Nobody wants to have surgery unless it’s absolutely necessary. But how do you know if it’s necessary to have a total knee replacement? No two patients are alike, but I typically ask my patients two questions before we decide that it’s time to visit the orthopedic surgeon:
Are you having high levels of knee pain on a consistent basis? This is subjective, but it matters to you (so it matters to me). If somebody is having unbearable knee pain and finds that they are living on anti-inflammatories, then it may be time to visit the orthopedist.
Is the knee arthritis limiting you from your activities of daily living? For example, are you no longer leaving your house as often because the steps are too much of a burden? If you find yourself unable to walk, negotiate stairs, stand stationary, or participate in your regular events due to the limited strength or range of motion, then it’s likely time to get an orthopedic surgeon involved on your case.
As a physical therapist, I like to see patients with knee arthritis for at least 2-3 months before deciding if a total knee replacement is necessary. Often times, we are able to avoid surgery if we work on your strength, endurance and flexibility.
An orthopedist may recommend a corticosteroid injection or a series of three hyaluronic acid (HA) injections. The corticosteroid injection is used for inflammatory purposes, whereas the HA injections are used to help lubricate the knee joint and provide additional cushioning between the bones. The HA injections are most commonly found in gel form.
If you have attempted these treatments without success and continue to have difficulty, you should consider the knee replacement route. Total knee replacement cases have great outcomes. They last about 20 years and the patient feels good as new if it was truly the arthritis causing the limitations.
The recovery is very long and strenuous, though. I find that most of my patients really underestimate the road ahead. You will have a lot of knee swelling and a lot of knee pain. But the swelling and pain will fade with time, ice packs, exercises, and increased activity levels/tolerance.
So, what should you expect when going for a total knee replacement?
Prior to Surgery: your orthopedic surgeon may want you to perform some prehab prior to surgery to make sure you are strong going into it. You will also need to go to the hospital beforehand to be cleared for surgery (x-rays, blood work, etc.)
Day of Surgery: a team comprised of the orthopedic surgeon, residents, and a nurse will be in operating room. You will most likely be under general anesthesia throughout the surgery. If not, you will receive an epidural injection to make sure you don’t feel any pain during the procedure. It should take about 3-4 hours to complete.
After Surgery: on post-op day 0 or 1, you will see a physical therapist who will evaluate your movement, strength and ability to walk. If it is appropriate, they will attempt the stairs with you. They (along with the case manager/social worker) will help you to decided where you should go next. I always advise patients who can go home to go home! This will decrease you risk of infection and allow you to start moving immediately. The earlier you start moving, the better. You must also make sure that the physical therapist working with you is stretching your knee to help you regain your range of motion. Be sure to ice your knee often (every 4 hours, for about 20-30 minutes). Going home is not an option for everybody, especially if you live on your own and don’t have help at home. Therefore, some of my patients will go to rehab (inpatient or short-term skilled nursing).
Once Home: when you return home, you will either receive homecare physical therapy, or you will be advised to seek an outpatient physical therapy provider. If receiving homecare, be sure the provider is stretching your knee (bending it, straightening it) and performing exercises with you. Walk as much as possible, but with good technique.
Where Do We Come In? – At Sarrica Physical Therapy & Wellness, we see patients 10-14 days post-operatively (although this does vary from patient to patient). We will work with you on strengthening your knee(s) and hips We will also use manual techniques (including, but not limited to): scar tissue management, stretching, massage, tape, corrective exercise, and functional retraining to get you back to doing what you love!
If you are considering a total knee replacement, or are having knee pain, feel free to reach out to us at (347) 560-6920. We’re here to help you avoid surgery, if possible. If not, we will be there to rehabilitate you to full strength after surgery.
Paul Nasri, PT, DPT
Doctor of Physical Therapy
Sarrica Physical Therapy & Wellness
Staff Physical Therapist