Knee Replacement- understanding what is normal

This Blog aims to help you manage your expectations about knee replacement recovery and the timelines you should expect following surgery. This will help you to focus on your recovery and hopefully create less anxiety over what is happening to you after going through this operation.

There will always be variability between patients. Just remember eventually most patients make a good recovery and get good results.

Hospital Period

Some of us remember a knee replacement patient being in hospital between 10-14 days. We used to see them twice per day for rehabilitation, on discharge most had a good range of movement, an improving muscle function and be able to walk with a couple of sticks whilst climbing stairs etc.

Now knee replacements are in hospital often less than 5 days and the one thing they miss is seeing other patients doing the same things and watching the journey. If you see someone else struggling with the post operative pain or swelling, struggling to get their straight leg raise or bend a sore knee, it somehow helped understand the process.

To manage your earliest discharge, once the post op medical checks have been achieved the hospital physiotherapist will be looking at these key outcomes:

1.Can you lift your leg up straight (straight leg raise or SLR). This tells us the muscles is in control of the knee and it is safe to get up. Most patients can do this within 24 hours and can be up out of bed.

2.Once the drains are removed then you can you move more freely. Usually they will start with a frame but quickly you will progress to two sticks. Remember the knee replacement is already very strong and the walking aids are for pain relief rather than as a support. Either option of frame or sticks is fine to go home with.

3.Can you bend the knee reasonably. Now in that short period some patients will get past 90 degrees and some won’t, but we need you to bend the knee and keep doing it whilst the body recovers or you will have a stiff knee. So they will make sure you are doing the right things to help.

4.Can you get up and downstairs safely.

First 14 days out of hospital

You will have been given a sheet of exercises and an information booklet to help but from now on you may be pretty much on your own. Although some people receive post operative physiotherapy many do not. We see a number of patients who have received little or no follow up care until their 6 week surgical review or even after that. We believe both pain and function improve quicker with physiotherapy and any problems are spotted sooner.

We prefer patients not being left to do a painful rehabilitation plan independently. You do not need a referral to start Physiotherapy if you are at all concerned, and we will always lease with your surgeon.

So here are some tips for this phase of your knee replacement recovery:

1.Even if you feel great, take it slowly. Those that walk too far too soon can make the knee swell and find it harder to bend the joint.

2.If you do not feel the pain is worth taking medication for, it will be when you do your exercises. So take regular amounts of the pain relief offered by your doctors.

3.Lack of mobility and swelling lead to increased risks of blood clots. Wear the pressure garments given, move the area regularly and get up sporadically to move.

4.Elevate the leg and if required use some ice packs to limit the swelling and this will allow you to move more comfortably.

DO YOUR EXERCISES!

14 days to week 6

Knee replacements are hard work for the patients and by this stage the surgical scar will have healed, staples/ stitches will be out and it is all about your rehabilitation.

So here are some targets:

1.Walking without sticks or frame takes a few weeks and is based upon your pain levels. The knee is strong enough to take your full weight but if it is still very painful and you feel you are limping then you need supports. Progress from 2 sticks to one stick (use the one stick in your opposite side to the replacement). You need to lean away from the operated side to press through the stick to offload the knee. If you use the same hand you will be leaning over the operated knee (therefore not off loading it).

2.Walking distance needs to be built up slowly. Watch for the reaction of the knee, it will feel okay during the walk but how stiff and sore does it get afterwards? Small reactions to activity are okay but too much and you will make the knee sorer to bend or straighten.

3.The bend of the knee is important. The first goal is to get to 90 degrees then make your way up towards 120 degrees. This the time to achieve the best bend. Leave it till it’s less sore and it will be too late. By week 6 you should be aiming for 100+ degrees but remember some people are slower.

4.Straightening the knee with a good hard thigh muscle (quadriceps) contraction, as well as being able to fully straighten the joint (extend it) and lift without any lag appearing. Most people will be able to achieve this within 6 weeks but if you have been suffering with an osteoarthritic knee for a long time your muscles will be very weak and this may be slower for some patients.

Balance recovery is required to make you feel safe on your new knee. If not this will mean you may be at a higher risk of future falls.

Week 6 to 18 months

In order to make the most of the knee and help your function now is the time to make sure the knee that you have is the one you thought you were getting. The surgical recovery of soft tissues take 6-12 weeks, but you need to address the following:

1.Have you been able to bend it as much as you may need to do all the things you wanted to do?

2.Are you walking pain free without sticks (due to any pain or weakness in the operated leg) and going as far as you wish too?

3.Have you recovered all of the strength you lost waiting for the knee to be replaced? This can take 12 months post operation and have you returned to golf, hill walking, bowls etc

A knee replacement does not just depend upon a good surgeon and a few simple weeks of post operative recovery. It is hard work for the patient to follow the rehabilitation plan. If you need help then our Physiotherapists will be able to guide you, but you need to be prepared for some hard work to achieve good results.

If you would like a helping hand then gives us a call on 83462000/ 8342 2233. One of our Physios can talk to you or you are welcome or book online as well.

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