Updated February 19th, 2023
Introduction
If you are reading this you are either very close to getting a knee replacement or have finally decided to get it done. Most people in this boat have pushed through years of pain, instability, and difficulty moving. Many end up with cortisone shots or various medications to mask their symptoms until the pain is bad enough to do something about it. Years of heavy lifting, overuse of the body, and past injuries have led you to this point.
But the good news is: YOU HAVE A LIGHT AT THE END OF THE TUNNEL!!
Basically, a knee replacement is a “restart” for the joint, where a surgeon can put the structures back in place and restore the bones with new material that isn’t breaking down daily. Although this is a “restart” for your knee joint, I caution you to still prepare for a physical and mental battle. No part of the body enjoys being injured or cut open, so the knee will respond with a significant amount of swelling, tightness, and pain in the beginning. As long as you stay diligent with therapy and stick with your exercises and protocol, you will come out better on the other side.
This is the beginning of a three part series that I will take you through to both prepare for surgery and survive the coming months afterwards. I will talk about physical and mental components of this recovery, which pair well with Physical Therapy :)
The Procedure
If you are a person who likes to know exactly what is going to happen to you during surgery, read on. If you would rather not learn the fine details, scroll to the next section.
Surprisingly, a knee replacement is NOT exactly what it sounds like. The surgeon doesn't take out the whole knee joint and put in a new one. You still have all of your original muscles, tendons, and most of your ligaments. Basically, they remove all of the damaged surfaces of the bone and replace them with new components. I have attached a video and website below if you would like to learn more about the procedure and see a visual of how it is completed (1).
Recovery Time
Each individual who has a total knee replacement has a different experience during recovery. In general, most patients are in Physical Therapy for 8-12 weeks, sometimes more if needed. Most people don’t report feeling back to “normal” for 8 months to a full year. That is a report that everyone NEEDS to hear before their surgery. Expectations are huge. If you think you will be back to work and moving around normally after a few weeks, you may be upset after those first few weeks. As a PT, I see this all of the time. Yes you may be back to work in four weeks, but to believe you will be moving perfectly without pain is an unrealistic expectation. Patients have been shown most recovery in the first 26 weeks. Expect to be working toward better movement and less pain for at least a few months! (2)
But don’t let the previous paragraph scare you, as that is not my intent. Knee replacements help many people go from constant pain and weakness to moving with better balance and less pain for a long time! The biggest key to remember is the dedication it takes to get there and the expectation that it won’t be a walk in the park.
Preparation
Attending a Physical Therapy session prior to surgery is becoming more prevalent today. Although research has not shown that therapy prior to surgery determines a better outcome, there are many advantages to seeing a therapist first (3).
Advantages:
Meet your therapist ahead of time - this can help you determine if they are the right fit for you and help you become familiar with the clinic you plan on going to after surgery.
Determine baseline strength and range of motion - how you move your knee prior to surgery may indicate how you will do after. More of a “nice” to know instead of “need” to know.
Home setup planning - a therapist can talk you through your specific home setup and help you determine what changes you may need to make (example - bathroom setup, narrow doorways, and entering your home).
Exercises - I will go through some generic exercises below, but in person a therapist would be able to tailor a program specifically to help you prepare for surgery.
Questions - most therapists have you for an appointment of about 30-60 minutes, leaving plenty of time to answer any of your questions and review exercises. This is a lot more time than the typical doctor can offer due to their busy schedules.
Have I talked you into a therapy appointment yet? Enough of that, let’s go over what you need to have ready before surgery!
Necessities:
Do you have a walker?
This needs to be a walker with two wheels or less (the fancy ones with the seat and four wheels will run away on you).
Usually, your insurance will cover this walker, just ask your doctor for a script.
Pick it up BEFORE surgery, that way you have it when you go home.
Make sure the walker fits through your doorways, if it doesn’t then watch my video below.
What kind of car are you riding home in after surgery?
Although your truck has been your baby for a long time, she may not be the best option to ride home in.
You will want a car that you can sit into first, then turn your legs in (see video below).
Picking yourself up into a truck won’t be as easy with a swollen knee and pain meds slowing you down.
Practice makes…..perfect?
There are a few things you will want to practice prior to having your knee bundled up in a big bandage. I have created some videos below for you to practice transferring and walking with your walker. There is also a video on the correct way to negotiate stairs with less pain and damage done to your knee.
Exercises
I have compiled a few general exercises for you to try before surgery. The tricky part about this is that most people who are about to have a total knee replacement are in too much pain to exercise. This is another advantage to attending a PT session prior, so a therapist can find specific exercises that don’t cause you more pain. For now, try some of these and hopefully you will find a couple that work for you. The important part is to get familiar with them prior to surgery because you will need to be doing them multiple times per day after.
Conclusion
If you gain only one thing from this article, I hope it is a sense of what to expect from your surgery. Any surgery is a big unknown for people, but a knee replacement is a whole other story. This will be a long healing process for you, but I hope it will be worth it!! I have seen many patients go from having a very difficult time walking to doing stairs and returning to work with no problems. Just remember: right now without surgical intervention you haven’t found a way to fix this issue, but after surgery you will have a light at the end of the tunnel. A “new” knee that you will be able to strengthen and move in ways that you haven’t in years. Best of luck to you, look out for our next article that reviews the first few weeks after surgery!
References
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