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.
Overview Of Knee Revision Surgery
The first step is removal of the existing implant. If there has been significant bone loss, bone grafts may be required to fill these voids. Bone grafts can be either autografts or an allograft . In some cases, metal wedges, wires or screws may be used to strengthen the bone.
Finally, specialized revision knee implants are inserted. Temporary drains may be placed to help prevent excessive swelling of the knee and are usually removed a few days after surgery. Additionally, specialized negative pressure incisional dressings are also frequently employed to improve wound healing as they have been shown to decrease post-operative wound complications in high risk patients. These dressings are usually connected to a small portable pump that stays on for about a week and keep the wound protected and dry.
Recovering From A Total Knee Replacement : A Surgeon / Caregivers Perspective
I had the opportunity to experience recovery from a TKA through the eyes of a close family member, who I, as a joint replacement surgeon was the primary caregiver. This experience gave me a new appreciation of what our patients experience in the weeks after TKR. I will break this up into segments: pre-op, day of surgery and the first day of recovery, day 2- day 6, and weeks 2-6.
Day of Surgery and First Day of Recovery
You are on your way to enjoying your new knee but some hard work will be required. Dont get discouraged remember to ice and elevate. See the picture above the post. Notice the foot is higher than heart and ice cuff on the knee. Remember, the knee is straight to assist in gaining knee extension.
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Reasons For The Procedure
Knee replacement surgery is a treatment for pain and disability in theknee. The most common condition that results in the need for kneereplacement surgery is osteoarthritis.
Osteoarthritis is characterized by the breakdown of joint cartilage.Damage to the cartilage and bones limits movement and may cause pain.People with severe degenerative joint disease may be unable to donormal activities that involve bending at the knee, such as walking orclimbing stairs, because they are painful. The knee may swell or”give-way” because the joint is not stable.
Other forms of arthritis, such as rheumatoid arthritis and arthritis thatresults from a knee injury, may also lead to degeneration of the kneejoint. In addition, fractures, torn cartilage, and/or torn ligaments maylead to irreversible damage to the knee joint.
If medical treatments are not satisfactory, knee replacement surgery may bean effective treatment. Some medical treatments for degenerative jointdisease may include, but are not limited to, the following:
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Anti-inflammatory medications
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Cortisone injections into the knee joint
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Viscosupplementation injections
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Weight loss
There may be other reasons for your doctor to recommend a knee replacementsurgery.
Day : The Initial Recovery
After a full knee replacement, you will likely wake up after 1½-2 hours under general anaesthetic with your knee elevated, a bandage covering the incision/s and possibly a drain to remove excess fluid from the joint.
The anaesthetic will leave your head feeling a bit foggy and the brain will be protecting the knee by avoiding movement.
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Where Will I Feel Knee Replacement Pain
As mentioned above, knee replacement pain can come in many different forms depending on the cause. Knee pain is to be expected due to the surgical procedure itself, with swelling, bruising, and the introduction of prosthetic parts.
Beyond that, it is possible to feel pain in parts of the body other than your knee. This is known as referred pain.
Your hips, lower back, groin area, and calves may initially hurt due to the change in your stance and the way you walk. Of course, it is also typical to feel sore due to extended amounts of time in bed during your recovery.
Genicular Nerve Block With Radiofrequency Ablation
Instead of more invasive surgical options, many patients turn to a genicular nerve block to treat and diagnose persistent knee pain. A genicular nerve block uses anesthetic injected into one or more of the genicular nerves to interrupt pain signals being sent to the brain.
Unfortunately, a genicular nerve blocks effects only last eight to 24 hours. Doctors use genicular nerve blocks to test the effectiveness of the procedure on a persons knee pain. Many patients who experience relief with genicular nerve blocks will then get radiofrequency ablation. When combined, these two procedures can offer pain relief that lasts anywhere from six months to a year.
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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.
