DEAR DOCTOR K:
I’m having knee replacement surgery next month. What can I do to speed my recovery and get back on my feet as quickly as possible?
I’m glad you asked, because you are very important in making the outcome of your surgery completely successful.
A knee replacement is major surgery. During the procedure, the surgeon removes damaged sections of your shin bone and thigh bone. He or she cuts the bone to precisely fit the shape of the replacement implant, then attaches the artificial joint at the knee. (I’ve put an illustration of a total knee replacement, below.)
Joint replacement surgery is usually scheduled weeks or months in advance. That’s important, because one of the best things you can do for a successful joint replacement is to make your joint as strong and healthy as possible before your surgery. Studies have found that “prehabilitation” — exercise and strength training performed before joint replacement — can help prevent pain and speed up recovery after the fact.
Exercises that strengthen the muscles of your legs obviously are important. But so are exercises to strengthen your arms: You’ll be depending on them to move you around on crutches or walkers after the surgery. And if you’re overweight, do what you can to lose weight: The heavier you are, the more pressure you will be placing on your new knee. Ask your doctor about “prehab” programs in your area.
In the hospital, shortly after the surgery is complete, you will be asked to start moving your feet and ankles. Your leg may be placed in a continuous passive motion (CPM) machine that bends and straightens your leg.
The hospital staff will help you get out of bed and move around. Before you go home, you’ll be asked to show that you can get in and out of bed without help. You’ll also have to show that you can walk with a walker, cane or crutches, and manage stairs or other obstacles you may face at home.
Once home, you should regularly see a physical therapist, who can design an exercise program tailored to your individual needs and goals.
Over the next weeks and months, the more you exercise and participate in physical therapy, the more successful your recovery will be. Be diligent about performing the targeted exercises prescribed by your physical therapist. You should also gradually increase the distance you walk or the duration you are active.
By the first week or two after surgery, you should be walking with a cane. After a few weeks, you should no longer need the cane. By three to six months, you should be back to normal.
About three to six weeks after surgery, people usually can resume their normal activities. That includes low-impact activities such as walking, swimming and riding a bicycle. However, it may be several months before your doctor says it’s OK to resume high-impact sports.
Total knee replacement
The surgeon first cuts away thin slices of bone with damaged cartilage from the end of the femur and the top of the tibia, making sure that the bones are cut to precisely fit the shape of the replacement pieces. The artificial joint is attached to the bones with cement or screws. A small plastic piece goes on the back of the kneecap (patella) to ride smoothly over the other parts of the artificial joint when you bend your knee.