What to Expect After Knee Replacement
You may think you’re ready for your knee replacement, but good chance you are unprepared for the next few months ahead. Not only may you have unrealistic explanations for your initial recovery, but you likely don’t fully understand your limitations once back home.
Below are some realistic expectations after knee replacement from the 20+ years of in home care I have provided as a home health physical therapist.
10 Things to Expect For Your New Knee Replacement
1. Your Old Knee Pain Will Be Gone IMMEDIATELY
You know that unbearable pain in your knee that you simply can’t live with anymore? There’s a good chance when you come out of surgery your old knee pain will be gone almost IMMEDIATELY. Your movement and comfort level will be improved right away when once home. Yes, there will be pain from the surgery itself and post-operative swelling but compared to your old pain, the new after surgery pain will be more than tolerable.
In comparing a knee to hip replacement surgery, knees tend to have some more post-op pain however it is different pain. The surrounding muscles and tendons of the hip are less involved in its movement vs. the knee and thus do not hold back the hip in terms of pain. With new knees, the surrounding tissues are much more involved and scar tissue buildup is more of a factor and thus cause more pain initially.
Bottom line, your original knee pain will be no longer.
2. Pain Medications – Love the Relief…Hate the Constipation!
Most if not all orthoepic surgeons will send you home with a variety of pain medications designed to provide you initial pain relief in the first few weeks home. Examples of some of the more commonly prescribed pain medications are Hydrocodone, Oxycodone, Hydromorphone, Tramadol and Codeine.
Based on your condition leaving the hospital after your knee replacement you will receive the proper dosage of each to continue taking once home. I suggest to my patients to attempt weening off of their strongest pain medication within the first 2-3 weeks after surgery.
Your surgeon will likely advise you to take some form of over the counter (OTC) pain relief such as acetaminophen (Tylenol) or ibuprofen (NSAID) depending on their protocol. Your surgeon might not allow you to take NSAIDs while you are on blood thinners so double check with your nurse or therapist.
Acetaminophen tends to be the OTC pain relief of choice after knee replacement and one that I suggest my patients always take initially.
One thing many don’t know before surgery is that taking the stronger prescription pain medications will many times cause constipation. Way too often this constipation can become severe and bring you way more distress than you can handle on your return home.
I recommend a strict regimen of constipation control as soon as you get home as detailed below.
How To Avoid Constipation After Knee Replacement
So how can you manage this you ask? Prepare ahead of time!
PT Pro Tip: A week before your surgery gather up all of these items: Milk of Magnesia, Senna or Stool Softener, Metamucil/Fiber Powder and Prune Juice. Each of these items provides a way that you can promote continued bowel movement and still take your pain medications as prescribed.
When you start your pain meds, start some or all of the above in some fashion to ensure you do not get constipated. Heated prune juice is an extra boost if you feel like you are going down the constipation road, heating 6-8 oz to coffee temperature in the microwave works well. Listen to Nike and ‘Just Do It.’
3. Everyone Needs A Little Help in the Bedroom & Bathroom
Even the so-called ‘strongest’ people coming into knee surgery will need a little bit of assistance once they return home. For example, lifting your leg in and out of bed after knee replacement can turn into a real chore.
Your combination of pain and swelling can make a simple task much more difficult. This is especially true for those of you who have high beds which may require using a step stool to get in and out of bed normally even prior to surgery.
PT Pro Tip: Using a leg lifter to help with this or a basic belt with a loop at the end can make this a much easier task.
Get ready to adjust your bathroom routine seeing you will have difficulty bending your knee comfortably. Getting in and out of the shower might require a tub bench or transfer bench if you cannot lift your surgery leg over the side of the tub safely. Chances are you will need this extra safety measure for the first few weeks.
Be ready to use any or all of the above adaptive equipment in your daily routine for the first 2-4 weeks after your knee replacement surgery. Yes, even you Mr. Tough Guy.
4. Going Up and Down Stairs – Should Not Be a Problem
Many of my home care patients are fearful of doing stairs after returning home. In fact many times they will set their first floor up for sleeping in the initial weeks to avoid stairs altogether.
