Hey all — a friend is getting a new knee and is understandably anxious. She’s got a great physio so that part is covered. I’m wondering if any of you have not-so-obvious ideas on what made you or your loved one comfortable and helped with healing.
i’m grateful for any input large or small
Most painful surgery I’ve ever had. You wake up feeling fantastic, and then the nerve block wears off.
Don’t skimp on the physical therapy. Walking every day is good, even if it’s just around the house. Take every bit of time available off work.
The weirdest thing was a good stretch of time post surgery, even up to almost a year, where I would wake up at 2 AM wide awake and have trouble going back to sleep. That made the following day not very fun. I hear that’s fairly common for some reason.
Cathy has a pretty accurate take.
I have to agree that a total knee replacement/TKA is probably one of the more difficult orthopedic procedures for most people.
It’s a delicate dance to keep it moving so it doesn’t stiffen up but also not so much that it’s overkill. Weightbearing leg strengthening is compressive for the joint so don’t discredit non-weight bearing movement and strength.
The only two things that matter are getting that sucked bending early and often and also quads quads quads quads and more fucking quads.
Moving: Flexion (bending) and extension (straightening) are both crucial but neither should be painful to the point where your friend is groaning and tensing up/swuirming. Also it’s a good idea to work on one at a time each session. We never try to improve both notions on the same day (nervous system).
Quads: after surgery your friend should be aiming for 500 quad sets a day. No that’s not a typo. I repeat, quads are the main focus early and often.
Don’t let them discharge her assistive device (can, crutches, walker) until she has no limp. That is crucial. Most people let the embarrassment or inconvenience of the assistance device take priority over their physical health.
Best to your friend!
I was hoping you would chime in.
The other thing is that I had planned to read all these books because I had six weeks off and didn’t have to work. I read none of them. My brain was so scattered, especially the first few weeks that the most taxing thing I could do was watch Reality TV and maybe read a magazine or two. I remember the first few days I was home from the hospital, I got a letter from work in the mail about disability payments, and I tried to read it and it made no sense. I handed it to my dad and asked him what it said.
i’d like to clone Yeeper and have him here when it all goes to hell
500 quad sets a day! I think i’m in love
What can I say, I have such sweet pillow talk.
I’m here to help if I can offer and any suggestions. Also, sleep. Tell your friend to get as much sleep and good calories in as possible.
Moonrocket asked a question in a different forum about TENS units and i offered my .02 there which wouldn’t be bad to read.
I’ll add, build as much strength as you safely can pre-op, to mitigate some of the atrophy that will happen. If you have several months before the surgery this can make a difference in recovery.
Exact same experience post shoulder surgery. The pain, the drugs, the trauma did a number on my brain and I couldn’t follow anything remotely complex.
My take on knee replacements and echo some of the things @Yeeper mentioned.
In order of importance.
Resting/doing nothing - You can’t make it heal.
Not being afraid of it.
It is very very difficult to do any damage to a total knee replacement so standing on it, lifting it, straightening, bending, lying in bed whatever way you like may hurt but is unlikely to harm it.
Pain control - You can most definitely make it more painful than it needs to be.
Note that when I say pain control, doing nothing with it elevated comfortably on a pillow, helping manage where swelling sits is a large part of pain control.
Not staying still for too long. Not moving too much in one go. Using cooling to soothe the pain and cool the knee. Oh and medications. These all encompass pain control
There is also a huge mental aspect to pain control. Understand that it is no longer the old bone pain, it is the flesh around the knee that’s sore, swollen, bruised and raw in the beginning but not the knee itself.
Moving - Little and often. You can’t move much if in pain so see steps 1 and 3
5-7 minutes of every waking hour do something.
As @Yeeper said about doing 500 quads sets. Those should become as easy as breathing and done frequently. Doing 30 isometric quads contractions for every hour awake (16-17Hrs) would still only take 3 minutes an hour and add up to around 500.
1-2 minutes of foot/ankle pumps to supplement the lack of walking for circulation. That’s the equivalent of 1-2000 steps a day.
1-2 minutes of teasing the bend without forcing it
Walking is also just moving, beneficial if walking properly, while having little benefit if walking with a limp. Being on your feet 10-12 times a day for 5-7mins happens almost automatically with getting in/out of bed, bathroom, kitchen, answering the door, with minimal mental effort but be purposeful of walking properly when up.
Extra things to not worry about
Hope your friend gets on well with the surgery and recovery.
It’s been nearly 10 years and mine is still noticeably thicker than the other leg.
And I still have the random clicking or clunking. Freaked me out at first until the surgeon explained that it will just continue to happen probably forever.
