More than 4.5 million Americans are living with at least one knee replacement. While there’s numerous reasons you may need a knee replacement, arthritis – the degenerative wear and tear on the joint over time – is the most common. Whether you’ve recently had a knee replacement or your doctor just mentioned it as a possibility, looking at what you can expect after the surgery is a great way to decide if and when it’s best for you.
For most people considering a knee replacement, significant knee pain has been a constant issue for quite some time, and you may have tried numerous forms of non-invasive or less invasive measures of dealing with it; braces, physical therapy, steroid shots, etc. But there comes a point where surgery really is necessary to improve your quality of life, because the degeneration of the joint is only going to get worse. The good news…the American Academy of Orthopedic Surgeons reports that 90% of people who have a knee replacement experience considerably less pain. But it’s not like you’ll just wake up from surgery and suddenly your knee is like it was when you were 20. Sorry! There’s a lot of work that’ll go into recovery, but it WILL be worth it. So, let’s break this down for you.
Immediately after you wake up from surgery, there will probably be a physical therapist there who’s going to want to get your knee moving right then. They may take you through some passive range of motion, meaning they’re moving the leg and knee for you, but they’ll also want you to try walking on it pretty soon after surgery too. Weight bearing is important to aid in the healing process of the joint. You may think that’s soon, but it’s absolutely necessary. Statistically speaking, those who put weight on the knee soon after surgery recover quicker than those who don’t. The last thing you want is scar tissue to set into a joint; that means limited range of motion. Not exactly an ideal situation.
Before release, most hospitals require you to be able to get in and out of bed, walk short distances, get up and down stairs, bend the knee to 90 degrees, follow precautions and avoid injuring the new knee. Note, every hospital is different; one may require just bending the knee to a 90-degree angle and others have a long list of requirements. Before you go in for surgery, you’ll want to find out the requirements for your release, so you know what to expect. If you have a multi-level home, don’t have a care-taker or are facing other rehabilitation challenges, you may be released to a rehabilitation facility so you have constant care until you’re able to move more freely on your own. The use of a cane, walker, or other forms of support may be necessary for the first few weeks.
You’ll more than likely be able to leave the hospital anywhere from 1 to 5 days after surgery; this really depends on the hospital policies, your health, recovery from anesthesia, and what your physical therapist and doctor decide based on your overall recovery outlook. When you go home, your doctor may prescribe the use of a continuous passive motion (CPM) machine. CPM machines help move the leg, straightening and bending it slowly while you’re lying down. Your doctor and physical therapist will decide if a CPM machine is recommended and if so, how many hours a day you’ll need to use it. Studies have come to conclude that the short-term benefit of CPM machine use is substantial, but long-term recovery is the same for those who use it as those who do not; so, many insurance companies no longer cover it. If that’s the case, don’t worry. Again, the long-term results seem to be the same.
Physical therapy is a must after a knee replacement; there’s no question about it. When meeting with your physical therapist they will evaluate your range of motion and all factors involving your plan for rehabilitation, including what personal goals you have. Don’t just settle for some arbitrary standard set by textbooks. Make it personal. What activities do you want to get back to? Just because a certain level of flexion and extension means “full recovery” for most people, that doesn’t apply if a good quality of life to you means going out to golf every weekend without pain, or hiking at your local parks. Your PT will need to adjust their rehab protocols to fit your goals.
Other daily activities will be affected, like driving. If your knee replacement took place on your non-driving leg, you should be released to drive as soon as you’re able to get in and out of the car comfortably and you’re not taking pain medications that can impair your ability to drive. If your driving leg was the one operated on, it may be anywhere from 2 to 6 weeks after surgery before your doctor releases you to drive. Returning to work after your surgery depends entirely on your job. If you work a sedentary job, you may return to work much earlier than if you work a job that requires any kind of standing or lower body physicality.
Just so you’re aware, those first few weeks may be hard. And generally speaking, the longer you waited to have the surgery (i.e. the more degeneration that occurred) the harder the recovery may be. That’s not to say you can’t fully recover, just that it may be more painful and frustrating at the start of the recovery process. For most, somewhere between 3 and 6 months is the point where patients start to really see just how great their knee feels and can get back to the activities they once enjoyed before the knee pain took over. For some, full recovery may take as long as 12 months. Listen to your doctor, your physical therapist, and your body. Push yourself when needed, even when you don’t want to, but give yourself time to rest too. Balance is key. It WILL be worth it!