Total Knee Replacement
Do you have a Total Knee Replacement surgery scheduled this year? Have questions about what to expect? We have some answers for you.
How long will my rehab take?
The most appropriate answer to this questions is, everyone is different. However, on average at least 3 to 6 months. The biggest challenge that most patients come up against when recovering from a knee replacement is pain and swelling. We spend a great deal of time on helping you manage your pain and swelling so that you can gain range of motion and strength. Knees tend to swell even more compared to other joints. Many reasons contribute to the amount of swelling you may develop after surgery. Swelling is impacted on how well your circulatory system works with your lymph system. Compression, elevation, and ice are key when it comes to managing the swelling you will experience. Swelling and pain is totally normal, and your physical therapist will help determine when there is too much swelling or pain present.
When do I start walking?
You will be up and walking before you are discharged from the hospital. You will be using a walker initially to get up and walk to the bathroom and back to bed. If you have steps to get into your home you will learn how to go up and down the stairs using your non-surgical leg. This is something you can practice prior to your surgery to get comfortable with returning home. Most patients typically can walk short distances within their homes and progress to longer distances.
What kind of mobility can I expect to be doing after surgery?
You should be able to walk short distances with your walker or crutches. You will be able to put weight on your leg within your comfort level. You should be able to go and down stairs using your non-surgical leg, get in and out of bed without help, get up and down from a chair, and get on and off your toilet. You’ll likely not be able to shower till your doctor has given you permission to get your surgical knee wet, that might be a week or 2 depending on your surgeon. Knee replacement surgery has come a long way, you’ll be amazed at how quickly you’ll be getting around after a major surgery.
Will I need to go to a rehab facility after surgery?
Some people may require a stay at a subacute rehab or skilled nursing facility after their joint replacement surgery. This will greatly depend on how your mobility and strength is prior to the surgery, and to an even great extent how much help you have at home. If you live alone, and have limited help from friends and family it may be beneficial for you to get the daily rehab you’d receive at a rehab facility. You may also consider planning on discharging to a rehab facility if you have any health complications that would benefit from closer monitoring or if you’ve had a great deal of difficulty with your mobility prior to your surgery. Discharging to a rehab facility will provide you with more intense daily exercise and mobility that may help you get your strength back faster.
If you go home, you will get home health therapy and nursing. We highly recommend you receive home health services if you return home since hospital stays are very short and having a healthcare professional check in regularly will help prevent any unforeseen complications.
*Note about current COVID-19 and Rehab facilities:
Given the higher likelihood of contracting the virus in nursing homes and rehab facilities, if you can return home but need help, be sure to discuss home health aides who can help you with household activities. Your insurance should provide some home health aide coverage even if it’s a few hours a day. You can also discuss your options with the social worker at the hospital.
What will outpatient therapy be like?
Once you have been discharged from your home health therapy you will set up an appointment with your outpatient PT. We’ll assess how well you are walking, your pain level, measure your range of motion and swelling. Your PT will also gather your medical history and discuss your own goals. Did you used to be an avid biker, tennis player, or gardener? These are all things that your therapist will help you work towards.
Generally the first few weeks focus on pain management, reducing swelling, establishing some gentle exercises, and improving your range of motion. As you progress and your scar has healed to fully closed we will work on some scar tissue mobilization. The scar can feel numb and sensitive, and mobilizing the tissue will help the tissue form more pliable scar tissue. It is normal for your scar to be pink or purple for quite a long time. What we see on the surface is just a small portion of your scar. There are many layers that have been cut through and stitched back together, so you’ll know if those deeper tissues are healed when the scar turns very pale or white.
We will also focus on improving your gait (or walking) pattern, your strength, and range of motion. These all depend on your pain level, swelling, and your own goals. We also help you address other issues that may arise during your recovery, such as hip or back pain that can develop from compensating for walking differently. Improving your strength to return to normal stair climbing will also be a part of plan of care.
Did you know many people aren’t told to try to return to kneeling on their knee with the replacement? Obviously you won’t be doing this quickly, but you should be able to return to some amount of kneeling through your knee. It’s best to discuss with your ortho MD, but some people who receive knee replacements have jobs requiring kneeling. This will be something we can help you work towards as well.
How do you help with pain management and swelling?
Our practice focuses on hands-on treatment. We typically do very gentle lymph massage that helps with reducing swelling, and we have a unique machine we also use to help promote healing which utilizes PEMF (Pulsed Electro Magnetic Field) therapy.
We have found that through the myofascia and lymph massage techniques we utilize that people greatly benefit from pain reduction and a reduction in swelling.
Do I have to go to the PT clinic my doctor tells me to go to?
You absolutely have every choice to go to the clinic and therapist you want to work with. Depending on your insurance this may limit which clinic you end up picking, but finding a clinic close to home is going to make it easier for you to stick with your therapy sessions. If you orthopedic surgeon has a very specific therapist you may consider their recommendation, but most clinics that your doctor may refer you to is associated with the hospital or network that hospital is located. They do this to keep as much insurance and money in their own network. This is just something to keep in mind. Bigger clinics will also make it harder to have a consistent therapist, and may spend less time doing one-on-one treatment with you as well.
We offer one-on-one treatment in a private space, no open gyms with us! We do however operate out-of-network. But depending on your co-pay and if you have out-of-network coverage sometimes we can be more affordable. We do cover those who’s primary insurance is Medicare.
What can I do to prepare for my Total Knee Replacement Surgery?
We have created a list of things you can consider prior to your surgery, and even some exercises to start doing now to help you be stronger and ready for the things you will do after your surgery. Check out that post here.
Thanks for taking the time to read our post, and if you have further comments or thoughts you think would be helpful to add feel free to contact us!
Disclaimer: The content in this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.