Above is a picture of a what the inside of total knee replacement looks like. It’s definitely not all fun and games, but compared to not being able to walk, run, play, it’s worth it.
I frequently get asked, “What should I expect with a total knee replacement?” or “How long does it take to recovery from a knee replacement?” Well, in this post I would like to share with you what I would say a normal recovery(with physical therapy) from knee replacement surgery might look like.
Day 1: The Surgery!
So depending on how extensive the knee arthritis and/or injury is to your knee, the actual procedure time may vary, but usually takes around 90 minutes to 2 hours. If you have your surgery done in the morning, there is a very likely chance that you will see a physical therapist at least once, if not twice that day. Crazy right! Yup, we will get you up only a few hours after surgery to have you stand or even start walking. This helps to get your bowels moving, blood pressure stabilized, and get you a little more oriented with your new knee. Actually, most people will tell you the first day isn’t too bad, as you still have the anesthesia in place. Nausea may be a problem however, as many times our stomachs don’t agree with the initial pain medication. But overall, usually day 1 isn’t too bad.
Day 2-4: The Hospital Stay
The next 2 to 4 days you will stay in the hospital where you will have nurses/physicians/OT/PT all helping/pestering you! Usually, you will have your nurse or nurses aids check on you every 2 to 4 hours for pain meds and vitals. You may or may not see your physician, but in most cases you will, and he/she will be able to answer any questions you have at that time. You will see a physical therapist at least twice a day, and an occupational therapist at least once. With physical therapy you will work on walking with a walker, knee range of motion(ROM), car transfers, and even possibly stairs. You may or may not be put in a continuous passive motion machine(new research shows it doesn’t lead to any improved outcomes, so don’t worry if you aren’t given one) which will bend and straighten your knee for you. Your knee WILL become more painful over these next 2-4 days. Remember what you had done!(see above picture), but the nurses will help to make sure your pain stays under control. Then discharge planning will come in on your 3rd or 4th day and decide where you will head to next.
Day 4-3 weeks: Early Recovery
So depending on what type of help you have in place at home, you will spend your next few weeks in 1 of 3 places. If you have a spouse at home who can care for your, or friends and family that can stay with you, you will go home. If you have this option, it’s usually the best, so try to find somebody who can help you out those first 2-3 weeks. If you go home and have someone who can drive you, you will come to see me in outpatient physical therapy. If not, you will get a home health physical therapist for 2-3 weeks until you can drive yourself to therapy. If you don’t have anybody at home, you will most likely go to a skilled nursing facility where you will get therapy at least 1 time a day. If you have both knees done at the same time(you crazy folks you), you are eligible to go to a rehab center where you will get therapy 3 times a day.
Now for the therapy part….let’s focus on those of you who went home and either received home health PT or outpatient PT. Your therapist will see you 3 times a week for the first 3 weeks, and will mostly be working on regaining your ROM. It is very important to get this back early in your rehab, before the harder scar tissue gets laid down. I’m not gonna lie, you knee is going to hurt these first few weeks. You won’t be able to sleep very well, and finding a comfortable position may be quite difficult. It’s essential that you are consistently icing and keeping your knee bending and straightening. I usually recommend getting a pedalor or recumbent bike that you can use 3 to 4 times a day to keep your knee from getting swollen and stiff. Stay on top of your pain meds, and let your therapist know how your feeling. What we do in therapy is going to hurt, but it should not leave you miserably sore for 3 to 4 days.
Days 3 weeks to 6 weeks: Middle Recovery
These are the days when you will start to see your swelling go down, and you will make some real gains in therapy. Your knee will still hurt a good amount, but not as bad as the first 3 weeks. You will hopefully start to get more sleep, be able to start driving(some will), and get a little of your life back. In therapy, you may go down to 2 times a week. You will still be working hard or regaining full ROM and especially full knee straightening. Getting your knee straight is very important in being able to walk correctly, so focus a lot of your home exercise effort at regaining a straight knee. This bring up another very important factor, you HAVE to be doing your home exercises/stretches! Therapy is only about 3 hours a week, which isn’t nearly enough to get all your ROM back, so you need to be stretching it 3-4 times a day at least. Don’t overdue it and make yourself really sore, but do work on stretching it as often as possible.
Days 6 weeks to 6 months/1 year: Late Recovery
After six weeks, most total knee replacement patients will tell you they seem to turn a corner. The pain should get moderately to significantly less, and walking, standing, and doing some household chores will become easier. Therapy will continue to work on regaining every last bit of ROM, but will also start to focus a lot more on strength. Specifically functional strength, meaning your ability to do everyday things like stairs, getting out of low chairs, squatting, and walking longer distances. You should still be doing your home exercises at least 2-3 times a day. Outpatient therapy will typically last about 12 weeks, but possibly longer depending on how therapy went in early/middle recovery. After 3 months, you will still notice stiffness every time you sit for a while and after getting out of bed, but the pain should be minimal. It is still important to stretch and exercise your knee 1-2 times a day, to get the full benefit of having a new knee!
If you are consistent with your therapy, do your home exercises, and avoid any crazy last minute ski trips, falls, or biking accidents, almost all new knee patients are completely happy after 1 year. The medical feat of a knee replacements is truly remarkable!. For those of you who have had one done already, I hope this did some justice to what you went through. And for those of you who need one, hopefully this gives you a better idea of what to expect when your expecting :).