KNEE REPLACEMENT SURGERY - A life changing event or a disappointment?

KNEE REPLACEMENT SURGERY - A life changing event or a disappointment?

Knee replacement surgery has become a very common yet is a major surgery. Anybody would want to be completely prepared for this life changing event, wouldn’t you?

Being aware can help you not only deal with the anxiety in a better way, but also can positively affect your recovery time! So let's get to know more about it..

Role of PREHAB

If you are deciding to go for Knee replacement, most probably you would be facing one or more of the following :-

Pain in the knee, difficulty in standing for long time, difficulty/ changes in walking, climbing up and down stairs. Your muscles may be weak and your gait (walking style) maybe affected.
You also may have bow knees or knock knees is some cases where the angle at the knee joint changes.

How can Physiotherapy help before surgery?

Pre-surgical physiotherapy (PREHAB) sessions can help to fasten the recovery process and one can start moving early. Muscles and joints are in a better condition, so goals can be achieved sooner. It can definitely reduce the chances of complications after the surgery.

This phase is right time to teach few exercises which can maintain good circulation, heart and lung capacity and endurance.

Instructions can be followed better in this phase as understanding and performance is much better.

Last but not the least the patient can form a good bond (rapport) with the Physio leading to best results.

Before a planned knee replacement surgery, we will not only focus on strengthening the muscles around the knee but also the hips, ankles and feet.
After a joint surgery, the muscle strength around the knee will definitely reduce as compared to the pre-surgery strength. Hence it becomes more important that your strength is at the best level, so as to minimize this effect, giving you faster recovery.

 

To get a better picture, let’s imagine CASE 1: a 72 year old woman who has been active, exercises regularly at home and goes for walk on flat surface.

CASE 2: an 68 year old of the same age who is not very active, walks only in the house. Both have knee pain and are recommended to undergo a knee replacement surgery.

The chances of speedy and healthy recovery is with CASE 1 compared to CASE 2 as he had active lifestyle involving good aerobic and muscular fitness. We as physiotherapists can help both of them before the surgery to make their journey to recovery easier and comfortable. 

 

What to expect just after the surgery?

Typically, you may spend 3 - 5 days in the hospital. In the hospital, your physiotherapist will see you the same day or the next day after surgery. Most likely you will be made to stand on the next day, after monitoring of all vitals. Basic physiotherapy exercises are taught which help to reduce pain and activate the muscles around the knee. You will also be taught basic suture care. After taking the physiotherapist’s advice, you can turn to both sides in lying down positions, but lying on your tummy is not allowed.

Initially, the hospital will give you short term painkillers to get your pain under control.

But a good physiotherapy program can control your pain for the long term.

Side effects of medications can be experienced, which commonly include constipation, nausea, vomiting and breathlessness. Talking to your health professional can give you quick easy solutions to the same. The point is these things are common and happens to most people.

Once you've been discharged, you will be needing a walker or crutches to help you walk and being independent. 

You will be learning to walk again with your new knee, so quick and jerky movements are to be avoided in the beginning. Small things like turning in bed, getting in and out of bed, walking to the bathroom and in the house will be made easy by your physiotherapist, and of course practice will make you better. 

Arranging the things that you need closer in your reach can help you be independent. Initially you will need help with dressing and cleaning activities. 

List of common things you might need after surgery-

- Grab bars in bathroom 
- Raised Toilet seat 
-  Raised(adequate)bed height
- Bath Chair/ stool
- Ice packs
- Extra pillows for comfort
- Comfortable clothing like shorts, loose pants etc. 
- Cane/walker

Knee Replacement Surgery Recovery Time

 

Recovery time for knee replacement surgery varies from person to person, but on average, post-surgery patients should recover within four to six weeks.

Factors that can influence your recovery time are - age, medical history, nutrition, pre-surgery activity levels and other lifestyle factors.

Typically, you will need to follow the exercise protocol for about 4 to 6 weeks after surgery, but the exercises keep changing and progressing by your therapist! This rehab program is intensive and should be completed till the end.

Many patients give up exercises as soon as they start feeling better and start walking at home, but that is not criteria to wean off from the program. Good and adequate muscle strength and ease of functional independence are good indicators of recovery.  You should be comfortable in walking up and down stairs, walking at a good speed/pace, and walking on different surfaces like gravel, sand, walking uphill and downhill etc.

To sum up, the recovery period is a roller coaster. Some days are very fruitful and some are painful, but despite the setbacks, the overall graph of recovery should be in the positive direction.

Talking to other friends or relatives who have been through the similar situation helps find some mental peace. Keeping yourself busy doing different tasks, planning your day in advance and staying positive and happy are my top take home messages. Working with your doctor and physiotherapist as a team can make this big event into a seamless one, and make your life easier!

 - Dr. Neha Gogate (PT),
Rehab Station Pune