As the active baby boomer’s age, there has been a steady rise in the number of knee replacement surgeries performed (Canadian Institute for Health Information, 2019). For most, undergoing a total knee replacement – also known as total knee arthroplasty (TKA), is a big decision. Many factors come into play when making this decision. Discussions with your family doctor, orthopedic surgeon, and physiotherapist will help lead you to the right decision. Everyone’s knee is unique, so don’t get caught up comparing yourself to a friend, neighbor, or relative when making your decision. Outcomes vary greatly as well. If you know someone who had a tough time post-TKA, this doesn’t necessarily mean that you will!
As a physiotherapist who has been treating TKA patients for over 13 years, I can tell you that in general, the vast majority of people are glad they had it done. The primary reason for needing a TKA is Osteoarthritis. This type of arthritis causes the joint to wear out, eroding the cartilage on the joint, which in turn leads to pain, stiffness, and overall decreased function. The primary goal of surgery is pain relief.
Will I be in pain after? How long is the recovery period?
You may have heard how painful the recovery post-operatively is, but remember, the pain from surgery is temporary, and will gradually subside as you recover. This post-op pain varies, depending on the individual.
Recovering from a TKA is akin to how the stock market behaves, up and down! Maintaining a positive attitude and keeping your perspective (ie. “this is going to be approx. 1 year recovery”) cannot be understated. Be kind to yourself, and try not to get overly frustrated if you’re not seeing the type of results you expect. Slow, steady gains are what we as physiotherapists typically hope to see following knee arthroplasty. I often tell my patients to gauge their progress on a weekly, or monthly basis. More often than not, I see people getting frustrated if they’re not making daily progress. This is mentally very difficult, and can lead to rehab. burnout! Saying to yourself, “am I doing better than I was one month ago?”, typically helps people feel better about their recovery, as the day to day can be very up and down. From my experience, the majority of people experience pain from anywhere between 6 weeks to 2 years! That being said, by 6 months most people are feeling great, and able to do a lot more than they were able to pre-operatively. I always tell my patients to expect about a year for near full recovery.
What are the goals of physiotherapy post-knee replacement?
Goals of physiotherapy include:
- increased joint range of motion
- increased muscular strength
- education on regaining a normal walking pattern
- pain control
- regaining as optimal level of function as possible
Keys to success are consistency, patience, and hard work! Getting the knee moving (bending and straightening as tolerated), immediately post-op is critical. Walking with a walker or crutches the day of surgery, or by day 1 after surgery is key. Knee replacements are designed to allow for full weight bearing post-op. I often tell people to do the exercises prescribed by their physiotherapist 3x/day – morning, afternoon, and evening. Icing for 15 minutes following exercises helps relieve swelling and provides pain relief. Elevation, with the knee above the level of the heart, also helps decrease swelling, in turn allowing for easier movement at the knee joint.
Will I be able to walk after surgery?
Patients often ask me how far they are allowed to walk post-operatively. This is a tough question, and varies from person to person. In general, the key is to gradually increase the amount of walking you do. A sudden increase in the amount of walking you do can often lead to a rise in pain. You may not feel it at the time, but later that day or the next day it may catch up with you. Try and keep track of the time or distance you walk each day. Keeping a diary of your walks and exercises is a great way to track your progress. This can also help pin point the cause of a flare-up, should that happen to you.
I’m constantly educating patients to pace themselves, and to balance their rest and activity! This is especially important in the early stages of recovery. Try and avoid doing too much of any one thing, be it standing, sitting, lying down, or walking. As you start to feel better you may want to do more, which is great, however, you may not be out of the woods quite yet! This is where your journal or diary can come in handy. Remember, gradually increase your activity levels. A simple outing for dinner or some shopping can really increase pain levels within 24 hrs! Trust me, I hear it all the time. I’m not saying don’t do those things, just try and keep them to a minimum initially, and see how your body reacts to the outing. As I mentioned earlier, you may not feel it at the time, but you may the next day.
What if the pain gets worse?
If you happen to experience a flare-up with respect to your pain level, rest, ice, and the medication your physician prescribed is often the best recipe to overcome this discomfort. If things don’t settle down within a couple of days you may want to consult your physiotherapist or physician for an evaluation. It’s important to stay on top of your pain. By that, I mean stick to your ice and medication regime that your surgeon recommends. Ongoing consultation with your physician with respect to pain management is paramount to your overall success. Be consistent!
When can I go back to work?
For patients who still work, I am often asked how long they should take off work. There is a great deal of variety on the type of work people do, and how they are making out with their recovery. Generally speaking, provided you don’t have an overly strenuous job, give yourself approximately 3 months to recover and focus on your rehab. A gradual return to work is often recommended if possible.
Remember, celebrating small gains is an important key to your success. I admire the hard work my patients put into their rehab. Be patient and kind to yourself! Don’t get hung-up on how your best- friend’s-neighbour did after their knee replacement! Some people fly through their recovery, while others have to fight for every degree of knee bend they get!
Chipperfield Physiotherapy specializes in the pre and post-operative management of total knee replacement. Mobile physiotherapy is an excellent option after your total knee replacement surgery as patients are often not able to drive to a clinic. As mobile physiotherapists, we are also able to get a sense of your daily obstacles and the environment you live in. Call us at 604-828-2610 to set up your appointment today!