Your physical therapist in the hospital and at home will show you the proper technique to go up and down stairs. You will be using a cane and railing with relative ease so no need to set up your first floor for sleeping.
Using the ‘Up with the good leg first, down with the bad leg first’ technique will place little to no stress on your new knee and make doing stairs easier than you might think. If you simply take your time and do each step one by one you will find stairs to be relatively easy.
There are a few exceptions to this statement. If your stairs at home do not have a railing you will need to either install one before coming home or you will need to avoid stairs early on.
If you have any additional underlying mobility issue on your non-surgery leg or elsewhere, you may want to avoid stairs in the early phase of returning home.
Don’t be afraid of stairs during your recovery from knee surgery.
5. Plan to Take Some Time Off of Work
If you are still working leading into your knee replacement, it may be tempting to return to work quickly. The mistake comes with those working office or limited labor jobs feeling they can return to work in a week or two. Bad idea. Your focus should be on your recovery and not performing your work duties.
For those working more labor positions requiring bending and lifting, you will need to take at least 2-3 months off of work in order to return to working capacity.
The reality of your new knee is that you will not be comfortable sitting or staying in one position for more than 60 minutes at a time. Even though you may have a job requiring only computer usage, you will not be comfortable working in the first month after surgery.
Don’t make the mistake of returning to work full time too early in the process, even if you are working form home, or you will be unhappy in the end. The truth about knee replacement surgery is that it is a MAJOR SURGERY and should be treated as such.
PT Pro Tip: Now is a great time to research and invest in a new office chair or entire office setup. Make sure your chair has wheels, adjustable armrests and gives excellent lumbar support. Set up your computer monitor and desk to reduce twisting or torque. Set yourself up for success when returning to work.
6. Your Knee and Leg WILL Swell Up and Its Ok – Just Check For 3 Things
Probably the #1 surprise to patients is when the new knee replacement leg swells up after returning home from the hospital in the first week. There are many reasons this occurs and they are all part of the natural process of putting weight on that new knee and starting new exercises to regain strength. This is normal and will occur in 95% of people.
Many surgeons will make you wear compression stockings for the first few weeks to help with the swelling and circulation. Your physical therapist will show you techniques and positions to help reduce the swelling. Don’t worry, your leg won’t stay swollen forever however it may linger for up to 6 weeks.
PT Pro Tip: To help reduce foot swelling after knee surgery, lay flat on a bed or sofa and elevate your entire leg placing 2-3 bed pillows lengthwise under your entire leg for at least 60 minutes. Make sure the pillows are NOT jammed under your knee but rather keeping the leg straight and elevated above heart level.
Add in some ankle pumps to help push the swelling out of your leg. Also be sure to ice your knee for 20-30 minutes 5-7x per day in the initial swelling phase.
Blood Clots After Knee Replacement?
Though uncommon, one concern would be the formation of blot clots causing swelling. Look for any severe redness in the calf muscle or groin regions as this could be a potential clot developing. Also, look for severe pain and or tenderness again in the calf muscle belly or groin region.
Finally, extreme swelling is not normal and by that we would say 2x the size or more of the original leg. If any of these symptoms appear, call your doctor and get to the emergency room for evaluation right away.
Calf pain, swelling and bruising after knee replacement is very common so look at all of the signs and symptoms before you get concerned.
7. Your Sleeping Habits Will Improve But Not Right Away
Most likely your knee pain is getting in the way of you having a good night’s sleep currently. Rest assured that pain will be gone right away after surgery. However, there will be a restriction on sleeping on your side initially after your return home for 4-6 weeks, If you are a side sleeper only, get ready for some rough early nights in bed trying to sleep on your back.
Don’t worry though, overall your sleep will be much improved compared to before surgery and that current pain you have will be gone. The initial position restrictions your surgeon will put on you won’t last forever.
PT Pro Tip: A good idea would be to use a supportive recliner chair in the early weeks after returning home from knee replacement for sleep as it will provide you with the best leg support while laying flat on your back
For those having severe sleeping difficulty in the first few weeks after surgery, adding a small dose of pain medication prior to bedtime can many times allow a better night’s sleep. Many are trying to avoid taking the stronger narcotic meds early on but in this case a small amount can help tremendously with sleep. Talk it over with your surgeon if concerned at all.
