Get In Shape For Surgery
Getting in the best physical shape possible before surgery can lessen the chance for complications and shorten your recovery time.
- If you smoke, cut down or quit. Smoking affects blood circulation, delays healing, slows recovery, and may increase the risk of infection.
- Eat a nutritious, well-balanced diet. If you are overweight, there will be more stress placed on your new joint. In some cases, your doctor may recommend a weight loss program before surgery.
- If you drink, do not consume any alcohol for at least 48 hours before surgery.
- If you use any other types of controlled substances, tell your doctor. Opioids and other drugs can cause complications and impact your surgery.
- Ask your doctor about exercises you can do before surgery. If you are having a hip or knee replacement, strengthening your upper body will make it easier to use crutches or a walker after surgery. Isometric exercises can help maintain the strength of your leg muscles. In addition, ask about the exercises that will be prescribed after surgery. If you become familiar with the exercises now, you will be ready to perform them after surgery.
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Commonly Required And Suggested Home Preparations
Deep bending and squatting can lead to knee injuries during the recovery period. A patient can minimize these risks by making advanced arrangements and preparing his or her home. For example:
- Arrange for a spouse, friend or other caregiver to provide meals and help around the house.
- Arrange for transportation, as most patients cannot drive for the first 4 to 6 weeks after surgery.
- Stock up on pre-made meals and toiletry items to avoid having to run errands post-surgery.
- If possible, arrange to spend sleeping and waking hours on the same floor in order to avoid stairs.
- If possible, adjust the bed height to help ease the transition in and out of bed.
- Take away or move anything that might be tripped over, such as area rugs or electrical cords.
- Make sure all stairs have sturdy railings.
- Install small rails or grab bars near toilets and in showers.
- Install a modified toilet seat a higher seat will put less stress on the knees and make it easier to sit down and get up.
- Put a small stool in shower to avoid standing on a slippery surface.
- Have a comfortable, supportive chair with an ottoman to keep leg elevated for intervals.
- Have cold packs on hand to help alleviate swelling.
- Consider practicing using walkers, canes and other assistive devices ahead of time to ensure proficiency using them.
Medically And Physically Preparing For Total Knee Replacement Surgery
A few weeks before surgery, you need to follow a few essential steps to have an easy operation without side effects. According to statistics, patients who are well prepared before the procedure are more likely to have a successful operation and improve in a short time. Some things you should consider a few weeks before surgery:
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Knee Replacements And Covid
Patients typically need to wait 8-12 weeks for knee replacement surgery, but with many hospitals delaying or cancelling elective surgeries due to the coronavirus pandemic, you may be waiting even longer.2 This can be frustrating and disappointing, especially when the term elective makes your surgery seem optional .
Andrew Ko, a doctor at the University of Washington, told The Atlantic that, his hospital is prioritizing surgeries in which the length of your life is affected. The quality of life surgeries are the ones now getting postponed.3 This limits people coming in and out of the hospital and allows doctors and nurses to conserve their supply of personal protective equipment.
While you wait for your doctor to resume knee replacement surgeries, there are steps you can take to get prepared at home. To relieve your existing knee pain, prepare by purchasing aids youll use during recovery and complete knee exercises to get you ready for surgery. You can still be productive while you wait!
Risks Of Knee Replacement Surgery
Knee replacement surgery is a common operation and most people do not have complications. However, as with any operation, there are risks as well as benefits.
Complications are rare but can include:
- stiffness of the knee
- infection of the joint replacement, needing further surgery
- unexpected bleeding into the knee joint
- ligament, artery or nerve damage in the area around the knee joint
- persistent pain in the knee
- a break in the bone around the knee replacement during or after the operation
In some cases, the new knee joint may not be completely stable and further surgery may be needed to correct it.
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What Are Some Exercises That Can Be Done
There are a variety of mobility exercises and flexibility exercises for you to perform, which can help with injury prevention. These were recommended in a separate article, Prehab Exercises to Perform at Home. We recommend speaking with your physician or a physical therapist before performing these, as a therapist can help make sure youre doing them with proper form and select the exercises that are best for your unique needs.