Returning To Activities / Sports
Here is some more guidance relating to specific activities and knee replacement recovery time:
- You can resume many 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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Prefer To Listen To This Article
We always encourage positive visualisation and documentation of the future here at The Physio Co , but, dont expect to be hopping out of bed and running home the day after a full knee replacement.
Thats not to say the tennis career is over! Merely to say youll likely be watching the next major tennis tournament on TV rather than attending or participating at your local club this year, anyway!
In addition to the six to eight prep for the operation, weve also put together an 8 to 12-week step-by-step guide as to how a professional TPC physio will support a full knee replacement patient in reaching a goal after the operation.
What Happens In The First Few Days After A Knee Replacement
After knee replacement surgery, youll remain in the hospital for 1 to 5 days and youll most likely start working with a physiotherapist immediately.
Its perfectly normal to experience pain, swelling and bruising in the first few days after your knee surgery but its still important to do your best to move your knee as much as possible as soon as possible. But, you shouldnt be putting any weight on your leg at this point.
Generally, knee replacement patients can leave hospital when theyre able to:
- Get in and out of bed and walk a short distance with the help of a walker or crutches
- Walk up and downstairs with a walking aid
- Bend the affected knee 90 degrees
- Understand the precautions to avoid potential injuries
However, different hospitals have discharge criteria. Keep in mind, you might continue to use a walking device once you leave the hospital.
You might have to stay in hospital longer if:
- You have had two knees replaced at the same time
- Uncontrolled pain
- General weakness
- Other pre-existing medical conditions
Some doctors also prescribe whats called a Continuous Passive Motion machine that will move your leg manually without your assistance. Its important for the health of your knee joint that it doesnt stay still for too long.
While your knee is bandaged, you may not be able to have a full shower for 5 to 7 days and it could be up to 3 or 4 weeks before the wound should be soaked in water at all.
Remember, youre recovering from major surgery.
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What Seniors Can Expect After A Full Knee Replacement
A full knee replacement is a big operation, but its not as scary as people sometimes think. Its almost bread and butter for surgeons and physiotherapists, so its important to feel comfortable with professionals who are well-versed in the latest research and developments.
While the majority of full knee replacement patients enjoy a positive outcome, we cant guarantee it every single time.
A six-to-eight-week pre-habilitation program is something we do recommend and can help you achieve a best-case scenario to optimise your pre-surgery fitness, body weight, pain and mobility.
Will I Need To Use Crutches Or Other Assistive Devices After Knee Replacement Surgery
Yes. And depending on the type of surgery youve had , youll probably need to use an assistive device for at least a few weeks during recovery.
Assistive devices make certain activities like walking, using the restroom and dressing easier to do. They also help keep you safe.
The types of assistive devices youll need after knee replacement surgery depend on your condition, but common devices include:
- Walking aids like crutches, canes or walkers
- Shoehorns and sock aids
- Raised toilet seat
- Tub chair
The good news is some assistive devices may be covered by your insurance, so be sure to check with your insurance provider before you go in for surgery.
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What To Expect Before Knee Replacement Surgery
Knee replacement surgery requires some form of anasthesia where youll either be unconscious or awake but unable to feel the procedure. Your doctor will inform you of your options to make the best decision for your particular circumstances.
During knee replacement surgery , damaged bone and cartilage from your thigh bone, shinbone and knee bone are replaced with a prosthetic joint made of metal alloys, plastic and polymers.
The goal of knee replacement surgery is to resurface the parts of the knee joint that have been damaged and to relieve knee pain that cannot be controlled by other treatments. – Hopkins Medicine
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 .
