Looking After Your Knee Replacement
Your new knee will continue to improve for as much as two years after your operation as the scar tissue heals and you exercise your muscles. You’ll need to look after yourself and pay attention to any of the following problems:
Stiffness Sometimes the knee can become very stiff in the weeks after the operation for no obvious reason. Try placing your foot on the first or second step of the stairs, hold on to the banister and lean into your knee. This should help to improve movement and flexibility in your knee. Its very important to continue with the exercises you were working on in the hospital.If the stiffness doesnt improve after about six weeks your surgeon may need to move or manipulate your knee. This will be done under anaesthetic.
Pain Pain caused by bruising from the operation is normal in the first two months, and you’ll probably still need to take painkillers at six weeks to help you sleep through the night. You may still have some pain for as long as six months. If you still have pain after this, speak to your physiotherapist or GP.
Infection You should speak to your GP or hospital if you notice any signs of infection, for example:
- breakdown of the wound with oozing/pus or sores
- increased pain
- redness and the affected area feeling warmer than usual or smelling unpleasant.
You should also look after your feet see a doctor or podiatrist if you notice any problems such as ingrown toenails that could become infected.
How Successful Is Surgery
Orthopedic surgeons have strict criteria to follow when deciding if a partial knee replacement is suitable to ensure they work and Physical Therapists are specially trained to help you make the best knee replacement recovery possible.
Studies looking at partial knee replacement recovery have shown that after:
- 10 years: approx 98% of partial knee replacements are still working
- 20 years: approx 92% are still working – 7% higher than Total Knee Replacements
Occasionally the fittings may come loose or arthritis may develop in the other side of the knee in which case a total knee replacementwill be performed. For more information see the risks and problems page.
How Is Partial Knee Replacement Performed
You will have surgery in a hospital or orthopedic specialty surgery center. Before your surgery date, discuss your anesthesia options with your surgeon. You may have a choice of regional anesthesia, which is when you are awake but numb from the waist down. The surgical team will most likely give you a sedative to make you groggy and relaxed during the procedure. The other option is to be completely asleep using general anesthesia.
The orthopedic surgeon will make a cut in your knee about three to five inches long to ensure the damage is confined to just one part of your knee. Typically, knee imaging beforehand will determine the extent of damage, but if there is more damage to the knee than expected, you may need a total knee replacement instead. Your surgeon should discuss this possibility with you in advance.
Partial knee replacement surgery is less invasive than total knee replacement, and the recovery is much quicker and easier. Youll be able to start moving again right away. Depending on your overall health and how you fare after surgery, you may have a hospital stay of only one to two days.
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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.
What Implants Are Used
A partial knee replacement implant is much smaller than a total knee replacement implant and does not disturb the healthy tissues of your knee. Most implants are metal-on-plastic and resurfaced with a cobalt chrome implant that conforms precisely to the anatomy of the knee. The tibial component would be made of polyethylene and only require minimal bone removal to secure the implant.
If only a single compartment in your knee is to be replaced, Professor Kohan will use a unicondylar fixed bearing knee implant, the most commonly used prosthesis, or a unicondylar mobile bearing knee implant. The advantage of these types of implants are such that only the arthritic portion of your knee to be covered by the implant needs to be removed.
In joints with mobile bearings, the plastic spacer isnt fixed but allowed to move back and forth with the action of the joint. Many believe that this allows greater freedom of movement in the joint and also reduces the amount of wear that could take place. Traditional partial knee replacements however retain good movement even in joints with fixed bearings and demonstrate a limited history of wear.
If osteoarthritis has progressed to more than one compartment of your knee we now have the ability to remove two or even three components of your knee joint and replace them with partial knee implants.
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Living With A Knee Replacement
Total knee replacement may greatly improve function, but most patients will not be able to do more than they did before the onset of arthritis.
A replacement knee may feel different than a natural knee. One small study3 found that most people report being aware of their new knees even 12 months after surgery. Their awareness was most notable when climbing stairs, kneeling, or rising from a chair. About half of the people in the study also reported symptoms such as knee stiffness , swelling, crackling, or numbness.
These symptoms can exist even though overall knee function is improved and knee pain is decreased. These symptoms do not mean the knee replacement surgery was not successful or that patients regretted having the surgery.
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.
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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 you’ve had keyhole surgery or are on an enhanced recovery programme, you may be able to walk on the same day as your operation. Generally, you’ll 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. It’s important to follow the physiotherapist’s advice to avoid complications or dislocation of your new joint.
It’s 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.
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.
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Recovery From Knee Replacement
Following your operation youll be able to go home when your pain is under control, you can get about safely, and any care you may need has been arranged.
Your wound is likely to take 10-14 days to heal. It may take up to 6 weeks to recover from the operation. It can take up to 12 months before you are back to normal activities.
Motivation To Regain Physical Function
And finally, Dr. Courtney sees another factor speeding recovery for certain patients. Motivation is big one, especially with knee replacement surgery, he says. If patients are involved in sports, like golf, tennis, or swimming, their motivation to get back to their activities plays an important role.
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What Does Partial Knee Replacement Surgery Involve
The doctor will start by ordering imaging tests such as X-rays and MRI scans to determine the extent of the damage to the knee. They will use this information to plan the surgery and set a date for the appointment. Patients undergoing knee replacement dont usually require an overnight stay in the hospital, although this decision is up to the medical team.
