The Hard Truth People Don’t Want To Hear When They Have A Knee Replacement

The Hard Truth People Don’t Want To Hear When They Have A Knee Replacement

Having knee replacement surgery can be scary and it’s good to be prepared. 

Many people have waited months, sometimes years to resolve their knee pain and already missed out on being able to do the things they love. 

If you are an active person and want to remain healthy throughout your life getting you strength and balance back is extremely important.

By the end end of the article I want you to know all the top tips of getting the best results with your knee replacement. 

So often I see people who think surgery is the main event. 

Unfortunately, people who have this attitude do not get the best results. 

Surgery is just the beginning. 

Imagine spending £6500+ on your knee operation (just because you didn’t spend it doesn’t mean the NHS didn’t) and then not receiving proper post operative rehabilitation to get the best results?

What’s the point of going through the risks, the discomfort and the distress of an operation unless you aim to get the best possible result?

What’s the point if you can’t return to activities you love because your strength and balance isn’t up to it or you don’t spend the time getting the bend needed to play with your grandchildren on the floor.

So often in clinic I see people 2 years post knee replacement, unsatisfied with the results and when asked what rehab they did they said ‘I was given a sheet of exercise.’

I say this because I believe you shouldn’t have a knee replacement if you aren’t prepared to do the rehab.

You’ll be disappointed with the result.

How much did you spend on your last car bill £500? £700? £1500?

Perhaps you need to consider allocating at least this amount for rehab on the operation that has the potential to change your life ( not just a annual service and few tyres).

So let’s get stuck in…

What Happens During A Knee Replacement?

Your knee is a hinge joint; flexion and extension of the knee is an integral part of recovery. 

The surgery team will work together to do a total knee replacement this involves moving the patella (kneecap) out of the way clean up behind patella, remove the ACL, shave around femur, and will fit a ceramic plate to form your new joint which is cemented in place. 

Why Do You Need Knee Replacement? 

Most people need a knee replacement because they have developed osteoarthritis either as they have aged or after an injury. Some people can have arthritis and not have pain so we can’t rely solely on an Xray for diagnosis.

Overtime sometimes your knee joint can develop arthritis which consists of worn catilage and bony spurs. Remember, these signs can be seen on people with NO pain too.

Generally, people who need knee replacements are suffering from severe pain, swelling, stiffness in the knee joint, knee pain interferes with quality of sleep and everyday tasks such as shopping or getting in or out of the bath becomes extremely difficult or impossible.

Many get extremely good results in reducing pain with weight loss combined with physiotherapy. If you want to try this first to see if you can avoid surgery book a discovery call to see if we can help. 

Many people have tried a number of ways to lose weight and feel like they ‘have tried everything.’

But, like learning to ride a bike, losing weight can be painful and difficult. People often give up hope that they will achieve long term results. 

Imagine trying to learn how to ride a bike with nil parental guidance or someone holding the seat for you. It would be far more painful and you would be much more likely to give up. 

This is what happens with weight loss. People try, fail and believe that the option they tried ‘didn’t work.’ With the appropriate guidance and support people can begin to realise that weight loss is a life long transformation. It’s not a six week diet where weight comes back on as soon as your revert to old habits. 

It’s about small changes. 

Eating sweet things with your main meal.

Portion sizes.

Getting in the pool and walking.

Ditching any kind of ‘diet’ culture.

If you’re sat there thinking about all the reasons why you can’t.

Think for a second about your pain.

If it’s bad enough your mind will fill with all the reasons why you must.

Potential Risks Of A Knee Replacement

With all surgeries comes risk and complications, these risks are unlikely but it’s good to know how to prevent them from happening. 

Risks to be aware of are:

  • Infection to the site of surgery can occur if you do not keep the site clean and germs away from this. 
  • Blood vessels/nerves can be damaged during surgery
  • Blood clots this can be reduced with stockings/muscle pumps in hospital/ mobilising /calf pumps.

How Should You Prepare For Knee Replacement Surgery?

It can be a scary time preparing for surgery, loads of thoughts running through your mind. 

Your therapy team will hand you information regarding your knee replacement, so you know what to do prior surgery and ease your mind going into surgery. 

The key is to have a great support network not only with your stay at the hospital but for when you get home.

