Is Knee Replacement Surgery
in your future?


Knee replacement surgery is scary. No one likes to think of having surgery. Unfortunately, in some cases, severe knee osteoarthritis means surgery is necessary.

Knowing what to do to prepare for surgery can mean whether your surgery is successful or not. Will you have a total or partial knee replacement? Will your doctor recommend a CPM? Who long should you expect to be in physical therapy? Get all the details before the big day.



Why undergo Knee Replacement Surgery?

Knee replacement is warranted when conservative osteoarthritis treatment has failed, not simply because x-rays indicate you have arthritis.


knee arthritis


Typical conservative treatment for knee osteoarthritis is as follows:

• Anti-inflammatory medication

• Weight loss

• Activity modification

• Physical Therapy

• Injections (Cortisone and/or Hyaluronan)

When all of these conservative measures fail, surgery is a reasonable option.

How do you know if you’re ready to have surgery for your arthritic knee?

In a word, pain.

Although x-rays are the means of diagnosing whether you have knee arthritis, pain and limited function are generally the determining factors as to whether you are ready to have surgery.

If pain limits your ability to walk, negotiate stairs, keeps you awake at night, or limits your ability to work or participate in recreational activities, surgery may be the best option.


What is knee replacement surgery?

Knee replacement involves mechanically removing the diseased aspect of the bone and replacing it with new surfaces. In the knee, the two bones involved are the femur above and the tibia below. For the femur, the regions of disease that are removed are called the femoral condyles. For the tibia, the region called the tibia plateau is removed. This removal of the diseased bone will in turn remove the cause of the joint pain. At times, the posterior or undersurface of the knee cap (or patella) is also resurfaced.


total knee replacement


In general, knee replacement simply involves resurfacing the painful weight bearing aspects of the knee by removing the arthritis and replacing them with new metals or plastics.

In the past, when knee arthritis warranted surgery, a total knee replacement was performed. This involves replacing both the medial (inside) and lateral (outside) aspects of the knee joint. With advancements in surgical techniques and replacement prosthesis, partial knee replacements are becoming more common. In this procedure, only the diseased bone, generally the medial compartment is replaced. This partial knee replacement results in a smaller incision, less swelling, greater range of motion, and generally a quicker recovery.


What to expect following knee replacement

Each surgeon is different as to the specific protocol set out following knee replacement. In addition, complications can occur with surgery can also impact typical progression. Such complications can include blood clots, infection, excessive swelling, and significant stiffness or pain. However, here are some general guidelines as to what to expect following knee replacement surgery.

Surgery will occur in the hospital and involve a minimum of a 2 day stay. Be prepared to start walking very quickly after surgery, either the same or next day. Walking will occur with the assistance of a walker. In addition, movement exercises will also begin immediately.

Some surgeons use the assistance of a machine called a CPM (continuous passive motion). This machine manually bends and extends the knee in a repetitive fashion with the goal of improving knee mobility. Often following surgery the doctor will also recommend the use of compression stockings to help minimize the risk of blood clots and minimize swelling.


knee cpm machine


Following the short hospital stay, some need to go to an inpatient rehabilitation facility for a number of days before returning home. At the facility you will be receiving physical therapy at least two times a day. Activities will include progressing walking tolerance with the walker, knee range of motion (ROM) activities, and light strengthening exercises.


Returning Home

In preparing for the return home following knee replacement surgery, some areas should be addressed in advance. As walking stairs is quite difficult after surgery, plan to have sleeping arrangements available on the first floor of your home. Bending the knee may be difficult and painful so consider obtaining a raised toilet seat to make toilet transfers easier. Some surgeons arrange for you to have an ice machine to be used at home. If this is not the case with your surgeon, plan on having large ice packs of your own available for frequent ice therapy.

After returning home, often a home physical therapist will visit for a week or two. The goals at this stage are to progress walking tolerance, stretch the knee to increase ROM, and improve muscle activity and strength. Within a couple of weeks, you will be directed to an outpatient physical therapy center where you will continue your rehabilitation.


Outpatient Physical Therapy

Once released from the home physical therapist, the remainder of your physical therapy will be at an outpatient physical therapy facility. In outpatient physical therapy, the intensity of the program increases. Initial goals include reducing swelling and pain, and progressing walking from a walker, to a cane, and then to using no assistance at all.

Range of motion is also a focus of rehabilitation. Extension, or the ability to straighten the knee, is key in that a knee that cannot fully extend will feel shorter then the opposite side. The physical therapist will manually stretch your knee to help improve ROM. The use of a stationary bike is very helpful in gaining knee mobility, specifically the ability to bend the knee.

knee range of motion

Swelling is the enemy to progress in physical therapy. The more swelling you have, the greater the pain, the more limited the ROM, and the more difficult for the muscles to work normally. Thus continuing to utilize ice therapy frequently throughout the day is important.

Strengthening exercises will be progressed in PT with emphasis on muscles of the thigh (quadriceps and hamstrings) and hip.

The exercises that are utilized in the recovery from knee replacement depend on the stage of healing and the amount of progress made in achieving independent walking, knee ROM, and muscle strength. Here are some of the typical exercises utilized following knee replacement: knee replacement surgery exercises.


Summary

• Knee replacement surgery is a major surgery and should only be done when conservative care has failed and you have significant pain.

• Surgery involves removing the diseased bone and resurfacing them with plastics or metals.

• Walking and knee motion exercises will begin within a day after surgery.

• Surgery will require a short hospital stay, often followed by a number of days in a rehabilitation facility.

• Pre-plan your return home with having a raised toilet, first floor sleeping arrangements, and ice packs available.

• Follow the guidance from your physical therapist to help restore knee ROM and strength: knee replacement surgery exercises.

If you are in significant knee pain and conservative osteoarthritis treatment has failed, knee replacement surgery may be right for you. Knowing what to expect and preparing for surgery can help put you in the best position to have a positive outcome following your knee replacement surgery.




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Partial Knee replacement and still pain/swelling 5 weeks PostOP 
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