Total Knee Replacement Do's and Don'ts
Knee replacements are becoming much more common as medical technology advances and outcomes following surgery are improving. The ability to diagnose knee osteoarthritis (the most common reason for knee replacements) has never been easier with the imaging and technology that we have in our healthcare system. Getting joint replacements has never been more popular as there are around 7 million people in America who have undergone knee replacement surgery according to The Journal of Bone and Joint Surgery. However, undergoing surgery is only the beginning of the recovery process. It’s often said that joint replacement surgery takes about 1 year to recover from, but with proper physical therapy intervention you may be able to get back to regular activity in a few months. Let’s outline some of the do’s and don’ts regarding knee replacement surgery.
Do’s
Stretch - Stretching the knee throughout the day is one of the most important things you can do during the recovery process. Scar tissue is being laid down following surgery, and without proper stretching the knee can develop joint adhesions that can limit knee mobility and leave you with a limp and ongoing knee pain.
Keep moving - The more mobility you maintain during the healing process the quicker you will be able to get back to regular activity. Motion is sometimes painful following surgery, but the more you adhere to the activity prescription you receive from your physical therapist the better your results will be.
Ice - Icing is a great way to help manage both pain and inflammation following joint surgery. Immediately following surgery it is recommended to ice the knee multiple times throughout the day (once every hour or two).
Use assistive devices - Canes, walkers, handrails, etc. Use any assistive device given to you by the medical professionals overseeing your care. They are sometimes bulky and may feel like they get in the way, but they are for your safety. Beyond safety, they allow you to keep a more even walking pattern and avoid limping. This avoids unnecessary stress on the recovering tissues.
Elevate - Place a pillow or rolled up towel under the ankle when relaxing in a chair or when laying down in bed. Keeping your ankle elevated and your knee in a fully extended position (not allowing it to bend or rest on a surface) allows the knee joint to stay mobile and keeps scar tissue from forming adhesions and joint contractures.
Compression stockings - Not everyone is given compression socks/stockings following surgery, but if you are given them or advised to use them, then follow that advice. They help to prevent blood clots in the legs that can cause pulmonary embolisms which is a life threatening situation.
Follow your physical therapy activity prescription. Your physical therapist is a specialist in the recovery process and knows how to manage your individual care. They should educate you throughout the process on additional do’s and don’ts as well as progress your activity to allow for a seamless recovery.
Don’ts
Do not allow the knee to rest in a “relaxed” position (slightly bent). This position may feel the most comfortable, but is also the worst for the recovery process as scar tissue continues to be laid down. As a physical therapist, it’s our nightmare when someone’s knee has “locked up” because of inadequate stretching.
Do not do all of your exercise and activity in one short spurt. Doing too much activity at one time can cause a significant increase and knee pain and swelling. It’s better to get up and move around throughout the day and spread out activity so the knee doesn’t get stiff.
Do not do an activity that you don’t feel safe doing or stable. During the recovery process it’s sometimes difficult to cope with the limited mobility that you may have immediately following the surgery. Only perform exercise or activity at home that you feel safe doing, which may be fairly limited.
Do not avoid assistive devices like canes and walkers. This was mentioned earlier, but avoiding using assistive devices causes improper walking patterns and can develop habits that can be hard to break. Walking slower, using canes, and keeping your stride even develops better habits than limping and telling yourself “I don’t need that thing, I feel fine.”
Lastly, do not put off a knee replacement so long that the rest of your body starts to fall apart because you can’t move. Osteoarthritis is a progressive pathology meaning that there is no reversing the process. When you stop moving the osteoarthritis process speeds up and your muscles will get weak. This can cause your body to feel more pain and more debilitated than it should. It’s a great idea to talk to your doctor and your physical therapist to see if a knee replacement is the best option for you.
Adage for the day - Motion is lotion. The more we move, the easier it is to keep moving.