Knee Replacement surgery recovery speed and ease can be highly variable. Don’t get caught unprepared. In this article, you will learn many important concepts, putting you at the head of the class. The unassuming picture of a field of late snow is a great metaphor for knee replacement recovery time. Everything seems straightforward, nice and tidy, nothing to see here folks and yet that quiet and docile field contained a flock of snow geese. This article is about preventing surprise at anything you encounter during total knee replacement therapy.

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Despite numerous advances in implant design and construction , the actual recovery and the traditional recovery techniques for knee replacement surgery have changed little; they represent a challenge that continues to frustrate and intimidate many people. Regaining range of motion and building strength in the knee are the primary recovery tasks in recovery that cause problems.

The standard exercises used by most facilities during the rehabilitation period can be found by a simple web search. If these exercises are common in most therapy situations, then why are there such marked differences in ease and length of recovery? Everyone knows someone that really had a bad time with the recovery. One study suggests that 15 percent of patients are less than thrilled with their results.

Is it the patient’s fault? Sometimes lack of effort is a problem but sometimes better insight and knowledge could have changed outcomes dramatically,

Occasionally, less than stellar outcomes are perceived mild osteoarthritis suffers, who “were at least two and a half times more likely to be dissatisfied with the procedure. …Dan Clearfield, DO, MS, a primary care sports medicine physician… states that “Many patients who undergo total knee arthroplasty are dissatisfied as they were hoping for less pain and more function out of the joint after it was replaced,” he said.”[1]

Factors That Influence A Successful Recovery

One of the most important variables is pre-surgical education. Patients that read up and learn about what recovery entails and the principles involved will usually do better. During the first 5-7 days after surgery, it can be hard to concentrate and focus, especially if you have never taken narcotic pain medicine before. It is much better to do your learning prior to surgery when your mind and brain are clear.

surgeon1Secondly, when choosing your surgeon, be sure to ask questions about the therapy process and the control he exerts over it. Better surgeons make sure their rehab pipeline is a smooth running machine from the hospital to the outpatient clinic. They leave nothing to chance to ensure your success. Having patients randomly distributed over many different facilities and caregivers is a recipe for problems.

The best surgeons do not tolerate this scenario for the simple reason that you and your success are their best marketing tools.  So find that doctor who is not only a great surgeon but has oversight along the entire knee replacement recovery spectrum.  Following this advice will ensure that you engage excellent caregivers following the best techniques.

Pain control is other super important factor in a successful recovery. What most people do not understand is that there is a certain amount of chemical pain from the trauma of the surgery itself that lasts about 2 weeks, this is over and above what most people have experienced with “normal” arthritis. Without a consistent blocking of that pain you are not likely to get a heck of a lot accomplished during that time. Without a consistent use of narcotics, you will end up wasting 2 weeks of your recovery feeling miserable and spinning your wheels.

By the way, this is the period when almost 90% of patients will wonder if they have done the right thing in having the surgery. The difficulty lies in modulating feeling poorly as a result of not taking the pain meds and feeling poorly as a result of the side effects of actually taking the medicine. This is where you need solid advice to stay the course in a way that mitigates the frustrations encountered on both ends of the spectrum so that you can get a lot accomplished in those 2 weeks.

Finally, the diligence and compliance of the patients themselves is important, though less important then some may lead you to believe. Sub par knee replacement rehab does take place, especially with some of the large profit-driven corporations. Knee replacement recovery is a very good revenue source and unfortunately greed does get in the way of excellent care.

What’s With All The Knee Swelling?

3d Men holding puzzeKnee replacement recovery swelling is caused initially by the trauma of the surgery itself. Bending the knee makes the joint space smaller and drives some of the swelling out, acting almost like a pump. Unfortunately, the swelling will slowly seep back in and so the battle goes in the early stages. Regular and repeated bending during the day will help keep the swelling down and is the quickest path to permanent swelling resolution.

Over-stretching and walking too much too soon may be a cause of additional swelling. Early weight bearing on the long bones of the leg that have been cut in surgery can cause irritation and swelling. It is best to use a walker for the first two weeks to reduce this chance of additional swelling.

Over-stretching occurs when you advance too far in one session by creating micro tears in the muscle or tendon tissues. This may cause a protective action of the body to swell a few hours after a particularly aggressive session of therapy.

In summary, the swelling caused by the trauma is normal and will resolve with a program of regular and repeated bending. The swelling caused by excessive walking and over-stretching will prolong the rehabilitation effort and should be avoided to speed recovery and lessen frustration.

What’s With All The Pain?

