More than 600,000 total knee replacement surgeries are performed in the United States every year. With people working longer (and weighing more) that number is expected to be greater than 3 million by the year 2030. If you or a loved one is dealing with chronic knee osteoarthritis, then here is some information that will help you prepare for and recover from knee replacement surgery.
I will share with you dozens of things that you can expect. Some are based on my experience as a Physical Therapist while others are based on the reports of some of my past patients. Many may be things that nobody else has warned you about. I really hope that this information will help you to decide when and if you should have knee replacement surgery, how to best prepare for it, and how to ensure that you have an uneventful recovery.
Before Knee Replacement Surgery
Your doctor may prescribe physical therapy prior to knee replacement surgery. Sometimes the point of the physical therapy is to see if your pain can be controlled by conservative measures rather than having surgery. Other times you and the doctor already know that knee replacement surgery is imminent, but they prescribe therapy so that you can build up your strength and flexibility as much as possible before surgery. Even if your doctor doesn’t prescribe physical therapy before surgery, your outcome will be much better after surgery if you make sure to strengthen and gain as much motion in your knee as possible before you go under the knife.
Regardless of whether or not you have “prehab,” many doctors will request that you attend a class prior to surgery. They’ll usually provide a notebook of information on topics like simple exercises that they want you to complete, when to stop eating prior to surgery, what kind of symptoms to look for after surgery, etc.
When to choose knee replacement surgery
After working with hundreds of people who’ve had knee replacement surgery, my observation is that those who choose to have surgery because of severe pain ultimately have an easier time after surgery. Several times I’ve worked with someone who’s said “I wish I’d never had surgery. My pain is way worse now.” Almost always, those are the people who didn’t really have a lot of pain before surgery, but they chose to have the procedure because the doctor told them that they were “bone on bone.” Those who were relatively pain free but were told that they needed surgery due to the severity of their arthritis have a harder time and often deal with increased pain after surgery.
Important questions to ask your doctor before surgery
Some orthopedic surgeons are open to sending someone to a rehab facility if they aren’t quite ready to take care of themselves at home when they are discharged from the hospital. Other orthopedic surgeons are not. If you live alone and have concerns about whether or not you’ll be able to safely return home 1-2 days after surgery then you should find out what your doctor’s opinion is on this matter. Check out this article for more details on what a short stay in rehab would look like. If the doctor is dead set on your returning home after surgery no matter what, then you may need to consider having a friend or family member stay with you for your first several days home.
You’ll also want to ask your doctor when you can plan to resume driving. This time-frame can vary considerably depending on which leg you have surgery on. Speaking of driving, find out from your local DMV what kind of documentation they need from your doctor in order to give you a temporary handicap parking placard.
Make arrangements for transportation
You’ll likely not be allowed to drive for several weeks after your knee replacement surgery. Be sure to arrange transportation for your outpatient PT appointments as well as to doctor appointments and errands that you need to run. If you have a choice, request to be transported in a medium/large sized sedan or a small SUV/truck. It will be difficult to get in and out of a low car or a very tall truck. Click here for more ideas on out-of-the box transportation optons.
Schedule outpatient physical therapy
Most people start their outpatient physical therapy within a few days after going home from the hospital. Once you’ve determined where you want to go, call ahead and get on their schedule so you won’t have to wait any longer than necessary to start. In most states, the clinic will want a prescription from your doctor to start therapy. The doctor’s office can fax it or you can hand deliver it.
Get a walker (and maybe a cane too)
You will definitely need a walker for at least the first few days after knee replacement surgery. Take it with you to the hospital when you go in for your procedure so you can use it during physical therapy sessions. Click here for a tutorial video on how to adjust your walker properly depending on your height. You might want to get a cane while you’re at it. For many people, the easiest and safest transition is to go from a walker, to a cane, to nothing. The video I linked above will detail how to safely use a cane. If you choose to skip the video, at least note that the cane should be used in the hand OPPOSITE the knee that you had surgery on.
Make your house as accessible as possible
Be sure to pull up rugs and remove any other unnecessary furniture or clutter, especially during the time that you’ll be using a walker. If your home has a lot of stairs then you may want to prepare a temporary place to sleep on the main level. Click here for more details on home safety and accessibility.
Somewhat related to home accessibility, I would recommend that you purchase a tray for your walker if you live alone. It’s very difficult to transport items as simple as a glass of water or a plate of food when both your hands are busy holding on to your walker. You can pick one up at your local equipment store or purchase one inexpensively from Amazon.
Make arrangements for meals
If you don’t have someone to bring you groceries or prepare meals, then there are many other things that you can do to ensure that you get good nutrition following your knee replacement surgery. You could have your groceries delivered by your local grocery store or online services like amazon pantry. You could also prepare several meals prior to surgery, store them in individual containers, and freeze until they’re ready to be eaten. Here’s a link to a high fiber chili recipe that I really like. It makes several servings and the high fiber will help keep you from getting constipated after surgery.
