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What To Expect After Outpatient Knee Replacement

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Outpatient Total Knee Replacement, what can I expect right after surgery?

I would highly recommend that you have a walker in your hospital room from the get-go. The hospital provided a walker for me. I assume I was billed for it.

Without the walker, I could not have gotten out of bed so soon. I needed it to use the bathroom and to take the walking and stair tests that allowed me to go home .

The cane felt just as comfortable as the walking pole. The reason I chose to transition from the walker to the walking pole was that I had two walking poles and I didnt have a cane. If I had a cane I may have opted for it.

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How Long Will You Be In Outpatient Physical Therapy

Outpatient physical therapy after a total knee replacement typically lasts 4 to 8 weeks. Remember that everyone heals at different rates, and your recovery time may be shorter or longer. Be sure to work closely with your healthcare provider and physical therapist to understand your specific rehabilitation process.

You may not feel like you are 100% when it comes time to stop attending outpatient physical therapy. Your physical therapist should ensure that you are performing an exercise program at home on a regular basis to help you make further gains in the months after discontinuing physical therapy.

Outpatient physical therapy can be a helpful and important component of your overall recovery after your total knee replacement surgery. By working hard in the physical therapy clinic, you can be sure you maximize your chances of quickly gaining normal functional mobility.

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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Before Being Discharged Following Outpatient Knee Replacement Surgery Patients Need To Be Able To:

  • Use the washroom, eat and drink.
  • Get in and out of bed.
  • Walk on a level surface using some type of assistive device .
  • Climb up and down a couple of steps.
  • Perform the exercises prescribed by their physical therapist.

Patients must also have acceptable pain control options and understand which activities they need to avoid, so that their knee has time to heal properly. Patients who are unable to meet these goals will be transferred to a skilled nursing or rehabilitation center

Knee Replacement Recovery Tips To Maximize Healing

What to Expect After Knee Replacement Surgery

Recovering from a total knee replacement is a slow process and can feel, in the immediate postoperative period, like very little progress is being made. However, a dedicated and consistent approach to recovering will always yield the best results. It is important to try to mobilize as soon as possible after your knee replacement surgery. This will be tricky immediately following the surgery as you will feel sore and have some pain, which will hopefully be controlled by the pain medications your surgeon will prescribe you.

If your pain is poorly controlled, it is important to let your surgeon know this so that your analgesic regimen can be altered to suit your needs. In the immediate postoperative period, you will have physical therapist assistance in getting up and on your feet in a safe and timely manner. They will help you get used to the feeling of your new knee and will teach you how to walk safely while your knee and tissues within the knee are still recovering from the surgery.

X-ray showing Total Knee Replacement.

It is important that you continue physical therapy assistance in the longer term recovery from your knee replacement surgery, as studies have shown consistently that patients who undergo a dedicated and standardized physical therapy regimen to recover from that knee replacement experience much better outcomes than those who do not.

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Who Needs Total Knee Replacement Surgery

Most total knee replacement surgeries occur in people who are 55 or older, but they can also occur when people are younger as well. The best way to tell if you or a loved one needs a total knee replacement is to talk to an orthopedic doctor to see if thats the best option for your lifestyle. The most common candidates for total knee replacement surgery are people who:

  • Have pain and stiffness in their knee every day
  • Have a knee that is so painful that they have trouble with daily activities such as climbing stairs, dressing, bathing, or preparing meals
  • Have a knee that is unstable and gives out
  • Have a knee or leg deformity
  • Take medications, experienced weight loss, or used injections to try and relieve pain, but have not seen results

Can Rehabilitation Be Done At Home

All patients are given a set of home exercises to do between supervised physical therapy sessions and the home exercises make up an important part of the recovery process. However, supervised therapy–which is best done in an outpatient physical therapy studio–is extremely helpful and those patients who are able to attend outpatient therapy are encouraged to do so.

For patients who are unable to attend outpatient physical therapy, home physical therapy is arranged.

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Alternatives To Total Knee Replacement Surgery

There are several different conservative or less invasive options that may be attempted prior to having a total knee replacement.

Injections are often used in an attempt to decrease inflammation, friction, and pain in the joint. Surgical options to consider aim to preserve or restructure remaining tissue and to prevent or put off a total knee replacement.

