What I Wish I Knew Before Knee Replacement Surgery

Who Should Consider Total Knee Replacement Surgery?

A total knee replacement is a significant step, typically recommended by an orthopedic surgeon for individuals whose knee pain severely impacts their quality of life. You might be a candidate if you suffer from conditions like advanced osteoarthritis or rheumatoid arthritis that have caused significant joint damage and damaged cartilage in the knee joint.

Ideal candidates often experience:

• Persistent knee pain that disrupts daily activities like walking, climbing stairs, or even resting.
• Chronic inflammation and swelling that doesn’t improve with rest or medication.
• A limited range of motion that makes bending or straightening the knee difficult.
• Failure to find relief from more conservative treatment options, such as physical therapy, injections, or over-the-counter pain relievers.

Your orthopedic specialist will conduct a thorough evaluation, including physical examinations and X-rays, to determine if total knee replacement surgery, also known as knee arthroplasty, is the right path for you.

1. Get An Experienced Provider

Many surgeons perform knee replacements, but not all provide the same quality of care. Some surgeons pursue additional training to sub-specialize in, or become experts in, knee replacement surgery. This is known as a fellowship in Adult Reconstruction and is often listed on the provider’s biography. (For instance, our own Dr. Jonathan Dattilo received an additional year of advanced training in hip and knee reconstruction at the world-renowned Anderson Orthopaedic Research Institute after he finished his residency at the University of Pennsylvania.) These surgeons are more likely to be experienced with the latest techniques and often perform several hundred knee replacements per year.

2. Physical Therapy Is Essential

Just like anything else in life, the more effort you put into recovering from your knee replacement, the better your ultimate function and outcome will be. Consider planning your surgery at a time when you’re able to devote 4 to 6 weeks to dedicated physical therapy. Avoid having surgery immediately before a trip or a significant life event, where you may be tempted to skip some of the treatment. A qualified physical therapist will be a crucial part of your healthcare team, guiding you through exercises to restore your range of motion and strength.

3. Recovery Is a Marathon, Not a Sprint

It may be frustrating at times if you’ve been living with years of knee pain. You understandably want to get back to the activities you’ve been missing as soon as possible. This can be helpful, and you should choose an ultimate goal or activity and use this as motivation throughout your physical therapy. Remember, though, that therapy is a series of small goals designed to ultimately help you achieve your recreational goals. Typically, these goals may include learning to walk again without the assistance of a walker or cane, progressively increasing your knee range of motion, and strengthening the muscles around your knee. It’s often helpful to ask your physician before surgery what a realistic timeline is to achieve your particular pre-operative goal.

4. The Pain Is Real, But It’s Manageable

Ask your physician for a personalized pain medication program. Pain control after total knee replacement has undergone tremendous improvements in recent years, with the introduction of many new techniques. Modern improvements utilize what is termed a ‘multi-modal’ pain protocol, meaning that they incorporate many different, non-narcotic medications to help control your pain, while limiting the side effects and addictive potential of narcotic medications. Additionally, many surgeons utilize injections as an additional way to decrease post-operative pain and swelling and allow you to recover faster.

What to Expect the First Week After Knee Replacement

The first week after your total knee replacement surgery is a critical period for healing and establishing a foundation for a successful recovery. On the day of surgery, your healthcare team will manage your immediate post-operative needs. You can expect some pain and swelling, which will be controlled with a structured pain management plan.

Here’s a general timeline for that first week:

• Hospital Stay: Many patients are now able to go home the same day as their outpatient procedure. If a short hospital stay is needed, you’ll be monitored closely. Your anesthesiologist will ensure your comfort as the general anesthesia wears off.
• Pain Management: Your pain medicine regimen will be carefully managed. This may include a combination of prescribed pain medication and over-the-counter options.
• Mobility: You'll be encouraged to start moving soon after surgery, often with the help of assistive devices like a walker or crutches. A physical therapist will guide you through gentle exercises to improve the range of motion.
• Preventing Complications: To reduce the risk of blood clots, you may be prescribed blood thinners and be required to wear compression stockings.

By the end of the first week, you should be able to walk short distances with support and perform basic daily activities with assistance from a family member or caregiver.

