As our population ages and people are getting more active, pain from knee osteoarthritis remains a big problem. This affects the quality of life of the patient with painful knee osteoarthritis.
Total knee replacement surgery can offer a new lease of active lifestyle to many sufferers of knee osteoarthritis.
This article will address what the patient undergoing this type of surgery should expect during the recovery period.
What is Knee Replacement Surgery for?
Knee replacement surgery, formally known as total knee arthroplasty (TKA), is a surgical procedure aimed at resurfacing a damaged knee joint. This surgery is primarily used to relieve severe pain and improve mobility in individuals whose knee joint has been significantly compromised by various conditions.
Here are the main reasons why someone might consider knee replacement surgery:
- Osteoarthritis: This is the most common reason for knee replacement. It’s a degenerative condition where the cartilage, the shock-absorbing cushioning in the joint, gradually wears down over time. This leads to bone rubbing against bone, causing pain, stiffness, and difficulty moving the knee.
- Rheumatoid arthritis: This autoimmune disease can damage the synovial membrane in the knee joint, leading to inflammation, pain, and joint destruction. While medications and other treatments can be helpful, severe cases might benefit from knee replacement.
- Post-traumatic arthritis: This type of arthritis can develop after a severe knee injury, like a fracture, that damages the joint surface and leads to long-term pain and dysfunction.
- Other less common reasons: Less frequently, knee replacement surgery might be considered for conditions like severe avascular necrosis (bone death due to lack of blood supply) or severe joint deformity.
Overall, knee replacement surgery is a major decision and should only be considered after exhausting conservative treatment options like physical therapy, pain medication, and injections. If you’re experiencing significant knee pain and limitations in your daily activities, discussing your options with an orthopaedic surgeon can help you determine if knee replacement is the right choice for you.
What to Expect During the First 24 hours Post-Surgery?
Here’s what you can expect during the immediate 24 hours following knee replacement surgery:
Recovery Room
You’ll spend the first few hours in a recovery room while waking up from anaesthesia. Your vital signs and pain levels will be closely monitored.
You might receive pain medication through an IV drip and oxygen to aid breathing.
You’ll likely have ice packs applied to your knee to reduce swelling.
Pain Management
Expect some pain and discomfort, but it should be manageable with medication. Communicate openly with your nurse or doctor about your pain level so they can adjust medication as needed.
You might receive a combination of pain medications, including oral medication, intravenous medication, and a pain pump.
I routinely use a continuous nerve block to the operated leg for the first 3 days as this significantly reduces pain and discomfort in my patients and reduces the need for strong pain medications which usually can result in nausea or vomiting.
Movement and Exercises
Within a few hours after surgery, you might be encouraged to start moving your legs by wiggling your toes and ankles. This helps prevent blood clots and improves circulation.
Later in the day, with the help of a physical therapist, you might attempt to stand and take a few steps with the assistance of a walker or crutches. Early movement is crucial for a smooth recovery.
Almost all of my patients walk within 24 hours of the surgery.
Monitoring and Comfort
Your blood pressure, heart rate, oxygen levels, and temperature will be monitored regularly.
You’ll be encouraged to wear compression stockings to prevent blood clots in your legs.
You might have a urinary catheter to drain urine for the first day or two, and a drainage tube near your incision to remove excess fluid.
Nurses will ensure you are comfortable and answer any questions you have.
Other Points
You might experience side effects from medication, like nausea or dizziness. Inform your nurse if you experience any discomfort. You might not have much appetite initially, but it’s important to start eating and drinking fluids as tolerated to aid recovery. You’ll likely get some sleep, but it might be interrupted by pain checks and monitoring.
How Long is the Hospital Stay for a Knee Replacement Surgery?
Most patients stay between 3 to 5 days for this surgery.
For patients who require additional care due to lack of caregivers at home, they may have to go to a community hospital for step-down care for a short period of time before going back home.
What is the Expected Recovery Period for a Knee Replacement Surgery?
The recovery period from knee replacement surgery can be lengthy but rewarding, leading to improved mobility and reduced pain. Here’s what you can expect:
Initial Days (Weeks 1-2):
- Pain Management: Expect moderate pain initially, manageable with medication. Communicate openly with your doctor about discomfort.
- Physical Therapy: Start gentle exercises to improve circulation and prevent stiffness.
- Wound Care: Keep your incision clean and dry according to your doctor’s instructions.
- Rest and Support: Prioritise sleep and rely on assistance for daily activities.
Progressing Recovery (Weeks 3-6):
- Increased Mobility: Gradually use a walker or crutches, progressing to independent walking with your doctor’s approval.
- Strengthening Exercises: Physical therapy intensifies, focusing on regaining strength and range of motion.
- Swelling and Pain Reduction: Expect gradual improvement, but some discomfort might persist.
- Return to Daily Activities: Begin basic tasks like cooking and showering with assistance.
- Driving: This might be restricted initially until you regain control and strength.
Continued Recovery (Months 3-6):
- Gradual Return to Activities: You can resume most daily activities like walking, climbing stairs, and light housework.
- Advanced Exercises: Physical therapy focuses on regaining full strength and flexibility.
- Reduced Pain and Swelling: You should experience significant improvement and reduced pain medication dependence.
- Return to Sports: Consult your doctor about gradual return to low-impact activities, avoiding high-impact sports for 6-12 months.
Beyond 6 Months:
- Continued Strength and Function: Continue physical therapy or exercise programs to maintain mobility and strength.
- Long-Term Management: Regular checkups with your doctor are crucial to monitor your progress and joint health.
- Lifestyle Adjustments: Maintaining a healthy weight and avoiding strenuous activities on the joint can extend the lifespan of your implant.
Is Physiotherapy Important After a Knee Replacement Surgery?
Yes, physiotherapy is absolutely crucial after knee replacement surgery. It plays a vital role in your recovery and achieving the best possible outcome. Here’s why:
Benefits of Physical Therapy after Knee Replacement:
- Pain Management: Physical therapy exercises help improve circulation and reduce swelling, contributing to pain management and faster healing.
- Regaining Range of Motion: Scar tissue formation around the knee joint after surgery can lead to stiffness. Physical therapy includes mobility exercises to restore your knee’s full range of motion, allowing for easier movement and daily activities.
- Strengthening Muscles: The muscles around your knee become weakened after surgery. Physical therapy focuses on strengthening these muscles, providing stability and support for your new joint, and preventing future injuries.
- Improving Balance and Coordination: Physical therapy helps regain balance and coordination, minimising the risk of falls, a significant concern after surgery.
- Returning to Daily Activities: Physical therapy teaches you safe ways to perform daily activities like walking, climbing stairs, and getting in and out of bed, helping you regain independence and improve your quality of life.
- Preventing Long-Term Complications: Regular physical therapy exercises can help prevent future complications like stiffness, muscle atrophy, and pain, extending the lifespan of your knee replacement.
What to Expect in Physical Therapy
- Individualised program: Your physical therapist will design a personalised program based on your specific needs, recovery progress, and goals.
- Progression: The program starts with gentle exercises and gradually progresses to more challenging ones as you gain strength and mobility.
- Variety of exercises: You can expect various exercises like stretching, strengthening, balance training, and gait training.
- Education: Your therapist will educate you on proper movement techniques, home exercises, and how to use assistive devices safely.
Overall, physical therapy is not an optional component of recovery after knee replacement surgery. It plays a key role in achieving optimal results, reducing pain, and ultimately returning to a healthy and active life.
