Optimize the Results of Your Knee Replacement
As the U.S. population ages, the need for total knee replacements (TKR) will rise. Currently, more than 600,000 TKRs are performed annually, and projections estimate that, by the year 2030, the number of TKRs will increase by almost 700 percent.
Pain and stiffness resulting from osteoarthritis (OA) is the most common reason for having a TKR. With OA, the cartilage in your knee joint gradually wears away. With less cartilage in the knee joint, your bones rub against each other, damaging the bones and sometimes producing bone spurs. Non-surgical treatment options, which include medications and physical therapy, can help ease pain, but once the OA has reached the moderate or severe stage, treatments may no longer be effective. Many patients prefer to avoid surgery as long as possible, but if you are in constant pain and suffering from impaired mobility, surgery may be your best option.
“If your pain is limiting your physical activity to the point that you are gaining weight, or it is preventing you from participating in social activities, it is time to consider TKR,” says Linda Russell, MD, the director of perioperative medicine at Weill Cornell.
WHAT YOU CAN DO
When planning for your return home, consider what type of assistance you may need.
- If you will be unable to drive to follow-up appointments, make arrangements for transportation.
- Assess your living environment and get any adaptive devices that you need to improve your safety, such as a grab bar in your shower or tub or an elevated toilet seat.
- Contact your insurance company to find out what equipment is covered and where you should get it; pick up the equipment (crutches, a walker, a shower chair) or have it delivered to your home before you go to the hospital for your surgery.
Plan Ahead
If you’re having a TKR, what you do before the surgery can have a significant impact on how you fare after the surgery. Research has shown that performing physical therapy exercises prior to surgery can speed your recovery and reduce your need for postoperative medical care. And, you can cut your out-of-pocket costs: A study found that having physical therapy before joint replacement surgery saved patients an average of more than $1,000.
“Patients who have stronger muscles and greater range of motion recover much more quickly following surgery,” says Dr. Russell. “This is especially true for women, who have less muscle mass than men.”
Dr. Russell suggests having your doctor refer you to a physical therapist six to 12 weeks before surgery. “The more effort you put in on the front end, the easier time you’ll have during rehab following the surgery,” she says.
If you are overweight or obese, reducing your weight will lower your risk of complications, such as infection, and reduce the likelihood that you will need a second TKR in future years. Ask your doctor for a referral to a registered dietitian, who can design a safe, effective weight-loss plan for you.
“Weight-loss efforts need to begin several months before surgery; you can’t wait until a month before surgery to lose excess weight,” says Dr. Russell.
Also, meet with your discharge caseworker before surgery to review your rehab plan, so you will be prepared for what will happen once you leave the hospital. Find out what equipment you will need, such as a walker, crutches, or a cane.
What to Expect
TKR surgery lasts one to two hours. The damaged cartilage and bone are removed and replaced with metal and plastic surfaces that are positioned between the femur (thigh bone) and the tibia (shin bone).
Following TKR, the hospital stay is typically just two to three days, according to Dr. Russell. Patients are strongly encouraged to go home rather than to a rehab facility following surgery; this decreases the risk of infection, as well as the cost. Patients then have physical therapy at home, and they are taught exercises to do on their own; the best way to achieve maximum mobility and function in your knee is to follow your physical therapist’s instructions.
“If you’re committing to a TKR, be prepared to participate actively in a post-operative program,” advises Dr. Russell.
“Patients are now being advised to expect some pain following a TKR; we are now using multi-modal pain control, rather than just opioid medications, to reduce the risk of opioid addiction or overdose. Other medications that may be used include gabapentin (Neurontin), acetaminophen (Tylenol), and anti-inflammatory drugs, depending on other medications, such as blood thinners, that the patient is taking,” explains Dr. Russell.
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