilitation process.
You will have some pain, bruising, and swelling after the surgery. Your doctor will likely prescribe some pain medications that are stepped down to over-the-counter anti-inflammatories and pain relievers over time. Your orthopaedic surgeon may have you wear a support hose or compression boots to reduce the risk of blood clots and cut down on leg swelling.
- Slow, careful stair climbing
- Achieving full knee extension and knee flexion
- Standing up and slowly walking
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