Dr. Justin Roe, states, “The best way to treat postoperative pain starts with preoperative education”. [2] Learning about pain management ahead of time is quite helpful. It can also help you evaluate the different methods your surgeon might use in the hospital to lesson unwanted pain.

The causes of knee replacement recovery pain are similar to the causes of swelling. It is primarily the chemical pain of trauma that hurts so much in the first two weeks. The remedy is regular and consistent use of the narcotic pain medicine provided for you by your surgeon.

Over stretching and early weight bearing (like doing a lot of misguided walking without the use of a walker in the first 2 weeks) will be a cause of preventable knee replacement pain that can be avoided with proper education and follow through.

Another source of “pain”, in quotes, because it is more like discomfort, is inactivity. Your knee wants to move. Everything just functions better and feels better with activity.  Typically many people will rate their pain higher before a good stretching and exercise session then after. The body responds to motion like plants to sunlight.

What Are The Main Complications?

According to the Agency of Research and Quality (AHRQ) , serious complications occur in less than 2 percent of cases. More specifically post-operative infection takes place in only 1 percent of cases, while blood clots occur in less than 2 percent of cases. [3]

A blood clot in the legs is called a DVT or deep vein thrombosis, while a blood clot that travels to the lungs is called a pulmonary embolism (PE). A pulmonary embolism is a serious condition that in rare cases causes death.

Reduction of clotting risks occurs by administration of blood thinners that your surgeon will prescribe.

There is always a risk of infection with any surgery. The hospitals put in place numerous protocols to prevent infections. Keeping the wound clean and applying bandages correctly can help mitigate this complication. Also patients with compromised immune systems (diabetics and rheumatoid arthritis patients) tend to have slightly higher risks of infection.

Recovery Exercises

Older women in an exercise classThe knee replacement exercises that are typically prescribed can be found many places on the Internet. If you read these posts it all sounds so easy, but in reality there are tips and techniques that can make or break successful, rapid knee replacement recovery. As the saying goes, the devil is in the details. The exercises look and sound simple but there are ways to utilize them that make them twice or three times as efficient.

In some cases having too many choices is detrimental because the patient becomes confused not sure what to focus on and which exercises will provide the most impact for the least amount of work. In this scenario, it is human nature to avoid the “tough” exercises and focus on the “easy” exercises. This is a mistake many people make.

Recovery Timeline

Traditional models project recovery to take from three to six months . Of course this depends on the degree of preparation, the level of debility prior to surgery, the quality of rehab care received and the level of effort on the part of the patient. All these factors will impact the length of the recovery period. Complications will, of course, add to the length of the recovery period.

Don’t settle for the typical recovery timeline. Find out about accelerated knee replacement recovery.

Double/Bilateral Knee Replacement Recovery

Older couple sitting on a benchAccording the Harvard Medical School, “replacing both knees at once can be a good option if the condition of your joints is so poor that replacing only one joint would still leave you unable to function during physical therapy, thereby slowing your recovery. “[4] Surgeons insist that you must be in good cardiovascular health to be eligible because of the increased surgical risks of doing both knees at the same time.

Rehabilitation following just one total knee replacement can be challenging. It requires a focused and sustained effort to be successful.   With a double knee replacement you will be doing double the work and having double the discomfort. The best advice that could be given is to get educated prior to the surgery about the techniques of recovery.

Without this education you are taking a substantial risk of making mistakes that will cause increased frustration and /or prolonged and tedious effort after having embarked on your bilateral knee replacement recovery journey. Many patients “learn” a lot during their first surgery thereby making the second surgery easier. The luxury does not exist with simultaneous knee replacements.

Partial Knee Replacement Recovery

Partial knee replacement recovery is a much simpler task than total knee replacement recovery. It entails a much smaller incision, reduced joint trauma and consequently less rehabilitation.

There is a caveat to this good news though. Alignment is critical to the success of the surgery because one half or the knee is altered, while the other half is still “natural”.

If alignment is off, it can cause problems like swelling possibly even bleeding in the healthy normal side of the joint. This can result in dysfunction until corrected with a total knee replacement; the surgery you were avoiding in the first place. Unfortunately your knee has now undergone significant debilitation prior to surgery, making the recovery more difficult.

Make sure you find a very good surgeon who specializes in partial knee replacements, as this is the most critical factor in success.


 

[1] http://www.dailyrx.com/mild-osteoarthritis-knee-replacement-patients-likelier-be-unhappy-procedure

[2] http://www.justinroe.com.au/resources/infosheet-TKR-Is-it-going-to-hurt-2014.pdf

[3] http://www.healthline.com/health/total-knee-replacement-surgery/risks-complications

[4] http://www.health.harvard.edu/healthbeat/does-double-knee-surgery-make-sense-for-you

 

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