Physical Therapists provide non-invasive treatment options to improve strength, flexibility, and body mechanics for functional activities to reduce knee pain. PTs can also educate patients on an exercise program for improving body composition.

More Than One Knee Replacement Surgery

Outpatient Knee Surgery: Day in the Life

Knee pain can develop from many causes. For most people, however, knee pain results from arthritis, which is a degenerative condition that worsens with time. When conservative treatments no longer alleviate your knee pain, then you may be considered a good candidate for knee replacement surgery.

Dr. Karas offers two knee replacement options:

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Knee Replacement Recovery Phase : Weeks 7

When recovering from knee arthroplasty, the fourth phase is when most patients see the most rapid improvement to mobility and range of motion. It is an exciting time where the hard work of attending physical 2-3 times a week and staying compliant with home exercise programs starts to pay off.

Some common goals and milestones during this phase of rehab include:

  • No extensor lag
  • Normal gait without the use of an assistive device
  • Engaging in everyday activities such as driving, housekeeping, and shopping
  • Ability to ascend and descend 1-2 flight of stairs with a reciprocal gait

Your physical therapist will continue to progress your rehab and increase difficulty in the 7-12 weeks following surgery. Patients can expect exercises such as:

  • Toe and heel raises while standing
  • Single leg balances
  • Step-ups in multiple directions
  • Continued lower extremity strengthening

Even if you do not see the best results, it is crucial to stay the course. Dont give up, ask questions, and continue to follow the guidance of your healthcare team.

Possible Benefits Of Total Knee Replacement Surgery

Regardless of whether a traditional total knee replacement or a minimally-invasive partial knee replacement is performed the goals and possible benefits are the same: relief of pain and restoration of function.

The large majority of total knee replacement patients experience substantial or complete relief of pain once they have recovered from the procedure. The large majority walk without a limp and most dont require a cane, even if they used one before the surgery. It is quite likely that you know someone with a knee replacement who walks so well that you dont know he even had surgery!

Frequently the stiffness from arthritis is also relieved by the surgery. Very often the distance one can walk will improve as well because of diminished pain and stiffness. The enjoyment of reasonable recreational activities such as golf, dancing, traveling, and swimming almost always improves following total knee replacement.

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A Few Days In The Hospital

In the past, patients stayed an excess of 10 days in post-operative care. Now, patients stay for just a few hours or days after the operation. During the time, the doctor occasionally observes the knee while checking for possible infections. Around this time, a physical therapist may visit the patient to create a therapy plan. Inpatient surgery is useful for observation, treating any complications, and dealing with the patients mobility.

What Should I Expect After My Total Hip Or Total Knee Replacement

Benefits to Outpatient Knee Surgery

NOTE: The following is a general guide to care following your procedure. Your healthcare provider may have somewhat different instructions for you. Please follow those.

After total knee or total hip replacement surgery you can expect gradual improvement over the coming months. You should gradually expect less pain, stiffness and swelling, and a more independent lifestyle. Returning to work depends on how quickly you heal and how demanding your job may be on a new joint.

After you are discharged from the hospital or rehabilitation facility, there will be a few weeks before you return for a follow-up visit with your surgeon. This period of time is critical in your rehabilitation and you may require outpatient therapy services for positive long-term results from your surgery.

In general, patients do very well after discharge. However, its important that you contact the surgeons office if any of these occur:

  • You have increasing pain in the operative site.
  • There is new or increased redness or warmth since discharge.
  • There is new or increased drainage from your incision.
  • The operative site is increasingly swollen.
  • Your calf becomes swollen, tender, warm or reddened.
  • You have a temperature above 101 degrees Fahrenheit for more than 24 hours.
  • For total knee replacement, your ability to flex has decreased or remains the same as when you were discharged from the hospital.

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Variables In Pain Level

There arefactors that can increase or decrease your level of pain after surgery.

  • Activity Level: Movement of the joint and physical activity is encouraged after surgery and should be guided by your doctor and physical therapist. Activity level can increase swelling and lead to more pain. This is normal and can be managed through medications or hot/cold therapy.
  • Time of Day: Believe it or not, the time of day can play a factor in your pain level after hip or knee replacement. Pain at night is more common. There are several reasons for this, including being active during the day and increased swelling, as well as not having any distractions at night and focusing on your pain or discomfort.
  • Stress: Heightened stress levels can worsen both physical and perceived pain. If you are feeling stressed or anxious, tell your doctor and set aside dedicated time each day to meditate or relax. Journaling, talking with a friend or listening to calming music are ways to relax while recovering from surgery.

