Knee Replacement Recovery
Knee replacement involves the replacement of damaged or diseased joint surfaces with artificial components, mostly for osteoarthritis of the knee. The numbers and costs now overtake hip replacement, reaching 70,000 operations annually in the UK, 67% of which are NHS knee replacement.
Knee replacement now has very good results which rival that of replacement of the hip and both these technologies have some of the largest quality of life improvement ratings of all medical treatments.
Knee replacement is a major operation and the lack of overlying tissues and potential compromise to the local blood supply means that the tissues around the knee need careful monitoring and management if the healing process is to be optimal. You need to be able to participate to your fullest to get the best out of your time with the nurses and physios after the operation and to do this it is important to have good knee replacement patient information such as a knee replacement information leaflet or booklet. This is typically given out at the outpatient appointment where you are listed for your operation.
To avoid knee replacement complications, the management of the wound starts with the surgeon ensuring that the tissues are treated carefully during the operation, limiting the time of oxygen depletion in the local area and controlling bleeding and swelling of the wound. A compressive bandage is applied after the completion of the operation to reduce oedema and protect the wound.
As the knee is a major weight bearing joint and any knee surgery is likely to disturb the ability to walk, the attention of a physiotherapist is often required to teach a good gait pattern and to establish a programme of knee replacement exercises to rehabilitate the joint. The same procedures apply to a partial knee replacement although partial replacement should be less difficult to rehabilitate due to the minimally invasive nature.
Even though the majority of the knee replacement cost is for the implant and the surgical and hospital services, the rehabilitation can go on for several months in some cases and physio costs can add to the overall.
Because the cooperation between the physiotherapist and the patient can be very important in getting the best outcome for the joint, understanding what has gone on in the operation and what has happened to the tissues around the knee is very useful. To do this it is helpful to watch a knee replacement surgery video which, although somewhat gory and at times like carpentry, really gives a good sense of the reasons for the management of the joint after the operation.
Innovation is moving towards increasing customisation of knee implants to the individual's size and shape as the choice of components may not suit the knees of some people. Biomet has the Signature knee replacement system which uses a 3D image of the patient's knee generated from an MRI scan, allowing more detailed operative planning and the manufacture of custom guides. These guides allow alignment of the implants during operation with less invasive techniques.
Back in the ward, you may be given a switch that allows you to give yourself painkillers in safe and effective amounts. You may also be prescribed oxygen via a mask or tubes and if needed you may be given a blood transfusion.
You will have a large compression dressing on your knee to protect your wound, with drains to siphon off blood from the operation site to stop it collecting inside the wound.
The team will continue to monitor you while you are in the ward in the initial period and may allow you to have a drink after a while and even to eat something in some cases. To move around in bed and use a bedpan you will need some assistance.
How soon will I be up and around?
The physiotherapist will help you get up and walk about as soon as possible. With minimally invasive surgery you may be able to walk on the same day as your operation but your first time up will commonly be on the day after operation.
The physiotherapist will teach you to walk with a frame or crutches, depending on how able you are and you may be progressed to sticks as soon as you are safe. The physio will also teach you the knee exercises, starting on the first day post operatively, and you will need to perform them regularly for several months.
Getting up and around and doing your exercises is commonly painful to some degree and you may have some swelling in the limb also, but this is normal and you should take your painkillers as advised regularly.
When can I go home?
You will usually be in hospital for 5 to 7 days, depending how fast you progress and what type of knee replacement you have had. Patients who have had a half knee replacement typically have a shorter hospital stay.
If you are overall fit and well or younger than average this process may be speede up and you will get going quickly and perhaps be ready for discharge after three days or so.
What will I be like when I get home?
It is very likely that you will quite tired when you get home and may have to have a lot of rest between active periods. The size of the operation means the body needs a lot of rest to heal although you can build up you periods of activity gradually as you get stronger.
The occupational therapist in the hosptital may check if you are eligible some home help or if any aids could help you. It can be sensible for you to arrange someone to be nearby to assist you in the first week or so after you return home.
Your recovery now partly relies on continuing the exercises your physiotherapist gave and these are important to your rehabilitation so keep them up at home. The physio may arrange for you to attend you nearest physiotherapy outpatient department to monitor your progress.
Taking regular short and gradually increasing walks can be integrated with getting back to normal activities and this approach will steadily make you more independent and functionally normal.
What about the longer term?
Although it can vary, you are likely to be able to progress off your frame or crutches within three to six weeks of operation, unless instructed otherwise. However, a knee replacement is at least a three month job so you may feel pain and discomfort to some degree during this time. You may not feel like your knee is wholly your own for up to a year, and the knee can continue to improve even up to two years from the operation.
You should monitor your knee over time and consult your doctor if it develops increased pain, swelling, redness or you have difficulty weight bearing. Vigorous sports involves contact or extreme effort or risk are best avoided.
You have to be able to bend your knee far enough to get in and out of the car and access the pedals effectively. There is some evidence that the reflex reactions of the leg do not recover for six weeks after the operation and you should ask your surgeon or physiotherapist about this. If you drive when you are not certain you may not be insured.
Depending on the type of job you have you are likely to be able to return to work six to twelve weeks after your operation unless you have heavy or difficult work. Work in confined spaces may always be too difficult.
Light household tasks like washing up and wiping or dusting are suitable for the first six weeks or so and if you balance is good some light vacuuming after this time. Avoid long periods on your feet to prevent swelling of the leg and you will also feel that kneeling on the leg will not be possible.
Attending the hospital
Routine outpatient appointments will be made to check on your progress, usually 6-12 weeks after your knee replacement. The surgeon will want to see you again after another year and likely for every five years after that, with your knee xrayed each time to make sure there is no loosening.
Having the Knee Redone
A knee replacement can be redone but each time the operation is repeated the results tend to be a little worse and the rehabilitation period a bit more difficult. Once settled through this however, the results can be good overall.