You might also look into a company called Silver Cuisine. They are a meal delivery service specifically for seniors. They deliver nationwide excluding Hawaii and Alaska. Each meal can be prepared in the microwave in 6 minutes or less and can be stored in the freezer for up to one year. They can accommodate several different special diets if needed. Click here to learn more about Silver Cuisine
Have ice packs on hand
Ice pack types can range from a simple $0.99 bag of frozen peas to a several-hundred-dollar cooler contraption with a hose that circulates cold water through a bladder that straps onto your knee. Whatever you choose to use, make sure that it’s easily accessible and ready to go when you get home from the hospital. You’ll need to ice and elevate your knee multiple times/day.
During your Hospital Stay after Knee Replacement Surgery
Plan your discharge date
The date of your surgery day is called post-op day #0. Most people go home from the hospital on post-op day #1 or #2. Sometimes if they’re having considerable difficulties then they’ll stay in the hospital until post-op day #3, but that is becoming increasingly more rare. If possible, try to arrange to have someone home with you 24 hours/day for the first few days that you’re home from the hospital.
Physical therapy immediately after knee replacement surgery
If you have your surgery in the morning then there is a good chance that you’ll begin physical therapy later that afternoon. For each additional day that you’re in the hospital, it is typical that you’ll work with physical therapy 2x/day. You will probably not be moving mountains the first time that you get up, but it is common that you’ll be assisted up to the toilet or a recliner. It is very important to move as much and as early as possible and to be out of bed when it’s feasible. Plan to sit up in a chair for most of the day rather than resting in bed. Hospital policies vary, but it is reasonable to expect 1 or 2 people to get you up for the first time only hours after your surgery.
Before you leave the hospital, the physical therapists will help you walk up to several hundred feet and will assist you with stair climbing if that’s something that you’ll have to do at home. They’ll also give advice on how to safely move and care for yourself at home. They may recommend more equipment for home use such as a bedside commode (aka potty chair.)
What to expect the first time you get up after knee replacement surgery
Getting up for the first time after surgery is not always pleasant. Most importantly, I want to prepare you to have a “jello leg.” Some people feel great when moving in bed and sitting up, but when they stand and start to walk they realize that they have no control or stability in their surgery leg. This is due to the nerve block that they received during surgery. You can easily fall if you approach your first time walking with too much confidence and rely on a leg that it’s yet working. My advice is to rely heavily on your arms and your walker the first time you’re up; just in case your surgery leg is not cooperating yet.
Other common issues include dizziness and/or nausea when first sitting up. Your blood pressure may be unstable or you may have a reaction to your pain medication, the anesthesia that you had during surgery, or simply to the knee pain. Some people vomit their first time up. Your nurse can provide anti-nausea medications if needed.
The final thing that I’ll warn you about is that you might end up urinating in your bed or on the floor when you first get up. When this happens, patients are unfortunately embarrassed. Most of the time they don’t even know it’s happening until it’s too late. If this happens to you, try not to worry about it. The hospital staff is used to this kind of thing. There is really nothing that you can do to control it as it’s due to still having decreased feeling in your pelvis area because of your anesthesia.
After Knee Replacement Surgery
Outpatient physical therapy
Be prepared to start outpatient physical therapy within a few days after getting home from the hospital. Usually these appointments will last 30-60 minutes and take place about 3x/week. The total amount of time that you’ll need to go will vary based on multiple different factors, but you can expect to go to PT for 2-3 months. This duration is commonly (but not always) about the same amount of time that you should expect to be off work.
Be on the lookout for signs of infection or DVT
When to ditch the walker
Many people begin to wean off their walker after about 1 week or so. Your outpatient physical therapist can assist you through this process. My best advice is to not get rid of the walker until you have a fairly normal walking pattern with it. You’re going to have increased pain in your knee if you start limping around without your walker. Sometimes the best transition is to go from a walker to a cane first. As mentioned above, you should use a cane in the hand opposite your knee replacement surgery. Check out this video for more information on that topic.
Long term outcomes of knee replacement surgery
For the first several weeks you will likely experience increased pain and stiffness anytime that you’re still for too long. You’ll probably find that you simply must move and shift every 15 minutes or so. That means that sleeping will probably be difficult for a while.
Another struggle is that your knee will be sore and stiff when changing positions. For example, when you’re knee is straight, it will be hard to bend. And when it’s bent, it’s difficult to straighten. This will eventually work itself out, but you may experience this annoyance for a couple months.
Plan to wait 6-12 months after knee replacement surgery before you actually start feeling “good.” Sometimes it’s sooner for those that had severe pain before surgery. Most people spend several months battling stiffness, soreness, swelling, and difficulty sleeping.
Here’s the good news! Knee replacement surgery is very effective. Research shows that 90% of people who have the surgery end up with less pain. Most can resume previous activities such as golf and walking for exercise. Plus the artificial knees are lasting longer and longer these days. It is not uncommon for these new knees to last 20 years or more.
If you or someone you know is planning to have knee replacement surgery then I truly hope that this information will help make the whole process more streamlined and less stressful. Here’s what you can do with this information: Prepare as much as possible before surgery, don’t fall in the hospital, know what to expect during your recovery, and do what your physical therapist says!
Check out this form I created. I’ll send it right to your email inbox if you’d like it. I truly think it can make your hospital stay run more smoothly if you have it with you during your knee replacement surgery as well as when you start outpatient physical therapy.