Surgical repair of the knee is sometimes not an option. Depending on the severity of your condition, the only way to recover knee function can be a total knee replacement. This is a complex procedure, and you need to adapt to a completely new body part and its function. That is why we can expect a lengthy recovery after this type of surgery, even in young patients.
What do you need to keep in mind after surgery to recover faster? In this article, you will find the answer. You need to know what to expect, understand the complications and warning signs, go through rehab, and contribute with a few lifestyle and day-to-day recommendations.
Knee replacement recovery
What can you expect after knee replacement surgery? First off, you will go through an observation period. During this time, you will have an oxygen mask and wait until the anesthetics’ effects wear off. In some cases, you might need a blood transfusion, which will be running when you wake up.
Looking down at your knee, you will find a large dressing, and it is likely to have a tube attached. This tube is meant to drain blood and other fluids from the inside of the wound.
In some cases, you will be able to walk on the same day. In others, you will have to wait 24 hours or more to stand for the first time. You’ll need crutches on your first walk, and you will probably feel different than before. It might feel uncomfortable, and your legs may feel swollen. This is normal and does not mean that the surgery went wrong. Still, you’re encouraged to talk to your doctor if any symptoms make you worried.
After two or three days, you’ll be granted clearance to return home. This time frame varies among patients according to their recovery process. When you’re at home, you might still feel very tired, but this is also expected, and you should have someone around to help for at least one week.
Understanding complications after knee replacement surgery
During the recovery time, it is essential that you understand the complications of the surgery. The most critical and dangerous complications are ruled out during the observation period when you are still in the hospital. But some of them can still develop, even when you are at home. It will be very helpful if you can detect warning signs early enough and report them to your doctor.
The most common complications include:
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- Infections: They usually show up during the first week or two. That’s why doctors prescribe antibiotics after surgery, and you should follow the schedule, even if you feel fine. Keep your wound dry and always clean to prevent infections.
- Scar tissue formation: Surgery involves cutting, scraping, and changing structures inside the knee. All of this triggers inflammation, which prompts the formation of scar tissue. This is normal, but some people form excessive scar tissue, which sticks to the articulation and causes mobility issues.
- Mechanical problems with the new prosthetic part: In some cases, patients may experience mechanical issues or adjustment issues with the prosthetic knee. Implant failure is a possibility. It is not the most common complication, however.
Warning signs and things to report to your doctor
The complications above are not very difficult to detect, and patients have an important role in reporting warning signs and symptoms. So, one of the most important recommendations we can give you to facilitate your recovery is to keep in mind and report these symptoms as soon as possible if they ever appear:
● Redness and swelling: This can be a sign of infection. The wound is usually swollen and red when you are still in the hospital. Take a look often and compare how it looks. Report to your doctor right away if you notice worsening in the general appearance of the wound.
● Stiffness: It is normal to experience some stiffness after surgery as your body gets used to the new prosthetic part. However, the sensation of stiffness will slowly go away and will probably resolve entirely after one or two months. If you see no advances and still experience stiffness after a long time, you’re likely not doing rehab correctly, or your body is forming excessive scar tissue. Report this concern to your physiotherapist and doctor.
● Persistent knee pain: You will be prescribed with painkillers after surgery, and pain is normal if you don’t take them. But it shouldn’t persist for months. If you still have knee pain after two months, there is probably something wrong with the prosthetic knee, or you may need a change in your treatment plan. Talk to your doctor about it to figure out what is happening.
● Instability: As mentioned above, you may need some time before your body adapts to the knee replacement. However, instability is expected to improve with rehabilitation. It is a slow but progressive improvement, and you will soon walk normally. If this is not happening, your doctor may need to rule out implant failure, especially if you endured a fall or had a fracture after knee replacement surgery.
Rehabilitation after knee replacement surgery
Rehabilitation is an integral part of knee replacement recovery. It is actually one of the most important steps toward your goal because it helps your body get used to the implant and its functions. Your muscles need to connect with each other, and the nervous system in a completely new way, and the transition is not immediate. So, rehabilitation is a must, and it is up to you to give your best during rehabilitation and follow the instructions to the letter.
The rehabilitation protocol is different depending on how many weeks passed after knee replacement surgery. After the procedure, this is what to expect from rehabilitation, and this is what you can do to contribute to your recovery:
Day 1 and 2:
During the first two days after the procedure, you will use something known as a continuous passive motion machine. This is a very useful device that straightens and bends your knee very slowly, getting the articulation prepared for rehabilitation.
During this period, your doctor may need your help to set up the machine, and you want to answer their questions as accurately as possible. After using this machine, it comes a moment when your physical therapist will ask you to sit up in your bed, stand, and walk with a wheeled walker or a standard walker. Even if it seems challenging at first, you want to follow their advice to get you moving as soon as possible.