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Looking After Your New Knee
- continue to take any prescribed painkillers or anti-inflammatories to help manage any pain and swelling
- use your walking aids but aim to gradually decrease the amount you rely on them as your leg feels stronger
- keep up your exercises to help prevent stiffness, but do not force your knee
- do not sit with your legs crossed for the first 6 weeks after your operation
- do not put a pillow underneath your knee when sleeping as this can result in a permanently bent knee
- avoid twisting at your knee
- wear supportive shoes outdoors
- do not kneel on your operated knee until your surgeon says you can
- raise your leg when sitting and apply an ice pack wrapped in a tea towel for 20 minutes every 3 or 4 hours to reduce any swelling
Page last reviewed: 02 August 2019 Next review due: 02 August 2022
What Is A Knee Replacement Surgery
Knee replacement, also called knee arthroplasty or total knee replacement, is a surgical procedure toresurface a knee damaged by arthritis. Metal and plastic parts are used tocap the ends of the bones that form the knee joint, along with the kneecap.This surgery may be considered for someone who has severe arthritis or asevere knee injury.
Various types of arthritis may affect the knee joint. Osteoarthritis, adegenerative joint disease that affects mostly middle-aged and olderadults, may cause the breakdown of joint cartilage and adjacent bone in theknees. Rheumatoid arthritis, which causes inflammation of the synovialmembrane and results in excessive synovial fluid, can lead to pain andstiffness. Traumatic arthritis, arthritis due to injury, may cause damageto the cartilage of the knee.
The goal of knee replacement surgery is to resurface the parts of the kneejoint that have been damaged and to relieve knee pain that cannot becontrolled by other treatments.
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Physical Therapy After Knee Replacement Surgery
Mobility is also another important factor to consider when it comes to physical therapy. This is because there are certain activities that you will need help with during the first few weeks. This includes showering, getting in and out of bed or chairs, as well as climbing stairs.
The first key milestone is reaching 90 degrees of knee flexion. This will allow you to sit comfortably on chairs/couches and walk up and downstairs. The next priority is to fully extend your leg as if one cannot do this it makes walking very difficult.
The normal amount of knee bend should be roughly 135 degrees, but achieving this goal takes a long time. The other option would be using an assisted-living home. You can also use a nursing facility for assistance with daily tasks such as bathing and toileting.
After you receive knee replacement surgery, it will take time for your range of motion to return. This is partly due to the swelling that can persist up until several months after receiving this procedure. You should expect a combination of movement and static stretches while incorporating these exercises into your routine.
Your rehab program will also include strengthening exercises. The reason for this is that after knee replacement, its common to see patients minimize how much they use their new knees due to pain. This can cause weakness in the leg muscles and those around the hip.
Physical Therapy Guide To Total Knee Replacement
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The knee is the most commonly replaced joint in the body. The decision to have knee replacement surgery is one that you should make in consultation with your orthopedic surgeon and your physical therapist. Usually, total knee replacement surgery is performed when people have:
- Knee joint damage due to osteoarthritis, rheumatoid arthritis, other bone diseases, or fracture that has not responded to more conservative treatment options
- Knee pain or alignment problems in the leg that cause difficulty with walking or performing daily activities, which have not responded to more conservative treatment options
Physical therapists are movement experts who improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation. To locate a physical therapist in your area, visit Find a PT.
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How Do I Manage Pain And Discomfort After Joint Replacement Surgery
Try to take your pain medication as soon as you begin to feel pain. Don’t wait until the pain becomes severe. Follow the instructions on the prescription label. Remember to take your pain medication before activity and bedtime.
If you need to have stitches or staples removed and you’re still taking pain medications, be sure to have a friend or family member drive you to your appointment.
Pain medication may cause nausea. If this happens, decrease the amount you are taking or stop and contact your surgeons office.
If you need additional pain medication, please contact your surgeons office. Give at least a few days advance notice before you run out of the medication. Please plan ahead, especially for holiday weekends.
Also remember:
- You aren’t permitted to drive a car while taking narcotic pain medication.
- It may take several days to have a bowel movement. Anesthesia and pain medication often cause constipation. Drink plenty of fluids and eat whole grains, fruits, and vegetables. A stool softener or laxative can help bowel function return to normal.
- Don’t hesitate to call your surgeons office with any questions or concerns.
Incision care
Walker, crutches, cane
Use your assistive devices for balance as instructed by your surgeon or therapist. By your first post-op visit with your surgeon, you may have already improved and changed from using a walker or crutches to a cane .