As learned in our previous blog posts on understanding surgeries (see: rotator cuff, knee scope), we used to work alongside surgeons. One of these surgeons completed A LOT of joint replacement surgeries - almost entirely on the knee and hip. Therefore, we’ve treated our fair share of post-operative clients - especially post-knee replacement! As an FYI, a total knee arthroplasty (TKA) is science speak for a total knee replacement (TKR), so they are used interchangeably!
So you’re going to have your knee replaced... The purpose of this blog post is to try and clarify the ins and outs of having a knee replacement surgery. Knowledge is power! Be prepared, and things will go smoothly!
Aside: We will use the same headings in this post as we did in the other ‘Must Know Knowledge’ posts. We’ll try to stick with the same format so that it’s easier to navigate. Some things might look similar, as some advice is “surgery” related, and less specific to the type of surgery.
How do I know if I even need a total knee arthroplasty (replacement)?
Typically, to qualify for a knee replacement, many, or all, of the following statements are true:
Do I have to do pre-operative physiotherapy?
In short, yes, you should. It helps in the following ways:
What else should I do before I get a total knee arthroplasty (replacement)?
How is a total knee arthroplasty (replacement) performed?
Every surgeon has their individual preferences, however, knee arthroplasty is typically performed as described here:
Note on the video: not every surgeon implants the drain
Psst. If you want to know more about knee anatomy, check out our post here: ACL. MCL, Meniscus - My Knee Injury Sounds Complicated
Before we get into the next part of this blog post, it is important to note that everything in this blog post is for information purposes only. This blog post is not intended to be strict medical advice. As previously mentioned, everyone is an individual, and therefore, individual variances do occur. It is important to consult your physiotherapist, surgeon, or doctor for the most applicable advice for you.
What does the typical rehabilitation process look like?
First, it’s important to reiterate that everyone is an individual, with individual circumstances, and therefore, the rehab process will be very individualized. That being said, in almost every case, it is safe to walk on your leg immediately after surgery, and you will typically spend 1-2 days in hospital post-operatively. In the hospital, you will learn how to walk with a walker, climb stairs safely, and be monitored for any post-surgical complications.
Once at home, you will often be allotted home physiotherapy appointments with a physiotherapist (for free), through the Community Care Access Centre (CCAC). That being said, the amount of appointments provided by the CCAC has been significantly reduced in the past couple years (down to 1-4 total appointments), which is not enough.
Due to the limitation in the number of CCAC-funded appointments, you will continue with further physiotherapy via one of two options: publically-funded (OHIP) physiotherapy, or privately funded (out of pocket/private benefits) physiotherapy. OHIP physiotherapy often has a limit to it as well, and many people require more than the “program of care” allows for. Therefore, it is important to consider the potential financial costs of ongoing physiotherapy when undergoing a total knee arthroplasty.
This next sentence is important: Complete rehabilitation after a total knee replacement will usually take 6-12 months. It’s likely that someone will tell you 3 months. 3 months of rehabilitation can get you back to work (depending on your job), or allow everyday life tasks to be more easily and comfortably completed. To get back to 100%, it will probably take longer. You may not be required to frequently attend physiotherapy appointments, but you should expect to be working on exercises, and self-management for up to 1 year postoperatively.
Overall, post-operative care looks something like this:
Here’s the unfortunate part: gaining the range of motion (over the first couple months postoperatively) in your brand new knee is usually not very fun.
That being said, speak openly and honestly with your physiotherapist to ensure the process is not completely unbearable, because that’s not helpful either.
How long does it take to heal after a total knee arthroplasty (replacement)?
In uncomplicated cases,
As with any surgery, here are some additional things to consider:
What exercises are safe to do right away after a total knee arthroplasty (replacement)?
In the hospital, or from the surgeon, you will likely be provided with a list of exercises to get started on. These usually include range of motion, and muscle activation exercises. These are a great place to start.
That being said, the primary goal in the early postoperative stage is to focus on gaining flexion range of motion (knee bend). Here’s one of the most common knee flexion exercises (called a heel slide):
A prescription of 10 repetitions with 5 second holds, 3 times a day is common when working on this ‘heel slide’ exercise.
Overall, you will progress in this order with rehab (roughly):
Lastly, it’s highly likely that you and your physiotherapist will work on other joints (such as the ankle and hip) together. You should be able to work on hip musculature (which greatly supports the knee) safely, so it is highly recommended. This should help to reduce any postoperative complications in your other joints, all while decreasing your pain, and improving your overall function!
How much function and how little pain can I expect at the end of my rehabilitation?
Alas, the loaded question. (We know we’ve started this section with that same sentence for each of the ‘Must Know Knowledge’ surgical blog posts… Sorry, but it’s always a loaded question).
Again, everyone is an individual, everyone heals differently, and therefore final pain and function are highly individualized. As mentioned earlier in this post, there are some indications of ongoing pain after a knee replacement. Further, if there are complications with surgery, it may alter the progress/end result of your recovery.
Here are some things we consider:
What are the potential complications associated with a total knee arthroplasty (surgery)?
All steps will be taken to limit complications postoperatively, however, it’s important to understand the possibilities. Complications include:
There’s a lot of information in this blog post. But there’s also a lot to know. Be informed, ask questions (even the hard ones), and look out for yourself.
Let us know if you thought this blog post was helpful, and we will try to post new ones outlining the helpful points for other types of surgeries!
Are you planning to undergo (or have already undergone) a total knee replacement? At Strive Physiotherapy and Performance, we are committed to providing an in-depth assessment to ensure we can work together to find the best plan of action for each individual client. Call us at 519-895-2020, or use our online booking tool on www.strivept.ca to book an appointment with one of our knowledgeable physiotherapists, and they will be sure to help you understand your injury.
Physiotherapist at Strive Physiotherapy & Performance
Strive Physiotherapy & Performance
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