Knee Replacement Recovery

Having realistic pain management expectations is a critical aspect to the preparation phase prior to surgery. Knee replacement is a large surgery which involves manipulation of soft tissue, bleeding, and resection of worn arthritic bone. While each of these issues can contribute to pain following the procedure, there are a few things that can limit and reduce your pain to ease the recovery.

When thinking about expectations for pain, it helps to first have a mindset that pain proceeds through phases, early middle, and late, and that each stage is somewhat predictable in severity and duration. The early stage is often the most feared and will be focused on here. Most patients benefit from as-needed access to opioid pills such as Norco for a couple weeks, with very few needing these pills after four weeks and almost rarely at three months(3). An early “multi-modal” pain regimen helps to use anti-inflammatories and possibly other types of medications can help you to eliminate the requirement for more toxic opioid pills within days following surgery(4). Most patients are completely off prescription medications by 6 weeks after surgery.

Anesthetic technique has substantially improved patient satisfaction and significantly reduced the requirement for opioid medication in the days following the surgery. Spinal anesthesia involves an injection of a medication around the spinal cord, and the nerves around the knee are numbed. In fact, spinal anesthesia alone has very substantially become a game changing intervention that has allowed a substantial fraction of patients to discharge from the facility the same day with little need for opioid medications such as Norco(2). And local nerve blocks targeted to the area of the knee can reduce systemic side effects of interventions such as pills or general anesthesia which can in some individuals create setbacks worse than the surgery itself. Lastly, an injection during surgery into the tissues surrounding the prepared bone surfaces by knee replacement and robotic surgery specialist Dr. Thomas Obermeyer can also substantially ease your pain and facilitate an early discharge.

A big part of the recovery from knee replacement is early activity and walking which helps you recover faster, limit the risk of blood clots, and improve your long-term functional results of the surgery. You will rise to walk on the day of surgery with assistance including a walker, and many patients will be able to do stairs within a week or so, by holding onto a rail and leading with the nonsurgical leg at first. By 3-4 weeks, the assistive device (typically a walker or sometimes a cane) is discontinued and almost all daily activities are resumed. By 4 weeks you are driving again and can start doing stairs reciprocally (leading with the surgical leg). By 6-8 weeks the quad muscle is strengthened back to normal, swelling is mostly resolved, and your knee motion continues to normalize so that your movements are more fluid and balance is easier.

Return to work is individualized and discussed prior to surgery with expert knee and robotic joint surgeon Dr. Thomas Obermeyer and his team. In general, sedentary desk work is resumed at 4 (or at most) 6 weeks and more demanding physical labor occupations are resumed by 3 months. By 3 months, you can resume a full round of golf; chipping and putting are performed closer to 6-8 weeks pending your progress. Pickleball can be resumed commonly prior to or at 3 months when you have nearly full motion and strength. Improvements in strength and function will continue for 6 to 9 months or longer for select highly ambitious activities.

The intensity and duration of rehab following knee replacement is very dependent on patient-specific factors including functional demands and adherence to exercise recommendations. Generally speaking, patients more motivated to rehab their replaced knee experience the benefits of a faster recovery with a better functioning knee(5). If discomfort is reasonably managed, you cannot “over-do” the rehab on your knee. Rehab sessions are usually scheduled once or twice a day, in periods of an hour or so. However, motivated patients can exceed these guidelines and exercise more frequently.

Many patients will discharge home shortly following the procedure with a home health aide that assists with mobility including walking, stairs, and using the bathroom. The home aide will facilitate the use of assistive devices, check your incision, and make sure pain is controlled. At approximately two weeks, you will start outpatient physical therapy which will continue with strengthening, swelling control, walking, and balance. Outpatient therapy is typically for approximately 6 weeks, once you have recovered most of your function, and motion and balance have normalized. Some patients will benefit from longer stints of therapy pending progress, milestones achieved, and functional goals.

Infections are very uncommon following robotic knee replacement by top knee surgeon Dr. Thomas Obermeyer. Dr. Obermeyer informs patients these infections are rare in his practice and large databases suggest they occur at a rate of less than one percent(6). More common than a true “deep” infection would be some mild pin site or incision drainage that could in some cases require an oral antibiotic. However, these issues are infrequent and in large databases(6) occur in about a third of a percentage point (about 3 patients in 1000).

Blood clots are largely preventable by several measures including taking medication as recommended (most commonly aspirin) and walking frequently which encourages blood flow. Large databases in low- and high- risk patients suggest the rate of blood clots is around 1%(7). You will review any specific risk factors with knee surgeon Dr. Thomas Obermeyer and his team to determine individualized methods to decrease your risk (such as changing your blood clot prevention medication).

Robotic surgery can limit scarring because the technology allows knee and sports medicine surgeon Dr. Obermeyer to understand anatomic landmarks around your knee without full exposing them surgically and therefore most incisions are around 5-6 inches long. This limits scarring, limits more substantial soft tissue releases used in traditional open surgery and can ease the recovery. The surgical incision is closed in layers to ensure the kneecap functions normally and staples are removed at two weeks postoperatively.

Due to the improved engineering and sterility methods used by device manufacturers, modern knee implants effectively do not “wear out” like they used to. In fact, if you achieve a favorable early result after surgery there is an overwhelmingly good chance you will never require revision surgery (even after 25 or 30 years). Additionally, the use of robotics to balance the ligaments and ensure stability and motion minimizes the need for revision surgery from surgical factors such as looseness (instability) or stiffness.