May 30 , 2017
What to Expect After a Knee Replacement

It is estimated that there are currently 4.7 million Americans with knee replacements. In fact, if you are 60 or older, more likely than not,  you or someone you know has undergone knee replacement surgery. For those who have significant knee pain and arthritis, a knee replacement, often a last resort, can significantly improve the everyday tasks that are limited  because of pain.  While a knee replacement is a major surgery that requires a longer recovery than many simple procedures, a knowledgeable physical therapist can significantly improve the recovery process. Below are some tips and answers for those who are considering a knee replacement.

1. Where will I have therapy?: Typically the surgery is performed in a hospital or outpatient surgery center. The hospital stay after surgery is typically 1-4 days. While there, you will be visited by a PT on the day of or after your surgery. The next stop after the hospital depends on how well you move after the surgery (getting up from your bed/chair, walking, getting in and out of a car, going up/down steps). You will either go home and have a therapist visit you 3-4x a week, go to an inpatient rehab facility for a couple of days to weeks (rare), or go home and start outpatient PT.

2. Recovery at Home: Many people will be home bound for a couple days to weeks after a knee replacement, so make sure you arrange for a friend or family member to be close by so that they an help you at home. You may be sent home after the hospital, but you may not be able to go up/down your stairs at home. You may have to temporarily rearrange your bed and bathroom situation to the the first floor. In order to make it easier for you to navigate the house, keep your walking paths clear and open. Arrange furniture so that you can walk easily with the cane and walker, and remove any extra/loose throw rugs or electrical cords. Be sure to have a sturdy chair, preferably one that is a little taller and has a footstool or ottoman in order to elevate your leg. You may also need a shower chair or grab bars installed in the bathroom in order to keep you safe while bathing.

3. Medication: Knee replacement surgery is painful. While the pain will feel different than it did before the surgery, this pain will go away. Take all medications as directed by your doctor. Medications may include narcotic and non-narcotic pain pills, oral or injectable blood thinners, stool softeners, and anti-nausea medications.  While attending therapy, take your pain medication 1 hour prior to your session so that you can get the maximum benefit with the least amount of pain. Many people taper off their pain medication as time progresses, but make sure you talk to your physician.

4. Swelling: It is normal to have swelling 3-6 months after surgery. Right after surgery make sure you are elevating and adding ice (20 min on, 20 min off)… you can’t do it too much! For those with persistent swelling, compression stockings might be appropriate (ask your doctor or therapist). If swelling is significant, red, and abnormally painful in your calf or above your knee, this might be a warning sign of a blood clot and you should contact your doctor immediately.

5. Driving: Everyone’s most frequent question is “When can I drive again?”  This decision is ultimately decided by your surgeon.  As a general guideline, if your left knee is replaced, you typically are cleared to get behind the wheel in a couple weeks. If your right knee is replaced usually around 4 weeks. Your ability to drive again depends on if you’ll be able to bend your knee appropriately to operate the pedals, your reflexes, and if you are taking narcotics for pain medication. DO NOT drive if you are still taking narcotic pain medications.

6. Exercise After Joint Replacement: It is extremely important to do the exercises assigned by your therapist daily and as frequently as possible. These exercises are focused on straightening and bending your knee so that you can get back to your daily life tasks as quickly as possible. After surgery, you will be given a walker and you will have a limp due to pain and knee stiffness. It is important to restore your knee flexibility as quickly as you can. This flexibility will help to get rid of a limp as well as prevent joint pain in other areas down the road (like your back or hip). Your therapist will progress these exercises as you are ready and guide you through your recovery. Don’t be afraid to walk as much as you like, as long as you are “listening” to your knee. Down the road, light impact sports are probably best for the longevity in your knee. If you were a runner, skier, tennis player etc, these may be sports that you can get back to, once you have recovered (4+ months).

7. Back to Work: This is different for each individual and type of job. Set realistic expectations about when you should go back to work. In most cases, it’ll be 3-6 weeks before you can return to work. You may be able to return to work within 10 days if you work at home. However, you’ll likely require much longer if your work is labor intensive. Don’t expect too much from yourself at first. Speak to your boss and co-workers to make them aware of your situation. Try to ease back into full working hours.
Knee replacement surgeries can be scary.  However you are not alone.  Partner with a skilled and caring physical therapist prior to your surgery to answer all of your questions and prepare you for your recovery by attending 2-3 prep sessions or “pre-hab”.  With their guidance, you can rest assured that you will return to your daily life activities safely and as quick as possible.