8. You Can Return to Most Activities in the Future
The goal of getting your knee replaced is to return to pain free movement and hopefully activities that you can enjoy. While some have simple goals such as driving again, walking without a walker or cane and moving around their homes without pain, most others want to get back to things outside of the home. So what are realistic activity goals?
The good news is that almost any low impact type of sporting activity from walking, hiking, golf, biking, dancing and swimming can be returned to within the first 4-8 months of surgery, many times even sooner. Will you feel like a teenager again? Not quite, but your quality of life will be immensely improved.
Returning to kneeling activities such as mowing the lawn, gardening or scrubbing the floor will not be as easy. You may be able to do so but artificial knee joints are not designed to be knelt on for long periods.
Core and stretching activities including yoga and pilates can be returned to one you are healed up however your expectations should be lowered in terms of full participation. Extreme end range stretch positions especially those flexing your knee at extreme bend should be avoided at all times.
“Can you run after a knee replacement?” is a very common question. Any sport involving running or jogging such as soccer along with jumping sports such as basketball or volleyball are not well tolerated by artificial knees unfortunately. Nor are contact sports such as rugby, football or hockey. These activities would not be advisable by your surgeon or physical therapist into the future.
A common question is regarding return to playing tennis or pickle ball. While tennis can at times be tolerated after a knee replacement it would need to be done on a limited competitive level and preferably on a clay or grass surface to avoid twisting and cutting motions.
Pickleball on the other hand is a sport you absolutely can return to playing after knee replacement due to its limited requirements when it comes to running and cutting.
These activity yes and nos are just some of the what to expect after knee replacement footnotes. There are many more activities you can easily return to doing.
9. Driving After Knee Replacement Comes Fast
Even those having their right knees replaced can return to driving in a relatively short amount of time. Most surgeons will allow you to drive after your initial followup which is normally between 2-3 weeks after surgery however some do want you to wait 4-6 weeks if it is your right knee which is involved more in the act of braking and accelerating.
The one limiting factor that plays into driving is whether or not you are still taking narcotics for pain. If so, your physician will now allow you to drive until you are no longer taking them.
Once you have regained your range of motion and ability to get in and out of the car independently you can return to driving. Be advised any drive over 30 minutes in length will be uncomfortable to your new knee and you should plan to make occasional stops to stretch your leg out.
PT Pro Tip: Using a foam cushion on the seat could be helpful for comfort. Also placing a garbage bag on the seat can ease your in and out of the car to reduce twisting your knee.
10. Surgeon Choice is 90% of the Success – Do Your Research
It would be wise to do your homework on the surgeon you ultimately choose to perform the knee replacement. Talk to everyone in your social network and find out who the better surgeons are not only in terms of good outcomes but also low infection rates which is readily available data from your insurance. You likely will run into a few common names, both on the good and the bad side.
Go online, weed through reviews and find patterns of who people are talking about. See which surgeons are doing more up to date procedures and find out if they are teaching others, usually a good sign.
If they are available to do the surgery right away, you may want to look elsewhere and find one that might have a longer wait which means they are much desired.
Look in your city’s ‘Best of’ guides and magazines for the top rated doctors.
Getting a new knee can be a life changing experience so make sure you put your body in the most capable hands available.
Final Thoughts on The Truth About Knee Replacement Surgery
To sum it all up, here are 10 Things You Should Know Before Your Knee Replacement Surgery in a brief list format from my 20+ years of Physical Therapy Experience:
- Your Old Knee Pain is Gone IMMEDIATELY
- Pain Medications – Love the Relief…Hate the Constipation!
- Everyone Needs A Little Help in the Bedroom & Bathroom
- Going Up and Down Stairs – Not a Problem
- Plan to Take Some Time Off of Work
- Your Leg WILL Swell Up and Its Ok – Just Check For 3 Things
- Your Sleeping Habits Will Improve But Not Right Away
- You Can Return to Most Activities in the Future
- You Will Drive Again Rather Quickly
- Make Sure to Research Your Surgeon