After Total Knee Replacement
What can I expect after my total knee replacement?
A total knee replacement is an excellent procedure to relieve pain that comes from diseased cartilage in your knee. In “What is a Total Knee Replacement” I detail what occurs during the surgery and note that most of the soft tissues around the knee are retained. It is also important to understand that perfect human knee mechanics cannot be fully achieved with current total knee implants and techniques. Because of that, the muscles and tendons that support the knee joint and cause it to move see the world in a little different way than they are used to. Up to 20% of total knee patients are not fully satisfied with their new knee due to some residual pain and tenderness. Despite that fact, 95-99% of patients are very happy they had the procedure and would choose to do it again.
Early stages of recovery, usually the first 1-4 weeks after surgery, are spent managing pain, swelling and starting your home exercises and supervised physical therapy appointments. You are encouraged to stand, walk and do range of motion exercises on a regular basis. It is also imperative that you take time to elevate, ice, and rest your knee on a regular basis for the first 2 weeks. The pain, swelling, bruising, and inflammation get gradually worse for 3-7 days, and you can help mitigate that by not overdoing your activity and taking the time to rest and ice the knee. It is possible to overdo your activities, but it is also possible to do too little and end up with a knee that is very painful, stiff and doesn’t bend well. I have found over the years that each individual patient has to find what works best for them. There is not a single recipe that works for everyone.
Once the early postoperative pain is adequately subsiding, and that varies quite a bit from patient to patient, you can start to increase the walking distance, try a stationary bike, and do any low impact activities that are comfortable. By 4-6 weeks the incision is generally healed enough to submerge in water for swimming, hot tubs, or baths. Increased pain is likely from too much activity in the preceding days, and generally improves with a little more rest. You may use heat to soothe the knee and leg during this time as well. Most patients use a combination of heat and ice to get them through the day. Often heat is used to warm up the knee before activities and ice to calm it down afterwards.
Pain that does not improve with rest, especially if associated with redness around the knee and a fever can be signs of infection. Infection can be difficult to diagnose since there is normally pain, swelling, and warmth for a few months after surgery. If you have any questions, please contact the surgeon.
It takes 3-4 months to be 90% recovered from the pain and swelling. The final stage of healing and return to activity truly takes a year or more. More and more patients who have a knee replacement are extremely active and participate in a multitude of competitive and recreational sports. The ability of your new knee to withstand a high level of activity has more to do with the condition of the soft tissues around the joint, than the implant itself. The new joint surfaces are incredibly strong and can last many decades. Years ago we used to say the knee would last 10-15 years, but now 20-30 years or even more is not unreasonable to expect. It is rare to see the modern implants wear out. The most common reasons for failure requiring another surgery are related to the soft tissue envelope around the knee. The common reasons are infection, stiffness and loss of motion, too much laxity in the ligaments leading to instability, and injuries. I now put very few restrictions on my patients, understanding that high end ballistic sports like football, basketball, soccer and others are not generally performed by this group. Walking, hiking, golf, tennis, skiing, water-skiing, running, weight lifting, and even basketball and soccer at a moderate recreational level are possible. This is not a complete list, but gives examples to help you decide what works for you.
The best results are achieved in patients who have advanced arthritic change in the knee and who have experienced significant limitations in their typical daily activities. These are patients for whom there is a lot of room for improvement. Patients who are in the early stages of arthritis and are just beginning to notice some limitations are not ideal candidates for knee replacement. Patient satisfaction after knee replacement is excellent as long as the surgeon educates the patient on realistic expectations and appropriate criteria are used in choosing the patient.