Thorough Preparation Is Key for Knee Replacement

If you have a total knee replacement (TKR) this year, you’ll have plenty of company: Nearly 800,000 TKRs are performed annually in the United States, and this number will continue to grow as the population ages.

Pain and limited mobility caused by osteoarthritis (OA) are the most common reasons for having a TKR. If you have knee OA, the cartilage in your knee joint gradually wears away. Eventually, your bones will rub directly against each other, which damages the bones and sometimes causes bone spurs to form.

In the earlier stages of OA, treatment options, such as medications, joint injections, and physical therapy, can help ease pain and improve mobility, but once the OA has reached an advanced stage, these treatments become ineffective. Of course, most people want to avoid surgery whenever possible, but if you are in constant pain and/or your mobility is significantly restricted, surgery may be your best option.

“If your knee OA is causing disabling pain, limiting your ability to do physical activities, and affecting your quality of life, it’s time to consider TKR,” says Linda Russell, MD, a rheumatologist at Weill Cornell Medicine.

Gather Information

Once you decide to have a TKR, get as much information as you can from your doctor and/or his or her staff about the entire process, including what you need to do before and after surgery, and an explanation of what will occur during the surgery. After you’ve met with your surgeon, if you get home and have more questions, or you’ve forgotten something that was said, call your doctor’s office: It’s important that you feel fully informed and confident that you understand every step of the process before undergoing surgery.

Prep Work

What you do before the surgery can have a major influence on how well you recuperate. Research has shown that doing exercises prior to surgery can shorten recovery time and reduce the need for postoperative medical care.

“People 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 prior to the surgery, the easier time you’ll have during postsurgery rehab,” she says.

If you are overweight or obese, reducing your weight will lower your risk of complications, such as infection, and reduce the odds that you will need a second TKR in future years. Ask your doctor for a referral to a health-care professional who specializes in weight loss.

“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.

You’ll also need to make preparations so you’ll have everything you need when you leave the hospital. Find out what equipment you will need, such as a walker or crutches, and whether you will need transportation to follow-up appointments, the pharmacy, or the grocery store.

During and After Surgery

TKR surgery usually lasts one to two hours, depending on the amount of damage that needs to be repaired. The remaining cartilage and bone are removed and replaced with a metal and plastic implant that are positioned between the femur (thigh bone) and the tibia (shin bone). You’ll probably be up and walking the same day as surgery; the sooner you can move, the better. Movement also helps reduce the risk of developing blood clots after surgery.

Following TKR, the hospital stay is typically just a few days; you may even be able to go home the same day if your overall health is good and you have someone at home to care for you. Usually, a nurse and physical therapist will visit you at home within a few days of your release. You’ll see a PT several times, so they can teach you exercises and monitor your progress. “If you’re committing to a TKR, be prepared to participate actively in a postoperative program,” advises Dr. Russell.

The best way to achieve maximum mobility and function in your knee is to follow your doctor’s and physical therapist’s instructions.

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