Knee Replacement Recovery Phase : Weeks 1

The first week after undergoing knee arthroplasty, patients can expect to be back in the comfort of their own homes. One of the first and most important things to know during this period is your follow-up appointment with your surgeon. Typically the follow-up is scheduled about two weeks after the knee replacement and is something every patient should markdown as must-attend.

Phase 2 of knee replacement rehabilitation also includes patients becoming more active with therapy. Some patients start treatment at home, while others can attend an outpatient clinic. One is not necessarily better than the other it just depends on a persons health status.

Some goals and priorities to be aware of include:

  • Reduce pain and stiffness
  • Being able to transfer from lying to sitting to standing safely with the help of assistive devices
  • Being able to heel strike while ambulating
  • Increase knee range of motion
  • Ability to extend leg without lag
  • Being consistent with the home exercise program provided
  • Understanding the pain scale and the difference between hurt and harm.

Your physical therapist will design a rehab program to help you reach these goals without harming the new knee hardware or incision. Examples of exercises to expect for the weeks 1-3 after your surgery include:

  • Heel Slides
  • Stationary bike with little to no resistance
  • Hamstring Curls

Note: These therapeutic modalities can and often are used throughout all phases of knee rehabilitation.

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Moving To Outpatient Procedures

More and more patients are opting for outpatient care. Due to minimally invasive techniques, persons can leave the same day. However, for hospitals to complete outpatient surgeries, several conditions need to be in place. These include timing, the success of surgery, and the familys social support. The patient should also be of sound medical health, with a strong support network to make at-home recovery easier.

Strategies To Reduce Pain After Knee Surgery Without Opioids

Outpatient Total Knee Replacement Patient Story – 1 week post surgery

Hinich and others at U of U Health are working on multiple strategies to reduce opioid pain medication usage.

Creating better tools for measuring pain

Asking patients to quantify pain on the Numerical Rating Scale of 0 to 10 is not scientific, which makes it harder to create effective treatment plans and avoid overprescribing opioids. U of U Health developed a better way to measure pain. Providers discuss pain and how its impacting quality of life with the patient, then input that information into a Clinically Aligned Pain Assessment tool . The tool analyzes the data and offers recommendations for an effective treatment plan.

While developing the tool, researchers studied more than 12,000 pain assessments and found that nurses and patients all preferred CAPA over NRS. The tool accurately identified pain severity and offered effective treatment 81% of the time, compared to just 42% of the time with NRS.

Setting realistic expectations

Recovery after a knee replacement is difficult and long. Pain can last for several weeks, and swelling can continue for up to six months after the operation. But its normal to have some pain. When orthopedic surgeons set that expectation from the start, many patients understand they only need pain medications for a short time, immediately after surgery, when the pain is most intense.

Teaching mindfulness

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The Question Surrounding Knee Replacement

A knee replacement sounds like a dangerous and intensive surgery. Long ago, this would be the case. Now, knee replacements are quite common, with millions of procedures happening every year. And with the invention of minimally invasive techniques, the conversation has shifted. People now want to know if the surgery is a same-day procedure. Outpatient joint surgery is growing in popularity and demand. But is everyone a candidate?

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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What To Expect After Outpatient Total Knee Replacement

Several hours after surgery, you will be discharged from the hospital following a thorough examination to make sure you meet the requirements for discharge such as stable vital signs during exercise, ability to eat and take pain medicine by mouth. You generally have a two- to four-week recovery compared to the two-to-three-months needed to recover from traditional knee surgery.

How Much Pain Will I Have After My Knee Surgery

What is Arthroscopic Knee Surgery?

This varies between patients, however, the advances in pain management have allowed our total knee patients sufficient pain relief to undergo this procedure on an outpatient basis. On average, the pain being reported is generally no more than four out of a 10-point scale. You will have one of us by your side when you wake up and throughout the day until you leave our facility. We can address any pain that you may have promptly and efficiently.

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