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 Is A Knee Replacement Considered
Knee replacement surgery is usually recommended if you have severe arthritis or a knee injury that causes disabling pain and other treatments, such as physiotherapy haven’t helped reduce pain or improve mobility. The most common reason a knee needs replacing is osteoarthritis of the knee joint. You may be offered knee replacement surgery if:
- you have severe pain, swelling and stiffness in your knee joint and your mobility is reduced
- your knee pain is so severe that it interferes with your quality of life and sleep
- everyday tasks, such as shopping or getting out of the bath, are difficult or impossible
- you’re feeling depressed because of the pain and lack of mobility
- you can’t work or have a normal social life.
You’ll also need to be well enough to cope with both a major operation and the rehabilitation afterwards.
Find Comfort After Knee Replacement Surgery
When you arrive home after surgery, youll feel groggy, a little pain , tired from sleepless nights, possibly irritable, and you wont be walking around well.
To be honest I was happy to leave the hospital and arrive home. I noticed immediately that Id no longer have nurses available for me 24 hours a day. Luckily my spouse was there to help me out but she needed sleep too!
We prepared well and had the house in order. Things were tidy, clean, and we moved some furniture to anticipate my limited movement. We planned out meals and kept important things like medicine, ice, and walking poles close by.
Below is a list of things we did to make things more convenient at home after knee replacement surgery. I recommend implementing the items on this list up to a week before because its too much to do in a single day. Each item is important in its own way. Feel free to use this list as a checklist as you prepare for the big day!
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Theraband Knee Curl In Standing
- Wrap a TheraBand resistance band around the ankle of your exercising leg
- Step on the band with the opposite foot to provide stability and hold the ends in your opposite hand
- You can hold onto the back of a chair for extra support while doing this exercise, if needed
Quit Smoking And Drinking Alcohol
If you are a smoker, you should quit smoking before the surgery as smoking interferes with the body functioning, medications, slows the healing process, and increases the risk of blood clots and infections after the surgery. You will also be suggested to stop drinking, at least a week before your surgery.
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If You Have A Spouse Consider Sleeping In The Spare Room Or On Recliner
Im torn on this point because its nice to have someone nearby when youre recovering from knee replacement surgery. Someone in the same room can help you out if something happens or you need help.
A great idea would be to bring a smaller bed in your shared room or a cot where the other person could sleep without being woke up by your constant repositioning. The first few nights will be tough to sleep in a bed.
Or if you prefer, sleep in the spare room or on a recliner. Dont worry, youll improve quickly and after a few days, youll be sleeping like a log.
How Can Physical Therapy Help
There are so many benefits to seeing a Physical Therapist before a major surgery. Prehabilitation can be just as important as rehab itself. Its been proven to help:
The Ivy Prehab Rehabilitation Physical Therapy plan is an investment in your post-op recovery. As our patient, youll receive concierge care, from your orthopedic surgeon to the physical therapist. Youll receive a detailed and structured prehab program consisting of daily exercises to prepare you for surgery and help you achieve your goals for your new knee. You can book your appointment by clicking here.
Article by: Holly Lookabaugh-Deur, PT, DSc, GCS, CEEAA
Ivy Rehab Network
Holly is a practicing physical therapist, partner and Director of Clinical Services at Ivy Rehab Network with more than 40 years of experience in sports management with young athletes, and is board certified as a geriatric clinical specialist and certified exercise expert for aging adults. Deuer is certified as an aquatic and oncology rehabilitation specialist and serves as adjunct faculty at Central Michigan University and Grand Valley State University.
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Get Your Knee Ready For Surgery
Repairing an issue with the knee has become significantly easier with knee arthroscopy. For the best outcomes, preparing the knee before surgery is crucial. Exercise is one of the best ways to strengthen the surrounding muscles and improve the overall outcome of surgery. However, the right exercises are necessary to avoid further injury. Speak with the surgeon in the weeks leading up to surgery for a safe yet effective exercise routine.
Activities And Restrictions After Knee Replacement Surgery
Some of the most common patient questions about knee replacement surgery are related to activities and restrictions after surgery. A lot of these factors depend on the individual patient and his or her recovery, although there are general guidelines to be aware of Dr. Tiberi will let you know when you are cleared for regular activities.
When in doubt about a particular activity, consult with Dr. Tiberi and he will be happy to answer your questions. Its better to err on the side of safety than to take on too much too soon.
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Theraband Hip Extension In Standing
- Wrap a TheraBand resistance band around the ankle of your exercising leg
- Step on the band with the opposite foot to provide stability and hold the ends in your opposite hand
- You can hold onto the back of a chair for extra support while doing this exercise, if needed
The National Joint Registry
The National Joint Registry collects details of knee replacements done in England, Wales, Northern Ireland and the Isle of Man. Although it’s voluntary, it’s worth registering. This enables the NJR to monitor knee replacements, so you can be identified if any problems emerge in the future.
