What to expect when you are expecting a total knee replacement

As a physical therapist assistant in my eighth year working in an orthopedic PT setting, I have worked with many postoperative total knee replacement patients. I have always enjoyed working with total knee replacement patients. I have found that most patients have many of the same questions, concerns, and fears once they get to their first therapy appointments. Let’s take this time to address some of those questions and concerns for those of you that are planning to have a total knee replacement or just had the operation done.

1. Am I going to hurt afterwards?
   1. I do wish the answer was no, but also honesty is usually the best policy. In many cases a nerve block will be present for a few days post op which will help, but overall, in most cases pain and discomfort is common.
   2. Why you ask? Well, a very skilled surgeon and his/her team will be completing a carpentry project in your leg complete with saws, hammers, and drills. There is a plethora of videos on YouTube (live and animated) on what takes place during a replacement if you are curious. Don’t be alarmed though you are in great hands with your surgical team. Total knee replacements are fairly commonplace, about 800,000 surgeries are done annually in the United States and that number continues to increase.
   3. Please try not to stress too much about the pain as it is common and can be mitigated. Ways to help control your pain include prescription medications prescribed by your surgeon, utilizing cold packs to decrease swelling, and further techniques completed in physical therapy (we have some tricks up our sleeves and can talk you through it).
2. Are swelling and bruising normal?
   1. Yes, and yes. How much swelling and bruising can vary person to person, but yes swelling and bruising is to be expected. Some postoperative patients will have swelling only around the knee, while some will have full leg swelling and others can even have swelling in feet and ankles. The same goes for bruising. You may have limited bruising, but you may also have dark purple bruising especially in the thigh.
   2. That being said, through discharge instructions and help from physical therapy, swelling and bruising can be dealt with, and your discomfort will improve. In most cases you will be sent home in compression stockings and instructions on what to watch for regarding blood clot risk. Your physical therapist will also be monitoring your swelling status and risk for blood clots.
3. What can I do ahead of time to improve my post op success?
   1. Attend a preoperative total knee class if your surgeon or hospital have a class available. Many places do offer these classes. It is a great way to have more understanding of what will be taking place during surgery and what to expect afterwards.
   2. One thing to help with post op success is to increase your leg strength and knee motion. You do not need to be too intense with these exercises but do your best to keep moving as much as possible prior to surgery.
   3. Another great option is to request a referral for a round of physical therapy prior to surgery. This is a great way to have some guidance in strengthening, flexibility as well as getting your questions answered.
4. Will I be able to return to my prior activities?
   1. The great news is for the most part yes. In most cases even better than before since your knee will be new and more stable than it has been in several years.
   2. A great goal is returning to lower impact exercises and activities such as doubles tennis, golf, swimming, biking, and hiking. However, talk with your surgeon and physical therapist before returning to these activities to ensure you are ready strength and balance wise.
   3. It is recommended to avoid repetitive high impact activities, such as jogging, basketball and football, as well as high intensity weightlifting.
   4. Many patients wonder if kneeling will be a possible, and the best answer is “if it works for you as an individual” then do it. There are no restrictions to avoid kneeling after the incision is healed, but for some patients it remains uncomfortable. I have worked with some patients who get back to kneeling and some who are not able to kneel comfortably even after fully rehabbing the knee.
5. What is my risk of damaging the replacement or prosthetic failure?
   1. Once your knee is fully healed, the risk of damaging your prosthetic due to a fall is low. The prosthetics are made with a strong titanium or cobalt-chromium metal alloy.
   2. Long term studies have shown and 85-90% chance of proper function for 15-20 years for proven knee and hip prosthetics that are implanted accurately.
   3. Loosening of the prosthetic and wear on the joint surface are the most common long-term issue. However, that risk can be mitigated by maintaining a healthy weight and remaining physically active. While remaining physically active you still need to avoid repetitive high-impact activities like jogging.
6. Will I receive therapy to help my recovery?
   1. Some patients will start off with in home therapy and some will get set up right away in outpatient services. Either way this is a great way to start getting help addressing your pain, inflammation, and daily tasks.
   2. Initial goals will be to decrease inflammation, start improving motion, muscle activation and safety with daily activities.

References

http://www.utahorthopediccenters.com/knee-replacement-surgery-and-fall-risks/          5A

https://holycrossleonecenter.com/durable-hip-knee-replacement-prosthetics        5.B, C

https://www.popb.md/2021/11/19/knee-replacement-surgery-statistics-you-should-know/    1.B