Knee Replacement Surgery: Long-Term Care

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Knee replacement surgery involves removing damaged portions of the joint and replacing them with prosthetic components. Depending on your case, it can take three to six weeks before you’re clear to return to normal, day to day activities.

However, complete rehabilitation can take anywhere from three months to a year. This is a critical period, and successful outcomes depend a great deal on a clear understanding of how to care for the post-surgical knee over the long term.

Doctor showing result of radiography to patient - stock photo
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Benefits of Surgery

The conditions treated with knee replacement surgery (including osteoarthritis, rheumatoid arthritis, and post-traumatic osteoarthritis) are characterized by inflammation, leading to pain and loss of mobility. Knee replacement surgery can reduce or eliminate the pain and restore mobility of the knee, though a complete return to pre-arthritic levels of motion isn’t expected.

In this procedure, a thin layer of bone is removed from the femur (thigh bone) and from the patella (knee cap), and an implant made of stainless steel, titanium, chrome, cobalt, or polyethylene. With proper care, knee implants are durable; in fact, over 90% of contemporary implants are still functioning well after 15 years.

Maintaining these benefits as well as the integrity of the artificial knee is a priority in the recovery period following surgery and beyond. What can you do to preserve the positive outcomes of knee replacement surgery over the long-term? Here are some quick tips:

Keep Follow-Up Appointments

Typically, following surgery, you’ll require several follow-up appointments to ensure the implant is working well and there are no other issues. These occur around six weeks following surgery (when initial recovery is expected), and then at three months and six months, with annual check-ups after that.

In addition, you’ll participate in regular physical therapy sessions. These are all crucial to recovery.

Set up Your Home

Accidents in the home can cause problems during recovery. As you look towards your recovery period, set up your home such that there are no trip hazards, important items are within reach, and furniture is arranged such that you can navigate around with crutches, a walker, or other assistive devices.

It’s also a good idea to install a chair, grab bar, and raised toilet seat in the bathroom. Since you’ll want to avoid deep bending or straining, consider acquiring grabbing tools, long shoe-horns, or long-handled sponges.

Balance Fitness and Safety

At discharge and subsequent appointments, you’ll be given specific instructions about activities you can and can’t do (see below). Ensuring that you’re still getting some exercise while recovering, while also making sure not to hurt yourself is key.

Listen carefully to your surgeon and physical therapist and keep up with any exercises they recommend. That said, if anything feels off or becomes painful, let your doctor know as soon as possible.

Medications and Supplements

Following surgery, you may be prescribed a number of medications to help manage pain, swelling, and potential infection. Some of these may be necessary over the longer-term, so make sure you have a complete understanding of prescribing information.

Unless directed otherwise, take the full course of any pills, and safely dispose of any leftovers by bringing them back to the pharmacy. In addition, your doctor and/or physical therapist may recommend you take other supplements to boost your bone and joint strength.

Communicate and Get Clearance

As tough and durable as artificial knee joints are, they have limitations. In general, you may want to avoid activities that would put the knee in danger, such as more high contact sports.

On the road of rehabilitation, make sure to get medical clearance before starting up new physical activities, or re-starting things you’d done in the past.

Possible Future Surgeries

While knee replacement surgeries are highly successful, additional treatment, called revision knee replacement may sometimes be required. In this procedure, all or part of your knee implant is replaced, a procedure that can be more complex than the original surgery.

What circumstances prompt consideration for this surgery? Here’s a breakdown.

Worn or Loosened Implant

For a variety of reasons, knee implants may come loose or become worn out over time. This is especially the case if you engage in high impact activities, are overweight, or if you’ve had for a longer period of time.

Not only does this lead to pain and discomfort, but it can lead to an immune response that attacks the supporting thigh or knee bone.

Infection

While the risk for infection is greatest when the incision is healing, this can also occur during recovery, even years after the operation. Infection here leads to pain, swelling and drainage from the knee, while also loosening the implant. This can be treated by debridement, in which the components are left in place, but are disinfected.

