Knee replacement recovery- what is normal?

In our series of blogs on total knee replacements we have covered ‘Do you need a knee replacement?’. But this blog will help you to manage your expectations about knee replacement recovery and the timelines you should expect following surgery. This will help you to focus on your recovery and hopefully create less anxiety over what is happening to you after going through this operation.

After total knee replacement (TKR) the time line can be split into sections but there will always be variability between patients. Just remember eventually most patients make a good recovery and get good results.

Hospital Period

Some of us ‘old physios’ remember a knee replacement patient being in hospital between 10-14 days. We used to see them twice per day for rehabilitation, on discharge most had a good range of movement, an improving muscle function and be able to walk with a couple of sticks whilst climbing stairs etc. The physio/patient relationship was built gradually and we could hold back those who were too keen to get going and encourage those more unwilling to move their knee, to do so! The patients worked as a group seeing those at a future stage of recovery and what they needed to do to get there. Eventually being able to help those behind them find the right way. The surgery may have been the same but as a physiotherapist you notice that all the patients were different, their bodies reacted differently. They may have followed a different path from each other during rehabilitation but they eventually got to the same place.

Now knee replacements are in hospital less than 3 days and the one thing they will miss is seeing other patients doing the same things and watching the journey. If you see someone else struggling with the post operative pain or swelling, struggling to get their straight leg raise or bend a sore knee, it somehow helped. There are a range of professionals such as nurses and doctors watching to make sure the time is right to remove drains, that your pain control is good, that the wound looks fine and that you have medically recovered post surgery. But seeing other patients go through the same things often helped more.

Once the post op medical checks have been achieved the physiotherapist will be looking at key outcomes to manage your earliest discharge.

1. Can you lift your leg up straight (straight leg raise or SLR). This tells us the muscles is in control of the knee and it is safe to get up. Most patients can do this within 24 hours and can be up out of bed.
2. Once the drains are removed then you can you move more freely. Usually they will start with a zimmer frame but quickly you will progress to two sticks. Remember the knee replacement is already very strong and the walking aids are for pain relief rather than as a support.
3. Can you bend the knee reasonably. Now in that short period some patients will get past 90 degrees and some won’t, but we need you to bend the knee and keep doing it whilst the body recovers or you will have a stiff knee. So they will make sure you are doing the right things to help.
4. Can you get up and downstairs safely.

Then you are clear to be discharged.

First 14 days out of hospital

You will have been given a sheet of exercises and an information booklet to help but from now on you are pretty much on your own. Although some receive post operative physiotherapy most do not. This may be unusual but in my experience I see a number of patients who have received little or no follow up care until at least there 6 week surgical review or even after that. As you will see from the blog about post operative physiotherapy, in my opinion both pain and function improve quicker with physiotherapy and any problems are spotted sooner! But then I suppose I am ‘old school’ now and do not like the idea of patients being left to do a painful rehabilitation plan independently.

So here are some tips for this phase of your knee replacement recovery:

1. Even if you feel great, take it slowly. Those that walk too far too soon can make the knee swell and find it harder to bend the joint.
2. If you do not feel the pain is worth taking medication for, it will be when you do your exercises. So take regular amounts of the pain relief offered by your doctors.
3. Lack of mobility and swelling lead to increased risks of blood clots. Wear the pressure garments given, move the area regularly and get up sporadically to move.
4. Elevate the leg and if required use some ice packs to limit the swelling and this will allow you to move more comfortably.
5. DO YOUR EXERCISES!

14 days to week 6 (usually your last chance to see the surgeon!)

Knee replacements are hard work for the patients and by this stage the surgical scar will have healed, staples will be out and it is all about your rehabilitation.

So here are your targets:

• Walking without sticks takes a few weeks and is based upon your pain levels. The knee is strong enough to take your full weight (standing on one leg) but if it is still very painful and you feel you are limping then you need supports from the stick/s. Progress from 2 sticks to one stick (use the one stick in your opposite side to the replacement). This may seem strange but you need to lean away from the operated side to press through the stick to offload the knee. If you use the same hand you will be leaning over the operated knee (therefore not off loading it). You will also be walking like John Wayne at a gun fight. Think of how you march. The right hand and the left leg go together and so on.
• Walking distance needs to be built up slowly. Watch for the reaction of the knee, it will feel okay during the walk but how stiff and sore does it get afterwards? Small reactions to activity are okay but too much and you will make the knee sorer to bend or straighten.
• The bend of the knee is important. The first goal is to get to 90 degrees then make your way up towards 120 degrees (usually you will not get above this). Most people function well with anything over 100 degrees but this is the time to achieve the best bend. Leave it till it’s less sore and it will be too late. By week 6 you should be aiming for 100+ degrees but remember some people are slower.
• Straightening the knee with a good hard thigh muscle (quadriceps) contraction, as well as being able to fully straighten the joint (extend it) and lift without any little bends appearing (a lag is what we call the bend that occurs when lifting the knee). Most people will be able to achieve this within 6 weeks but if you have been suffering with an osteoarthritic knee for a long time your muscles will be very weak and this may be slower for some patients.
• Balance recovery is required to make you feel safe on your new knee. If not this will mean you may be at a higher risk of future falls.

Week 6 to 18 months

At this stage the surgeon has patted themselves on the back for a great job. You are discharged from the NHS and all in the world is easy going! Wrong. In order to make the most of the knee and help your function now is the time to make sure the knee that you have is the one you thought you were getting. The surgical recovery of soft tissues take 6-12 weeks, but you need to address the following:

1. Have you been able to bend it as much as you may need to do all the things you wanted to do?
2. Are you walking pain free without sticks (due to any pain or weakness in the operated leg) and going as far as you wish too?
3. Have you recovered all of the strength you lost waiting for the knee to be replaced? This can take 12 months post operation (yes they don’t tell you that bit!) and have you returned to golf, hill walking, bowls etc

A knee replacement does not just depend upon a good surgeon and a few simple weeks of post operative recovery. It is hard work for the patient to follow the rehabilitation plan. If you need help then a physiotherapist will be able to guide you, but you need to be prepared for some hard work to achieve good results.

If you would like a helping hand then gives us a call on 0131 478 4646 or book online.