Next, the doctor will discuss options for anesthesia. Potential options include general anesthesia, spinal anesthesia, or peripheral nerve blocks .
The surgery may take up to two hours and starts with a small knee incision. The surgeon will then explore the knee and remove any damaged cartilage. They will then measure the bones and replace the missing cartilage with metal coverings. Finally, they will insert a plastic spacer between the metal pieces to ensure the joint moves smoothly.
Life After Knee Replacement
The goal of knee replacement surgery is to improve your quality of life and restore function that has been lost as a result of arthritis in the knee, there are a number of activities that knee replacement patients find that even years after the surgery, they are unable to do comfortably. The most common complaint in knee replacement patients is that they have difficulty performing tasks that require kneeling. This is normal and whether or not the patient has had their kneecap replaced as part of their knee replacement does not seem to affect this phenomenon.
Total knee replacement prosthetic components
The image shows the prosthetic components consisting of cobalt chromium alloy metallic tibial and femoral components and polyethylene insert. The femoral component and insert are cruciate retaining. The choice between cruciate retaining and posterior stabilized implant is made depending upon the disease in the knee joint and the integrity of the posterior cruciate ligament.
Modular femoral and tibial components along with polyethylene insert
Modular prosthetic components differ from primary knee replacement components as they allow the surgeon to make intraoperative changes. The surgeon may add bone augments or stems to achieve additional stability. The constrained insert allows stable range of motion.
Modular femoral component
Femoral component stem
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The Partial Knee Replacement Procedure
At Beacon Orthopaedics, partial knee replacement is typically an outpatient procedure. Once the surgeon makes an incision at the front of the knee, the joint and three compartments will be inspected to identify all damaged areas. If only limited compartments are affected, the surgeon will continue with a partial knee replacement. If damage is more generalized, a total knee replacement may need to be performed.
The next step in a partial knee replacement is to remove damaged cartilage and prepare the bone for the prosthesis. Next, the replacement knee portion is inserted and held in place with cement. A spacer will be inserted between metal parts to ensure smooth movement, then the incision is closed.
Are There Any Risks
As with any surgical procedure, there is always a minimal risk of infection, blood clots, or nerve damage. There is also the risk of requiring additional surgery in the future if your osteoarthritis spreads to other parts of the knee. In this case, total knee replacement may be needed.
Dr. Guttentag will go over the risks with you in detail and answer any questions you may have during your preoperative medical assessment.
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Managing Your Recovery At Home
To begin with, its normal to experience:
- tiredness get plenty of rest, but then its important to slowly increase your activity
- swelling to ease this, keep your leg raised when sitting and use the cryocuff cold compress we gave you, or apply an ice pack wrapped in a tea towel
- pain take any painkillers weve prescribed until youre pain free
Here are a few things you can do to strengthen your knee, avoid damaging it and help your wound heal:
- Keep your wound dry for 45 days afterwards, and use a waterproof dressing when you have a bath or shower
- Continue the exercises the physiotherapist showed you
- Try low-impact activities like walking and gradually increase how far you walk
- Keep using your crutches or walking stick for as long as you feel you need to
- Dont lift anything heavy or do any strenuous exercise
- Youll be able to bend your knee 90-120 degrees, but you should avoid kneeling down
- Dont sit with your legs crossed for the first 6 weeks
- Avoid twisting at your knee
How Much Does A Partial Knee Replacement Cost
Costs associated with partial knee replacement surgery ranged from $35,000 for an 85-year-old patient to $46,600 for a 45-year-old patient, while the costs for a total knee replacement ranged from $42,000 to $47,600, respectively. Researchers estimate that 10 to 21 percent of total knee replacement patients qualify for partial knee replacement.
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Total Knee Replacement Surgery Recovery
Patients are encouraged to begin ambulation the same day as their knee replacement surgery, with the aid of a walker or other orthopedic device. A patient typically stays in the hospital for 1 to 2 days, and longer if needed. Some may be able to go home the same day of their surgery if their medical team feels it is safe to do so. Patients who require extra attention or do not have home support may be transferred from the hospital to a rehabilitation center, but every effort is made to help the patient return to their home environment with additional support.
Anterior view of a knee that has undergone a total knee replacement.
What Is Recovery From Partial Knee Replacement Like
Following surgery, most patients undergoing partial knee replacement can expect to spend one to two nights in the hospital. At HSS, most patients are able to walk with assistance, or independently, on the same day as their surgery. Typically, the patient is given a cane within a week of surgery to allow for increased independence and begins outpatient rehabilitation. Patients are often finished taking prescription pain medication within four weeks post-surgery.
Partial knee replacement usually involves minimal blood loss and is associated with a low rate of complications most patients can expect to be back to their daily activities within three to six weeks. Many patients find that after undergoing physical rehabilitation, they are able to return to sports such as golf, within six to ten weeks.
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Is A Knee Replacement Right For Me
Your consultant may recommend a knee replacement if:
- your knee pain is so severe that you cant sleep at night
- youre having trouble walking
- youve tried alternative treatments and they havent helped
While most people who have a knee replacement are between 60 and 80 with the average age at 69 years many younger patients also benefit from surgery.
The decision to carry out a knee replacement is made jointly between you, your GP and your surgeon. There’s almost never an absolute indication for knee replacement surgery, but ultimately the decision is yours.
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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