Or, it can be treated with staged surgery, which is a two-part procedure. In the first part, the implant is taken out and replaced with a cement spacer that has been treated with antibiotics. In the second, this spacer is removed and the prosthetic knee joint is replaced.

Instability

This condition occurs when ligaments and tendons around the prosthetic knee are damaged or imbalanced, leading to swelling and weakness in the knee. Physical therapy and bracing the knee are the first line of treatment, but if these don’t yield results, revision surgery may be the best option.

Stiffness

Often a result of scar tissue build-up around the knee, poor mobility can persist despite knee replacement surgery. If the initial treatment—“manipulation under anesthesia,” in which the doctor aggressively bends your knee to breakdown the scar tissue—doesn’t work, then the implant may need to be partially or totally replaced.

Fracture

Breaking the bone around a knee implant due to an accident or fall will also call for revision surgery. In doing so, the doctor will need to assess the health and stability of the bone structures and may need to widen the scope of the implant. In some cases, parts of the broken bone may also need to be replaced with a prosthetic.

Lifestyle Adjustments

You’ll need to make some changes and adjustments as you navigate life after knee replacement surgery. The key is ensuring that you’re remaining healthy and active without excessively straining the area and causing injury. In addition, other changes to your habits may be necessary, such as:

  • Eating healthy: Alongside the usual benefits, ensuring a healthy diet rich in proteins, vitamins and minerals can aid in knee replacement because it promotes weight loss. Excessive weight can put undue stress on your implant, so talk to your doctor about what you can do to manage it.
  • Avoid vitamin K: If you’ve been prescribed a blood-thinning medication like warfarin following your surgery, you’ll be advised against eating foods rich in this vitamin. These include broccoli, cauliflower, Brussels sprouts, onions, as well as many greens, such as kale, spinach, and turnip greens.
  • Driving: Typically, total knee replacement patients are able to drive once they’re off pain managing medications and have restored strength and mobility in the knee. Don’t start driving until after you get your doctor’s OK; in most cases, you’ll be able to get back behind the wheel at about three to four weeks.
  • Physical therapy: Following total knee replacement, you’ll undergo physical therapy sessions, in which you’ll be educated on exercises you can do to promote positive results. For instance, riding a stationary bike can be a good way to help build muscle without stressing the knee.
  • Lower-impact exercise: Once you’re cleared for physical activities, keep in mind that some sports or exercises are safer than others. Swimming, walking, golfing, and light tennis are all considered relatively safe, while, more intense sports, such as racquetball, jogging, or skiing, might need to be skipped.
  • Air travel: When going through security at an airport, be sure to let the security staff know that you have a knee implant as it may set off their sensors. In addition, some knee replacement patients experience swelling or pain in the knee while flying. As such, be sure to get your doctor’s OK before making plans.

The rule of thumb here is to make sure you completely understand your doctor and physical therapist’s orders. Never hesitate to ask questions you have or to contact these professionals if anything seems off.

A Word From Verywell

While having a knee replacement surgery is far from a walk in the park, it’s important to remember that this treatment is well-tolerated and highly successful. It’s helped countless people get back on their feet, letting them enjoy life free of pain, swelling, and discomfort.

Today’s techniques and technologies have made this procedure even more successful, with reduced chances of complications. Successful outcomes, however, require more than doctors, physical therapists, support staff, and top-of-the-line equipment. They require you, the patient, to be proactive, engaged, and committed to doing what it takes to get better.

With the help of your medical care staff, as well as the support of your loved ones, you can pave the way towards better days ahead.

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Article Sources
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  1. Foran J. Total knee replacement. American Academy of Orthopaedic Surgeons. Updated June, 2020.

  2. Cleveland Clinic. A patient's guide to total joint replacement and complete care. 2016. 

  3. Foran J. Activities after knee replacement. American Academy of Orthopaedic Surgeons. Updated December, 2018. 

  4. Cross M. Revision total knee replacement. American Academy of Orthopaedic Surgeons. Updated 2015.