Written by SMH Copywriter Phil Lederer
Wear and tear on joints — particularly the knees — is a normal part of healthy aging. But as cartilage breaks down and bone begins to scrape against bone, stiffness and discomfort can turn into debilitating pain and loss of function. Chronic joint pain often keeps us from living active lives, which not only erodes our quality of life, but also our health.
An increasingly common solution to this deterioration is knee replacement surgery. In 2017, nearly 1 million knee-replacements were performed in the U.S., with a significant (and growing) percentage of those being Total Knee Arthroplasty (TKA) surgeries.
In a TKA, or total knee replacement surgery, a surgeon removes deteriorated cartilage and the underlying bone of the femur and tibia, and recreates the entire joint with metal implants and a plastic spacer.
Thanks to advances in technology and technique — including robotic-assisted surgical tools like the ROSA Knee System — recovery times for these major surgeries have been drastically reduced. Gone are the days of three-week hospital stays for a knee replacement.
Getting Back to Life
So what is the norm these days, as far as recovery and returning to normal activity after a knee replacement surgery?
A full recovery may take up to a year, but most of the rehabilitation will be done at home or through an outpatient rehab program. While most patients leave the hospital in three to five days, experiences will differ and recovery can be affected by age, health, pre-surgical fitness and dedication to rehab exercises.
To get a general idea of the TKA recovery and rehab process, Healthe-Matters editors talked with local experts specializing in orthopedics and post-surgery physical therapy. If you’re considering a total knee replacement, here’s what you can expect the first few days after surgery.
Day 0 – Surgery Day
After surgery, you’ll wake up in the recovery room, where your care team will monitor your blood pressure, breathing and oxygen level, and will focus on managing your post-op pain. Once the doctor gives the green light, you will transition to inpatient rehabilitation.
Depending on when you arrive at inpatient rehab, you may be able to start rehabilitation that same day. “The sooner you get moving, the better,” explains Physical Therapist Jeri Floyd, who specializes in post-surgery rehab at Sarasota Memorial Hospital. “We will get you up. We will do the exercises.”
Surgery-day goals — regardless of whether you begin rehab exercises that day — will include: managing post-surgery nausea; eating a little, starting with ice chips, then clear liquids and then light fare; urinating (hopefully within five to six hours post-op); controlling pain with ice and medication; and with assistance, transferring to the bedside commode.
That night, you may be given IV antibiotics, and your blood pressure, temperature and oxygen levels will be monitored.
Day 1 Post-op
If you began rehab exercises the day prior, you may experience greater pain and discomfort today. This is normal, and likely due to residual soreness from the exercises and/or the lack of anesthetic lingering in your system.
On this day, rehab for your new knee begins in earnest. Your physical therapist will visit at least twice for 20 to 30 minutes of exercise.
Simple movements and exercises will help familiarize you with your new knee and facilitate proper scar formation to promote mobility. The physical therapist will lead you through four key exercises that you will use throughout your rehabilitation journey; these focus on the ankles, to prevent blood clots; the thighs, to strengthen the muscles around the new knee implant; the heels, to improve joint mobility and range of motion; and the legs, to boost leg strength.
You also will practice bending and straightening your knee as much as possible; by the time you leave the hospital, you’ll be able to bend your knee to about a 90-degree angle, but for now, you and your therapist will simply establish a baseline to work from.
Assisted by the physical therapist and a walker, you also will go for a short stroll (up to 50 feet), focusing on balance and maintaining proper form, before returning to the bed. If you have stairs or steps in your house, your rehab may begin to incorporate those as well.
NOTE: If you experience dizziness, nausea or unmanageable pain throughout the process, alert a care team member. While some pain is to be expected, it should not interfere with rehab exercises.
TKA Rehab & Recovery
There are four key exercises the physical therapist will lead you through at this time, and you will continue with these throughout your rehabilitation journey.
- Ankle Pumps – Flex your ankles by first pointing down with your toes and then pointing them back up at you. These improve circulation in your legs and help prevent any blood clots.
- Quadriceps Sets, or Thigh Tighteners – Lie in bed with both legs straight, and tighten the thigh muscles directly above your knees, further straightening your legs and gently pressing the backs of your knees into the bed. These help strengthen the muscles cradling your new knee.
- Heel Slides – Wrapping a towel or cloth around one foot like a stirrup, keep the other leg straight while maintaining your heel against the bed and sliding that foot towards you, bending at the knee, and then straightening it back out, sliding your heel away from you.
- Leg Raises – Keeping your leg straight, gently raise it only a few inches and hold for a moment before gently lowering it back to the bed.
Afterward, the therapist will help you practice bending and straightening as much as possible.
Days 2 – 5
Some patients will be ready to go home and transition to outpatient rehab after Day 1, but most will stay in the hospital through Day 2 or Day 3, and some until Day 5. Barring any issues, such as blood pressure or pain management concerns, most patients progress to outpatient rehab by Day 5.
In these intervening days in the hospital, your physical therapist will continue to visit twice a day to lead you through your exercises and to gauge the range of motion of your new knee. You will walk a little farther each day.
Nursing staff also monitor your health closely, but be sure to let them know if you experience increased or unexplained swelling that’s “angry red,” possibly indicating infection, or unexplained, severe pain, which should be controlled by medication at this point. Also keep an eye out for increased drainage from the incision.
You will be discharged once you can:
• walk with good balance.
• use a walker or cane, without assistance.
• get in and out of the bed with minimal assistance.
• bend your knee to a 90-degree angle and extend it to around a 10-degree angle.
Though your in-hospital rehabilitation has come to an end and the worst of the pain is behind you, full recovery and rehabilitation from your Total Knee Arthroplasty will be the result of months of diligent outpatient work, both with a therapist and on your own.
Connect with SMH’s Ortho Experts
Have a question about orthopedic surgery? Wonder whether joint replacement is right for you? Ask our Ortho nurse navigator at 941-917-7963 or visit our webpage.
As a Sarasota Memorial copywriter, local journalist and in-house wordsmith Philip Lederer, MA, crafts a variety of external communications for the healthcare system. He earned his Master’s degree in Public Administration and Political Philosophy from Morehead State University, Ky.