Yes, a few patches of numbness 10 years later. It makes shaving your leg interesting.
I tell my patients to bend the knee and when you feeling like cursing my name bend it a bit more. Its not gonna fall apart neither will the incision burst open. Don’t baby it too much, it is meant to be used. Weight bearing stimulates the bone growth so it will grip the new implant sooner and also will desensitize the area.
Don’t let family and friends cater to her too much, or at all. She is not disabled so walk as much as she can tolerate, use ice after physio and exercises at home. Bed is for sleeping only so get out of it once at home, even in a hospital try to have meals in a chair.
She may feel constipated, walking helps.
Get a raised toilet seat so it is easier to stand up, sitting on a 4" thick cuisine is also useful.
If she feels she needs to go to the toilet, get going, don’t wait until she has to rush and risk falling. She can go on Amazon and buy a device called leg lifter, about $15. Patients tell me it is worth its weight in gold for the first few days as it helps move the leg. But she should wean herself off it soon and use her own muscles.
Walk as much as she can tolerate and have chairs strategically placed around the house, depending on how she feels.
She will most likely start walking with 2 wheel walker, don’t use a 4 wheel walker as it is too mobile and her reflexes will be a bit off for few days. Then progress to crutches and then a cane under physio supervision.
Driving wise, she should ideally have no pain at all and be off narcotics for pain.
Does she have stairs in her house? Here is a little tip for climbing: ABC up, CBA down.
A able leg
B bad leg
C crutch
She should use railing on one side, doesn’t matter which on and a crutch on the other.
Knee replacement has been studied and researched a lot, it is a fairly routine surgery but still a serious surgery. She may feel like her leg is full of rocks, nausea, lightheartedness, dizziness, vomiting is not a surprise. Typically, in our hospital knee patients go home after 2 days on average, surgery day is day 0.
thanks to all for this detailed advice, it’s so helpful. my friend will benefit for sure!
My mother had hers done at 70
Changed her life
She was relentless on the physio though, to the point where her surgeon told her to ease up
In less than 6 months she was back to her usual long walks (>5 miles) three times a week
She used one of those desk cycles on the sofa to regain movement as well as all her PT
Interesting. My Surgeon is of the thought of no crutches at all.
The leg lifter was very helpful for the first week. Though yes you can get too reliant upon it.
Crutches are a must. The risk of compensatory movements is not worth it at all. Especially considering most people at the age of TKA will be at risk of pissing off their other leg or back. Or cause calf issues because they’re not fully relying on the involved knee.
I actually inquired about bringing them to the hospital, but I was told not to.
For lots of patients walking with crutches in a hospital is too early. She vwill start with 2 wheeled walker, crutches are a progression. They may try her on crutches, just to see how she does. But they are less stabile. Cane is the least stable. Some patients cling to the walker for a while, others progress to cruthes sooner.
Interesting. I had nothing from day one. I do remember taking my crutches somewhere where there was going to be a lot of people, but that was only if I needed to whack somebody with one if they got too close.
Question @Mart.S @softrun @Yeeper
What are your opinions on someone returning to jogging? My surgeon is very against it. But I have other friends whose surgeons say go for it, for shorter runs.
I just saw my surgeon last week for an almost 10 year follow up. X-rays are perfect. Everything is solid. He still says no running, but says I can do everything else.
Hah, funny enough I’m talking with my orthopedic friend and coworker about this very thing. We’re planning a blog series on return to participation for ortho procedures like total joints (hip/knee/ankle) specifically running (endurance and shorter distance), crossfit/HIIT, squatting, rock climbing, cycling, hiking, etc, essentially we’re trying to cover the majority of popular recreational activities especially as the gen pop is more active than ever before and into later decades of life.
The unfortunate reality is that much of the answer lies in the adult diaper response…it depends.
Depends on the rest of your body, depends on your experience with said activity prior to the procedure, depends on your fitness age, bone density, training volume approach, etc,
I think a common theme will be that higher intensity exercise/plyometrics will be limited more so than before. But truthfully, running is a low impact activity. While it is technically a plyometric activity (hopping from one leg to the next), it is lower impact and the forces can be mitigated even more with things like cadence manipulation, walk/jog alternating (think Galloway method), shoe/stride choice, treadmill vs overground, etc.
It’s a great question and much will depend on the person and also coaching/oversight.
As much as I respect surgeons and MDs, the rehab literature is equally as evolved and we stay on top of advancements like the medical professionals need to stay on top of advancements in medicine and non-conservative treatments. My father was an orthopedic surgeon sports med specialist and we talk about this constantly.