 

  • Exercise – stay as active as you can before surgery. Strengthening the muscles around your knee will aid recovery. It’s great to continue with activity especially walking/ swimming in the weeks/ months before your operation.
  • Sleep– get a good night’s sleep especially the night before your surgery.
  • Nutrition– keep a well-balanced diet as this will help aid your recovery process.
  • Stop smoking at least 2 weeks before surgery as this can increase the chances of infection heart attacks and pneumonia. There is help alongside you which will allow you to give up. 
  • Do not shave surgical site for at least 5 days prior to surgery as this can open up cuts around skin source of infection. 
  • Freshly washed sheets and clothes day before surgery to help prevent infection
  • Prepare and freeze meals; this is to help you when you get home from surgery 
  • Prepare your home for immobility when you return

Put important things at waist level, so you’re able to reach everything to minimise risk of hurting yourself.

What Should You Take With You For Knee Replacement Surgery?

Clothing such as nightwear, dressing gown, loose fitted clothing such as t-shirts and tracksuit bottoms this will help your stay be as comfortable as possible.

Footwear such as slippers as they are easy to get in and out of, just ensure they have good grip.

Medication

Pack any medication you are currently taking with original containers, so this makes it easier for the nursing staff to know what you are taking.

Wash Bag

All washing essentials soaps, toothbrush, toothpaste, shampoo, hairbrush, sanitary wear and a small hand towel.

Entertainment 

Entertainment is an essential, hospital stays can get boring so by bringing something to keep you occupied is key 

Eyewear

Eyecare- contact lenses, eye drops and glasses 

How Long Are You In The Hospital For When You Have A Knee Replacement? 

Typically, your hospital stay can be between 3-5 days, but this can vary depending on your recovery process.

The hospital will try to discharge you as quickly as possible to avoid hospital acquired infections.

This is a misconception people tend to have about hospital stays, the nursing staff will send you home when they believe you are ready to go home, they will ensure you are safe, managing pain and able to cope at home before they send you home.

How Will I know I Am Safe To Go Home?

The therapy team will work alongside you; they will be there throughout your stay to assist you with mobility. These are the kind of things they will be monitoring throughout.

– stair walking

– mobilising 

– toileting normally

 

What AIDS Are Used To Help Me To Mobilise Following A Total Knee Replacement (TKR)? 

Zimmer frame, crutches, or sticks are used to aid your recovery. The physios are expert and making sure you feel safe and secure and offering support to build confidence.

 

How To Increase ROM Of Your Knee Following A Knee Replacement?

It is important to get you leg bending as quickly as possible. 

The worst thing you can do post knee surgery is keep it in one position.

We can not offer direct advice for you so the following content is what we would advise a ‘typical’ patient. You need to receive specific advice from your physio based on you as an individual.

Heel slides are a great exercise to gain range back in your knee. You can do this lying on your back or in the chair. We aim to get 90 degrees flexion (knee bend) before you leave hospital.

What Can I Expect On Day 1 Following A Total Knee Replacement?

Day 1

First nursing/physio staff will get you up with Zimmer frame, sit to stand in a chair and walking around hospital assisted.

 

How To Manage A Scar Post Knee Replacement

Once your incision has healed a physical therapist can begin scar massage. Scar massage promotes healing and smoothing out the incision. 

How To Manage Post Knee Replacement Swelling

Swelling is a normal part of healing, many patients after knee replacement experience moderate to severe swelling in the first few days or weeks after surgery and mild to moderate swelling 3-6 months post op. Try to keep your leg elevated when sat or lying by propping it on a foot stool or pillow under the foot ( avoid a pillow just under the knee as this can make it harder to straighten and make rehab harder).

 

What Knee Replacement Recovery Aids Will I need?

Crutches, Zimmer frames and walking sticks are all types of recovery aids the hospital may provide you with during your stay at the hospital and to aid recovery at home.

 

Post Knee Surgery Pillow

It is very tempting to put a pillow under the knee but this is not recommended unless you can’t manage pain. This is because although it feels more comfortable it encourages your knee to remain flexed and we need to achieve full extension for a fully functioning knee. It you must use a pillow for short periods for pain relief it is very important you stretch it to check it can go fully straight easily. If you can’t see your physio immediately to help rehab focus on getting the best results post op.

