Total Knee Replacement 2023. Your Journey Begins With The Right Start.
The first 2 weeks are key!
As in any journey, the road to recovery following knee replacement is simple if you have a map and a good plan. Keep in mind, the first two weeks after surgery may be the most important period as you launch your recovery. Your physical therapist will be your coach and your tour guide rolled into one. Their primary role is to guide you to perform the right activities, and to coach you when you may need to slow it down. Use this guide to help you get started in the right direction.
Stay ahead of the pain
So, how do you get to where you want to go with all this pain? The effects of the nerve block usually wear off between 24 to 36 hours after surgery. During this time, don’t be fooled that you’re unique or have a really high pain tolerance. Staying ahead of the pain simply means this: begin taking your oral pain medicines prior to the onset of the nerve block wearing off. Plan to have taken at least two cycles of your pain medicine plan completed as the waning-off time approaches. If the nerve block wears off and you do not have any pain medicine in your system, you can be caught off-guard with more pain than you bargained for. Early on, you will have to be regular with your pain medicine, taking it as prescribed on the label. When your pain level is consistently low, you can begin to extend the times between doses to start your weaning process. Most patients are off major pain medicine between two to four weeks after surgery.
A quick note about your pain medicine. Many medical professionals including doctors, nurses, and therapists have instructed patients to take their pain medicine one hour prior to physical therapy. I do not endorse that suggestion. Instead, pain medicine should be taken to maintain a level of comfort / tolerance regardless of the therapeutic exercises being performed with the therapist or by the patient alone. Exercises should be performed gently with or without the therapist present. Therefore, if pain medicine is taken regularly and appropriately, there is no need to take timely pain medicine prior to the physical therapist’s session.
Physical therapy exercises
The primary objective for physical therapy within the first two weeks after total knee replacement should be guided by your physical therapist. It is this: to attain straight knee extension (known as zero degrees), and 90 degrees of knee flexion (a right angle between your lower leg and thigh) while simultaneously protecting the joint from excessive forces and decreasing the swelling inside and around the joint. This is a critically important time requiring good communication and coaching with your therapist. There are different exercises and activities which my be substituted based on your needs.
Below, please find a common effective home exercise routine to help you reach your goals.
Perform this exercise routine three times per day.
Warm-up: Begin with a four to five minute walk around your home. Make sure your knee is fully straight in the standing position before beginning the walk. A rolling walker or crutches are highly recommended. Walk softly. Try to normalize your gait as your pain decreases.
Simple exercise routine: Perform each of these exercises 10 times each: Sitting knee flexion, Sitting knee extensio, Ankle pumps, Ankle circles, Quadriceps sets, Gluteal sets.
Cool down: With a towel rolled under your ankle, apply a cold pack or cryotherapy unit for 15 minutes.
This routine is designed to be simple and gentle. It should only take about 25 minutes in total. To ensure best results, initial performance should be under the guidance of your home physical therapist. Initially, the sitting knee flexion and extension exercise will be difficult. If swelling and pain are properly managed, it is highly likely that 0 to 90 degrees of knee flexion and extension will be obtained within the first two weeks following surgery. This routine may be adjusted by the therapist to help you reach your milestones.
In addition, to prevent blood clots forming in your lower legs, you are also required to walk around your home frequently, usually every hour or so during the day.
Diet, hydration and nutrition
The healthy diet that you started prior to surgery should continue following surgery. If you have not done this or have questions about your diet, seek the counsel of a registered dietitian or nutritionist. A healthy diet will strengthen your immune system and help you heal. Your diet should include green leafy vegetables, bright-colored fruits and berries, and easily digested protein from fish and eggs, and plenty of water.
Whether or not you are a diabetic, it is important to maintain proper blood glucose levels. Diabetic patients will have the assistance of their glucose monitors. Non-diabetic patients should continue their normal healthy diet while avoiding foods with a high glycemic effect. Simply stated, avoid anything with excessive sugar. It is very common for patients to look for satisfaction through eating their favorite comfort foods. Don’t do it. Avoid the temptation to binge on the bad! Both your immune system and your healing process/system will perform optimally when you maintain a healthy diet without excessive sugar.
Stay properly hydrated to prevent constipation and help improve the effectiveness of your pain medicine. Keep a bottle of water next to you and continue to hydrate throughout the day. Hydrating frequently will make you urinate frequently. This is good. It will help flush your system of the anesthesia, and also help maintain proper blood pressure. With your doctor’s permission, resume any vitamins and supplements you were taking prior to surgery. These were likely stopped approximately two weeks before your surgery but can now be resumed.
Positioning and Swelling
Throughout the day you will be challenged on what position to keep your knee in to be both comfortable and therapeutic. “Should I keep it up straight or keep it flexed on the floor”. Most patients express that this is a challenge they did not expect. The answer is: you will need to alternate these two therapeutic positions: the knee extended straight and the knee flexed comfortably. It is likely that you will develop swelling in your lower leg and foot, so it’s not wise to sit with your knee flexed continuously. After 30 minutes, put you foot up on an ottoman switching to the extended position. Swelling, known as edema, will develop in your lower leg and foot within a few days after surgery. To address this normal response, you will need to elevate your lower extremity. The sitting position with your foot on the ottoman does not count. It should be elevated in bed so the foot and lower leg is positioned above the level of the heart. This is recommended twice per day for the first two weeks.
Getting good sleep
Proper sleep after surgery is critically important. Many patients are challenged with both their sleep duration and frequency. You are allowed to sleep in any position of comfort that does not put pressure on the incision. These positions tend to be variations of side-sleeping. Best tolerated is sleeping on the opposite side of the surgery with pillows between your thighs and lower legs. You are allowed to sleep on the operated side as well with a similar setup.
Generally, it is not advised to sleep on your back with a pillow under your ankle as this position is usually poorly tolerated and does not foster good sleep. Confusion over this position is common because it is a recommended position during the day when you are not sleeping. Additionally, avoid sleeping on you stomach as this position may put pressure on the incision.
Finally, avoid long and frequent naps during the day as these will play a role in sleep disturbance at night.
Final Thoughts
As you journey through the first two weeks following your knee replacement, you may feel that your progress is slow. It is important to “stay on track” by meeting your recovery milestones.
Here is a summary of what is happening during this time:
You are hitting your range of motion milestones (full knee extension and 90 degrees flexion)
Your pain and swelling are decreasing.
You are transitioning from using a walker/crutches to using a straight cane.
You have begun to wean off the stronger pain meds (opiate/narcotic meds).
If you have staples or sutures, those will be removed approximately 2 weeks after surgery. Your physician / surgeon will recommend outpatient physical therapy to help guide you toward success. This usually begins between two to four weeks after surgery. Start slow with your outpatient physical therapy being cautious not to overdo it. The healing process and the elimination of joint swelling will continue for 6 to 12 months after surgery.
Enjoy the rest of the journey!