Your doctor and therapist may also recommend simple exercises such as squeezing the buttons or pumping the ankles. It may seem too simple, and some patients could even forget to do these exercises. But set a timer or figure out a way to remember to do as instructed. These exercises are important to stop blood from pooling and creating blood clots in your veins.
Week 1 and 2:
You can be moved to sub-acute rehabilitation or home physical therapy, depending on your progress. The former is performed in a rehabilitation center, where you will be taken as an inpatient for a while. The latter is done at home, and a physical therapist will visit you with a set of tools.
The main goal of weeks 1 and 2 is to increase knee strength and range of motion, especially if you’re taken to a sub-acute rehabilitation center. If you’re receiving the physical therapist at home, you will receive a type of massage known as scar tissue massage. It is meant to dissolve scar tissue that usually forms in the deep tissues.
Scar tissue massage and range of motion exercises will probably feel uncomfortable, but they are necessary for your recovery. Remember that every time you feel like protesting against doing the exercises, and ask your therapist if what you feel is expected according to the type of rehabilitation protocol they are following.
Weeks 3 to 6:
By this time, most patients will be working at home, if not all. Range of motion exercises are more demanding during this time, and the goal is to achieve knee motion of at least 100 degrees by the end of the sixth week. During this time, some patients have found significant benefits from riding stationary bicycles, which may speed up recovery. Ask your doctor or physical therapist if this type of exercise is appropriate for you according to your current advances.
When you use a stationary bike, do not feel discouraged if you can’t move the pedal as you did before. This is absolutely normal as your body adapts to the implant, and it will get better in time. As you keep building strength, your range of motion will increase, and the stationary bike will become an easy task.
During this time, you may also be given neuromuscular electrical stimulation as a part of the rehabilitation protocol. Strengthening exercises are still essential, and you may need straight leg raising exercises to improve hip, hamstring, and quadriceps strength.
Weeks 7 and 8:
During this time, you have probably achieved a range of motion of 100 degrees with your knee, and now rehabilitation will focus on building something called functional mobility. In other words, we are now putting into practice the new skills and mobility improvements achieved in previous weeks.
Therapists will focus on proprioception and balance. In simple terms, now your muscles need to learn how to interact with the brain to keep your movements smooth and prevent falls. Report any type of pain because it shouldn’t be present by now, and do as instructed by your physical therapist to complete your rehab.
Speed up your recovery
We have reviewed the most important aspects of recovery after knee replacement surgery throughout this article. But let us briefly bring to the table the most critical recovery tips and recommendations mentioned above and a few others that will help speed up your recovery:
- Learn to manage your pain: It does not mean living through the pain. It means you need to understand the difference between discomfort and pain. Remember that we all have different pain thresholds, and you’re not supposed to live with pain. Quite the opposite, because this is a warning sign, as noted above. Learn to describe your pain accurately, differentiate the sensation from others, and identify whether it is intermittent, tingling, sharp, or burning. This skill will be very helpful throughout your recovery.
- Don’t be afraid of walking: The soonest you walk, your recovery will be faster. So, don’t be afraid to get yourself walking as soon as possible. Remember that your doctor has previous experience and will only give you clearance when you are ready to do it. So, as soon as he instructs, get back on your feet and start walking. Doing so will improve circulation, prevent blood clot formation, and help you strengthen your limbs. Of course, not being afraid is different from being reckless. Walking aids are important during the first stages of your recovery, and you should always move carefully as instructed by your doctor.
- Follow physical therapy and give your best efforts: Physical therapy can sometimes be tiring, but it is necessary. It is one of the most critical aspects of your recovery after knee replacement surgery. So, don’t take it lightly. Follow the instructions to the letter and collaborate with your physical therapist for better results.
- Exercise: Your physical therapist will guide you through a series of home exercises you can do during this time. When he gives you clearance to exercise with a stationary bike or in a fitness center, doing so will help a lot. Exercising improves the outcome of physical therapy and helps the muscle tissue recover more quickly. If you experience any type of pain during exercise sessions, discontinue immediately and talk to your physical therapist or doctor about it.
- Rest: This is also an essential step to recovery. Your muscle tissue needs to rest, and that is how the tissue grows back. During the first phase of your recovery, you will need to keep your knee elevated and rest almost all day long. Try to find ways to entertain yourself during this time to avoid feeling uneasy.
References:
Isaac, D., Falode, T., Liu, P., I’Anson, H., Dillow, K., & Gill, P. (2005). Accelerated rehabilitation after total knee replacement. The knee, 12(5), 346-350.
Han, A. S., Nairn, L., Harmer, A. R., Crosbie, J., March, L., Parker, D., … & Fransen, M. (2015). Early rehabilitation after total knee replacement surgery: a multicenter, noninferiority, randomized clinical trial comparing a home exercise program with usual outpatient care. Arthritis care & research, 67(2), 196-202.
Shakespeare, D., & Kinzel, V. (2005). Rehabilitation after total knee replacement: time to go home?. The Knee, 12(3), 185-189.