Let’s Talk: Total Knee Replacement

So you just had a total knee replacement:

Congratulations on your brand-new knee! You’ve taken a big step to managing your stubborn knee pain. However, a total knee replacement is an invasive surgery, and it’s helpful to know what to expect and how to manage your symptoms after surgery. Here are some tips to be successful when you come home from the hospital.

Pain: There will be pain, unfortunately many people think they will come out of the operating room pain free now that they have a new knee. The type of pain that was present before your surgery will be gone, but there will be pain associated with surgery itself.

  • Often, you won’t have much pain immediately after surgery because the numbing agent hasn’t worn off yet. This can create a false sense of confidence about pain levels, and you may be tempted not to take your pain medication as scheduled.
  • ***It is very important to stay ahead of your pain!*** You need to start your pain medication before the post-surgical pain kicks in.
  • If you get behind the pain, it can take 1-2 days of taking your medication regularly to get it under control.
  • Take your pain medication as soon as you are instructed after coming home from the hospital, and take it regularly as scheduled.
  • Additionally, it is helpful to take your medication about 1-2 hours prior to your physical therapy appointments. The treatments required to restore range of motion are often painful, and you will have better tolerance if your pain medication has kicked in.

Ice/elevation: You will likely have a lot of swelling in your knee after your surgery, this is normal. However, swelling can contribute to pain, can inhibit your range of motion, and can inhibit return of normal muscle firing, so it is important to manage the swelling right away.

  • Keep your knee elevated above the level of your heart to allow the fluid to drain.
  • Use of a gel ice pack will also help reduce the swelling, buy 2-3 ice packs ahead of time to ensure that you always have a cold one ready to go in the freezer.
  • Initially after surgery, ice 15 minutes every hour that you are lying down.
  • We recommend the large “ColPak” brand ice packs

Avoid propping: After surgery, it will be painful to take your knee to end ranges, especially straightening the knee. It is tempting to prop several pillows under your knee so it can rest comfortably in a mid-range.

  • It is important NOT to do this, as it makes it more difficult to restore the straight range of motion.
  • Try to use as little support under your knee as you can tolerate, and spend a few minutes every hour with pillows under your ankle only, allowing your knee hang in space.

Rest: You are recovering from an invasive surgery, it is important for you to rest.

  • DO: do your home exercise program.
  • DON’T: do excessive walking, work, or errand running in the first few weeks after surgery as it may increase pain and swelling, and inhibit your healing.

Heel slides: Gentle, active range of motion is helpful for reducing swelling, stiffness, and pain.

  • Lying on your back, keeping your heel on the couch or the ground, gently bend and straighten your knee within a small range of motion.
  • You can do this 20-30 repetitions, up to every hour.

Assistive device: You will be sent home with an assistive device, usually a walker. Be sure to use the assistive device, and adhere to your surgeon’s restrictions on how much weight you can put through your post-surgical knee.

  • You will want to assess your home ahead of time to make sure there are no trip hazards, e.g. pick up area rugs, move small or light weight furniture, and remove cords.
  • Additionally, think about night time trips to the bathroom, avoid leaving clothes and shoes by the bed which can be a trip hazard, and use a light whenever possible as your balance might be impaired.

Stairs: If you have to negotiate stairs to get into or out of your home, there is a pattern for utilizing your uninvolved leg and reducing the stress on your involved leg.

  • Use a handrail if it is available, and a person on the other side of you if possible.
  • When going up stairs, always lead with your uninvolved leg.
  • When going down stairs, always lead with your surgical leg.

Physical therapy: Start your physical therapy as soon as your doctor recommends.

  • Some doctors may recommend a “pre-hab” visit with a physical therapist for discussing exercises and stretches to work on prior to surgery, set expectations and provide advice for after surgery, and instruct your family or friends on how best to assist you after surgery.
  • It is helpful to find out ahead of time your doctor’s preference for when you start physical therapy, and how often you should be going, this way you can make those appointments prior to surgery to ensure availability and convenience of visits.
  • During your post-surgical rehab, your physical therapist will help you manage your swelling and pain, restore your range of motion and strength, and get you back to a life without knee pain.