 

Sleeping Positions Post Knee Replacement

Most people sleep on their back initially following a total knee replacement. As time goes on and you wish to sleep on your side put a pillow or duvet between your knees to provide comfort.

sports-physio-north-devon

What Are The Best Knee Replacement Exercises?

The best knee replacement exercises in the first phase are heel slides as it acts as a muscle pump to reduce pain and swelling, quad setting- helps with contraction of the quads, gaining strength back in the quads are key to any knee surgery. 

We then want to think about the muscles groups in and around the knee that will be affected by surgery and pre op pain. 

We look at exercises that target the quads, hamstrings, calf and hip. It is also important to incorporate proprioceptive and balance exercises to reduce the risk of falls and ensure you go back to walking on uneven terrain with confidence. 

An expert will help guide you which exercises work well together, what discomfort is normal and when to push/ when to back off and how to structure your program for maximum effectiveness without irritating it unnecessarily. 

It is a fine art but luckily we have lots of experience!

 

Why Is It Important To Normalise Gait Following Knee Surgery?

Following surgery gait can be impaired due to changes in the way you walk because of pain. Normalising gait is key in helping you to recover and rebuild muscle strength and reduce pain as quickly as possible. 

What Is The Goal Of Physiotherapy Post Op?

Physiotherapy aims to…

  • Reduce pain
  • Increase independence
  • Help get you mobilising safely with EX/ sticks/ walker
  • Independence getting in/out of bed
  • Gain strength in your leg 

When Can You Drive Following A Total Knee Replacement?

6-8 weeks minimum, you can resume driving when you can bend your knee enough to get in and out of the car, you also need to be able to do safe emergency stop.

You will also need to consider pain meds as some can make you drowsy and unsafe to drive.

 

What Can I Expect For My Knee Replacement Recovery?

You should be able to stop using your walking aids and resume to some activities 6 weeks after surgery. 

However, it may take up to a year for pain and swelling to settle down. Usually people report that after 3 months they feel they are on the road to recovery.

 

When Can I Return To… Following A Knee Replacement?

In a recent 2021 study a survey of the European knee association was conducted

 

5 Sports Were Recommended In The First 6 Weeks

Static cycling 

Stair climbing

Aqua fit

Swimming 

Walking

 

7 Sports Were Recommended At 6-12 weeks

Static cycling

Cycling

Stair climbing

Aqua fit

Swimming 

Walking

Yoga

 

Beyond 12 Weeks

Tennis doubles

Golf

Fitness/weight lifting

Aerobics 

Hiking 

Nordic walking 

Sailing

The study said that squash was a sport that was ‘not recommended’ after a total knee replacement.

 

Click here to read more

A further study showed 18.7 % returned at 3 months and 84% at 12 months. 

 

Further Individual Information On Return To Sport.

The information below is a guide but completely depends on whether you have hit your mile stones. Some people will be ready earlier and some people require more time.

Return to golf: Survey responses showed that 81.5% of patients surveyed successfully returned to play five months after surgery.

A physio will guide you on when your knee is ready. Strength, mobility and the ability to cope with twisting load is key.

 

What Is The Expected Knee Replacement Recovery Timeline?

After surgery nursing staff will come around and assess you, get you out of bed and help you stand from a chair/ seated position. 

To allow you to go home you must be able to walk, stand to sit, and go to the toilet properly. After this they will send you home with an aid and exercises to continue whilst they refer you for physiotherapy. 

Knee Replacement Recovery Week 1 

from weeks 1-3 patients should be walking and standing for longer than 10 minutes, start using a cane instead of a Zimmer frame or crutches.

Knee Replacement After 6 Weeks 

Significant improvements continue during weeks 4 through to 6, majority of patients are off pain medication and have resumed their day-to-day routines. To achieve post-surgical success, patients must continue physical therapy, pain management and avoid risky behaviour. 

The general time to resume normal leisure is typically 6 weeks (please see break down of sports below). In this time the physio team will work alongside you to gain range of movement back, strength and decrease any pain and swelling you have. 

 

Any Final Knee Replacement Recovery Tips?

Continue to take any prescribed painkillers or anti-inflammatories regularly to help with pain management. Use your walking aids they are there for a reason; aim to gradually decrease the amount you rely on them. Keep up with your exercises as this helps prevent stiffness. If you need any further help getting the best results from your knee replacement then book from free discovery call here.

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