5. Prepare Your Home for Recovery

Preparation is the key to success. Before surgery, inspect your home for any potential hazards, such as carpets or rugs, that could pose tripping risks during your recovery. Also, consider the type of shower you have and whether you may require additional assistance to get in and out of the shower after surgery. Installing a support rail in your shower is a relatively quick and easy way to feel more secure while recovering. Placing a sturdy chair or footstool nearby can also be helpful.

6. Have a Strong Support Network

Identify a coach before surgery who can attend pre-operative and post-operative visits with you and assist with your recovery. This could be a spouse, significant other, or friend. If you know others who have had a knee replacement, ask them about their experience and whether they would do anything differently.

7. Recovery Is Mentally Draining

Recovering from a knee replacement doesn’t just require physical effort; it can also be mentally draining. Putting the time in for physical therapy is an investment, and it can feel frustrating when you’re not back to your old self right away. Treat it like you would any long-term project: take it one step at a time, and focus on the small victories. Before long, you’ll see the transformation has occurred.

8. Pain Management Is Key

Adequately controlling your pain following surgery is paramount to allow you to participate in the therapy process. There are many new techniques, often using non-narcotic medications, that have greatly improved our patients’ pain management after surgery. For this reason, many patients are choosing to undergo this procedure as an outpatient procedure, allowing them to recover in their own homes and eat their own food, surrounded by family who can support them through the process. Ask your physician to personalize a pain management protocol tailored to your specific medical conditions before surgery, so that you have a clear plan for how your pain will be managed and allow you to focus on your knee recovery.

9. Explore Other Treatment Options

While knee replacement is a highly successful operation, many non-surgical treatment options may provide substantial benefits before proceeding with surgery. This may include physical therapy, medications, and injections. Sometimes, a partial knee replacement is an option if damage is limited to only one part of the knee, such as the patella (kneecap), femur (thighbone), tibia (shin bone), or fibula (calf bone). Discuss whether you may be a candidate for alternative treatments with an orthopedic specialist before proceeding with surgery.

10. Knee Surgery Is Not a Cure-All

A knee joint replacement involves replacing the worn bone and cartilage in your knee. However, remember that you still have the same muscles and many of the same ligaments around the knee, and they can still experience soreness or stiffness after prolonged activities. Strengthening these muscles and ligaments through physical therapy after surgery is a crucial part of the recovery process. The goal is to return to normal activities, particularly low-impact ones, but it’s important to manage expectations about high-impact activities.

11. Your Knee Might Feel Different

While modern knee replacement technology has evolved significantly over the last several decades, it remains an implanted device that may initially feel unfamiliar. Occasionally, particularly in the first several months after your surgery, it may take some time for the muscles around your knee to become strong again. This is not typically painful and usually resolves, but it may take several months for your knee to feel like a ‘normal’ knee again. Your new knee, or artificial joint, is made of durable materials, but it won't feel exactly like your natural joint. It might even trigger metal detectors.

What Are the Risks of Knee Replacement Surgery?

Like any major healthcare procedure, total knee replacement carries potential risks. While our orthopaedic team takes every precaution to ensure your safety, it's essential to be aware of possible complications. These include:

• Infection: Infection can occur at the incision site or deep within the artificial knee. We take extensive measures to prevent this, but it's a risk with any knee surgery.
• Blood Clots: Blood clots are a serious concern. They can form in your leg veins (deep vein thrombosis) and potentially travel to your lungs, causing chest pain and other severe symptoms. Using blood thinners and compression stockings helps mitigate this risk.
• Prosthesis Issues: Over time, the prosthesis can loosen or wear out, though modern artificial joints are designed to last for many years.
• Nerve or Blood Vessel Injury: There is a small risk of damage to nerves or blood vessels around the knee joint during the procedure.
• Stiffness: Some patients may experience persistent stiffness that limits their range of motion, even after extensive physical therapy.

Your healthcare provider will discuss these and other risks with you to ensure you can make an informed decision about your overall health and treatment.

Trust Alexander Orthopaedics Associates With Your Knee Replacement

Understanding the surgery and recovery process is crucial for a successful and healthy recovery after knee replacement surgery. At Alexander Orthopaedic Associates, we work closely with our patients to ensure you understand all your options and never feel rushed into a procedure you don’t fully understand. Our board-certified surgeons are experts in both total knee replacement and partial knee replacement. If you’ve been living with knee pain and want to explore ways to feel better and get back to the activities you love, schedule an appointment today.