What to expect and tips to get the best results after your TKA surgery
Knee replacement surgery, technically known as total knee arthroplasty, has become a very common surgery for those suffering with severe knee pain. While it is common, it isn’t a small matter. There’s a lot that goes on during the surgery itself and with the rehab afterward. This post will help to address some of the myths, common misconceptions, and tips for recovery.
A word of warning before we get started. This is an educational/informational post only, please don’t try to use this as a substitute for rehab. Every patient is unique and has unique challenges. Talk with your healthcare providers and make sure they address any concerns you have so they can help you get better, faster.
Total Knee Replacement Surgery
Below is a short animated video about the surgery. For those of you who are interested in watching parts of a real surgery, I’ll add that at the end of this post as some people find that difficult to watch.
Rehab In The Hospital
Therapy begins as soon as possible in the hospital. The early goals are to keep your pain under control and get you moving. Movement is very important at all stages, but especially early on. It may seem counterintuative at first, but frequent, gentle movement will help to keep your pain and stiffness down as well as promote healing. Additionally, your surgeon may have you on a continuously passive motion (CPM) machine to slowly bend and straighten your knee while you recover in your hospital bed.
Rehab Outside Of The Hospital
Depending on your overall health, condition, and level of support at home, you might be discharged from the hospital directly to home or to a special rehab center. Some people require a short stay in a skilled rehab center, some don’t. Many people start their therapy and rehab with home health. This is where the physical therapist (and possibly occupational therapist and nurse) come directly to your home to provide care. The focus of care at this time is to help you get around your home safely, make sure the incision is healing correctly, and work on your knee range of motion (ROM).
Outpatient physical therapy is where you go to a clinic and work with a physical therapist to continue to improve your motion, strength, and walking. There are many ways that your PT can help, including modalities to control pain, manual therapy to decrease muscle guarding and stiffness, and exercises to help get you moving. Make sure that you have a home exercise program that you are able to complete on a regular basis to help you get better, faster.
Myths & Misconceptions
No pain, no gain is NOT a mantra for you to embrace. Yes, surgery is painful and rehab isn’t what anyone would call a pleasant experience. But you shouldn’t torture yourself, either. Being overly forceful with your motion almost always causes more problems than any benefit it could provide. As a general rule, frequent, gentle, and persistent is a much better approach than being very aggressive with your motion but only doing it a couple of times a day.
Your home exercise program (HEP) is supposed to be your best friend, not your enemy. Many patients don’t take their rehab as seriously as they should. Your HEP isn’t something your therapist has given you as a way to annoy you or make you miserable. It is supposed to help you improve your motion, control your pain, and get you better. If there is a particular exercise that is really painful or too difficult for you to do, tell your therapist ASAP so you can change it out for something that will work for you instead.
Tips and Tricks
Sleep is incredibly important for healing. Your body needs proper rest so you can heal. Many patients have a lot of difficulty getting into a comfortable position and getting quality sleep. This can be a controversial topic for some surgeons and therapists, but many PTs recommend you get as much sleep as you can without worrying about keeping your knee straight the whole time. The video section below has helpful tips on sleeping positions.
Nutrition is also very important for healing. Many people can have stomach discomfort and nausea after surgery and as a side effect of the pain medication. A common mistake is when patients take their meds on an empty stomach. While you may not feel like eating a full course meal of steak and steamed veggies, try and find something you can eat that will give you some good nutrition. The video below has great advice from a dietitian on nutrition after surgery.
Below are a collection of videos on some of the above topics and more. Tony Maritato, PT, has an extensive collection of videos on his YouTube channel.
Sleep positions and using pillows
Using heat or ice for pain control
Compression sock plastic bag trick! I’ve found that using a more sturdy bag like a gallon sized Ziploc bag works even better for this.
How long will you need to exercise? Tony’s advice is spot on here.
Actual total knee surgery procedure – caution, this will be too graphic for some viewers.