Total knee arthroplasty is the most common joint replacement procedure, occurring for around 750,000 in the year 2017. With the correct education and treatment plan, it is a challenging yet totally seamless recovery process. We recommend getting into PT no more than 3-5 days following your procedure and no longer. The longer you wait, the more difficult it will be. If it is difficult to get into a clinic, you can always begin with home health therapy where the therapist comes to you. We still recommend getting into an outpatient clinic as soon as possible as they will have more equipment readily available.
Total knee replacements will come with plenty of swelling and is completely normal. We ask that you ice and elevate 4-5x/day for 10 minutes. This means full elevation of your leg above you heart so gravity can help push the fluid back upstream. In addition to ice and elevation, you will be asked to perform some edema exercises. These consist of quad sets, ankle pumps, glute sets, and knee bends. This will help improve circulation and reduce the risk of blood clots. We will review these in more depth later in this post and in some videos later on. If you are to ever have any significant calf pain, increased swelling in the calf 3cm larger than the unaffected side, or severe tenderness/redness along the calf, go immediately to the emergency department. This could be a sign of a blood clot and there they can perform an ultrasound to rule out any harm. If it is accompanied by shortness of breath, it may have spread to your lungs and you must drive faster. This is not to scare you as blood clots are rare, only informative.
Something else to pay attention to is skin care. If you have any redness, discoloration, drainage, or fever, this could be a sign of infection and you should contact your physician. Keep the skin around the incision clean and dry. No lotions or jumping in the pool/hot tub until the scar has completely healed; this means no scabbing. Keep sunscreen on the scar to avoid burning. Keeping the scar mobile will be imperative as this can prevent you from regaining full motion. Consult your physical therapist, but they will ask you to perform scar mobilizations at home, gently moving the scar in all directions. This will help loosen the tissue to allow full motion in all planes.
Improving motion is high on list of priorities during your recovery. Due to the swelling and pain, it will be challenging but achievable to gain your motion back. Our goals are to achieve 0 degrees of extension (fully straight), to 90 degrees of bend by the second week post-operative. By week 6, we hope to be at 120 degrees of bend while maintaining that 0 degree extension. The easiest stretch for bending is hooking your unaffected leg over the affected and pulling towards you, like you’re doing a hamstring curl. Do them every hour on the hour. It’s most important you get your full extension back in order to walk without a limp so when you’re not doing your knee bends, sit with your affected leg propped up on a chair without anything under your knee to avoid a slight bend. If you do the stretch on your bed or couch, it’s imperative you prop your ankle up on a towel as the soft cushion under your knee can provide a bend when we don’t want one. Swelling is completely normal and expected for up to a year after surgery, especially after two surgeries. Don’t worry, just ice and elevate 4-5x per day and you’ll be good to go.
Total knees are full time jobs and require full attention. Quad sets are your best friend. That’s the exercise where you tighten your thigh for 5 seconds. Also do these every hour on the hour as you need that quad muscle to begin working normally again soon. I recommend all my patients to also get foot pedals off Amazon to keep your knee moving throughout the day. They can be found online or at most sporting goods stores for around $20. Use the pedals 5 minutes at a time, starting with 1-2x per day. They mimic a bike without the hassle. If you’re comfortable walking, you can walk 5-10 min per day, paying attention to swelling. If you swell up, walk less. It’s important you use a cane or walking stick until you no longer are limping. This could take a week or could take 6, everyone progresses at different speeds. Last thing we want is for you to develop a habit of limping. Don’t be embarrassed to use your cane for as long as it takes to eliminate your limp. I recommend my patients to use their cane outside the house and without inside if they are trying to wean from it.
Expect around 12-16 weeks of formal physical therapy with another 6-8 months on independent rehab following that. Return to activities such as golf, horseback riding, hiking are all generally OK following 12 weeks; however, consult with your physician before returning. During your rehab process, you will work directly with your physical therapist to establish smart, achievable, and specific goals for you. We will cover a typical rehab program progression with videos later on. Most importantly, it is not uncommon to run into some issues along the way and is honestly to be expected. Just remember, everyone progresses at different speeds but the end results are generally the same, good to go.