The registry also gives you the chance to participate in a patient feedback survey.
It’s confidential and you have a right under the Data Protection Act to see what details are kept about you.
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Develop A Pain Plan And Practice Mindfulness
Naturally, one of the most pressing concerns and drivers of anxiety before surgery is the amount of pain that will be endured. No one wants to be in more pain than absolutely necessary and uncontrolled amounts of pain actually slows down the healing process. Learning about pain management, developing a pain plan, and practicing mindfulness before surgery puts your mind at ease and places you back in control.
Important Pain Management To-Dos:
1. Understand Your Pain Medications
Many patients require medications to minimize pain prior to surgery. These medications come in many varieties and are classified as: 1. Acetaminophen-based 2. Anti-inflammatory based NSAIDs and 3. Narcotic-based.
Anti-inflammatory based medications should be stopped about a week prior to surgery while acetaminophen-based medications can be taken through to surgery day. Since acetaminophen is a common over-the-counter pain reliever as well as a common ingredient in prescribed post-surgery narcotics, you have to be careful not to double-up on acetaminophen-based medications and exceed the maximum daily dose.
During the PreHab period, narcotic-based opioid medications should be stopped as early as possible. Using opioids prior to surgery increases postoperative pain, the length of hospital stay, as well as the need for revision surgery. Narcotic use can also reduce the overall satisfaction with a joint replacement.
2. Saying Yes or No to a Nerve Block
3. Practice Mindfulness
Set The Thermostat To A Comfortable Temperature
You wont want to worry about turning on the heater or turning off the air conditioner. Set it at a comfortable temperature and forget about it for a few days.
If you have a remote keep it close to your favorite chair. In my house, we always turned the a/c or heater off at night, but in this case, I wanted to be as comfortable as possible.
I left it on and didnt think twice. When I became more mobile then I resumed my old habits.
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Advanced Exercises And Activities
Once you have regained independence for short distances and a few steps, you may increase your activity. The pain of your knee problems before surgery and the pain and swelling after surgery have weakened your knee. A full recovery will take many months. The following exercises and activities will help you recover fully.
Will I Need Anything Special At Home
You will need crutches and/or a walker and handrails for the stairs leading to your house. Optional things include a raised toilet seat and handrails around the toilet, bath areas and stairwells. Any scatter rugs should be removed and torn areas in the carpet or tile tacked down to prevent falling. In addition, watch out for pets that may get underfoot!
When preparing for surgery, you should begin thinking about the recovery period after you leave the hospital. Discharge from the hospital is usually in about one to two days and a patient with a new total knee replacement is strongly encouraged to have someone at home to assist with dressing, getting meals and so on for the first couple of weeks.
If assistance from someone at home is not possible, please discuss this with your surgeon. It may be necessary to think about arranging to stay a few weeks in a skilled extended care facility, an acute rehab unit, or receive therapy at home with in-home care. To qualify for these options, you must meet certain criteria as directed by Medicare and/or your insurance carrier. If needed, outpatient therapy can be arranged in a facility near your home.
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Preparing For Your Arthroscopy
Exercising before knee surgery can significantly improve the outcome. Yet, some general preparations can help with overall success. These include:
- Stopping medications and supplements as these may increase the risk of bleeding.
- Fasting for a few hours before the procedure.
- Wear comfortable clothing thats easy to put on after the surgery.
- Leave valuables such as jewelry and watches at home.
- Arrange for a ride home since patients cannot drive after surgery.
- Patients who live alone should arrange for at-home support during recovery.
Most knee arthroscopy procedures have high success rates. Speak with the surgeon about any concerns before the procedure.
Prepare A Recovery Space
Get your house ready and prepare a recovery space for yourself. It may be by a favorite recliner or a comfortable couch where you will spend most of your time. Try to be as close to a bathroom as possible.
Items that should be nearby so that you can reach them include: your phone, remotes, reading material, glasses, tissues, a wastebasket, and a computer.
Good lighting is also essential and low shelves can make life easier while you recover. Remove area rugs, mats and any electrical cords that might be trip hazards.
If you feel that it is necessary, you can install temporary handrails in the bathroom and the in the shower. If you have a two-story house consider setting up a temporary bed downstairs and if you need to climb stairs use the handrail.
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