The decision to have a knee replacement is significant. It is a very common surgery with over 50,000 knee replacements per year in Australia, BUT it is still major surgery. Understanding what is involved in the surgery and the importance of rehabilitation is essential.
First things first: deciding on when to have surgery is crucial, consider the following statements and if they apply to you.
“Am I ready for a total knee Replacement yet? – YES I AM”
Your knee pain is preventing you doing many things that you enjoy, such as going for a walk or playing with your grandchildren.
Your knee pain significantly limits your ability to do required activities like shopping, cleaning, and going up and down stairs.
You have tried other treatments such as a course of physiotherapy focusing on improving your lower limb strength and capacity, but the pain is still limiting your life.
“Am I ready for a Total Knee Replacement Yet? – NOT QUITE THERE YET”
Your knee is painful, but you can still manage normal activity.
You have seen improvements with maintaining lower limb strengthening exercises from your exercise physiologist or physiotherapist in the past.
You haven’t tried a exercise program designed to improve the loading capacity of your knee yet.
Once you have made the decision that your knee pain is limiting your life, and you are ready to start planning for your total knee replacement.
Preparation is the key for successful TKR surgery
Pre-habilitation is the prep stage, it’s getting you and your body as prepared as possible for the upcoming surgery.
The surgery itself can take 1-2 hours. Immediately after surgery you will usually have an IV tube in your arm, and also a catheter to drain your bladder. Some surgeons will pop on compression stockings also to prevent clots.
You will receive pain relief immediately, and this will continue as controlling pain is essential to allow you to get onto the importance business of getting moving.
Your brain is amazing, and will go into protection mode at this stage. The muscle the move your knee particularly the quadriceps at the front of your thigh will essentially switch off. It will be very normal to find moving the knee difficult at this point.
Now the Frightening Bit – Getting Up and Getting Your Knee Going
Your brain will say don’t move! We get it – you have just had a major surgical event. But we know from the millions of total knee replacement completed, that getting going early is the best possible way. The brain learns quickly that it is safe and good to move. Your muscles have less opportunity to weaken.
Your Physiotherapist will assist you getting out of bed. Walking frames, and crutches are usually used to assist with your walking, as you learn to become accustomed to loading you new knee.
As you are less active than normal, and you have also had an anesthetic, your Physiotherapist will also work on breathing exercises with you to keep your lungs in good shape.
Your Physiotherapist will also introduce to the knee some bending movement – as we want to get this back as soon as possible. It feels scary, but your knee is safe to bend.
Following the operation some standard procedures will be used to reduce the inflammation – ice, compression and elevation.
Those First Few Days – Starting the Total knee rehabilitation Journey
By day 2 you will be up and about, the IV is usually removed and you will start on pain medication. Controlling pain is essential to allow you to get onto the importance business of getting moving.
Your Physiotherapist will be focusing hard on ensuring you have achieved a good amount of bend in the knee – we aim for 90 degrees. Now to think about getting you home. Your Physiotherapist will assess how well you can get around, and also perform general tasks that you will need to be able to do such as getting up and down stairs.
You will have some basic knee rehabilitation exercises to complete – performing this well and regularly is the secret.
Will it Hurt?
Due to the nature of the operation it can be expected that there will be pain and soreness. Pain relief is important, and your Surgeon and the nursing staff will work very hard on ensuring this is under control to allow you to perform the movement and strengthening that your knee needs.
What can I expect from my new knee in the long term ?
The great news is following your knee replacement and rehabilitation you can usually expect a well functioning pain-free knee! Sport and activities that you once struggled with start to become a regular part of life again. Playing with grandchildren is no longer a real struggle.
We do need to remember that we have a prosthesis, and we want to maintain the health of the prosthesis. So we tend to advise limiting higher impact activities that involve heavy loading such as jumping. There is much debate regarding running following a knee replacement. I personally believe that this needs to be a decision made on an individual basis. How well you can absorb the load with your muscle system has an important role in the decision making. It is also a decision that needs to be made with your Orthopaedic surgeon.
Like all good rehabilitation – do the basics well, and once you have a strong foundation the worlds your oyster!
The end of the total knee 10 year myth
The good news is that a recent review has shown that you can expect a total knee replacement to last anywhere from 15 -20 years in over 90% of people electing to have this procedure done. This has come along way from the statutory 10 years we used to be told not so long ago.
If you are considering or have had a knee replacement please feel free to get in touch or book in to see me. I’m more than happy to help you ace your rehab and get the best out of your new knee.
The Lancet, February 16, 2019.