What to Do Before and After a Knee Replacement

Life on the other side of knee replacement surgery can be full of better mobility, less pain, and the ability to get back to doing the things that make your life full of joy and energy.

While the process to get there takes time and effort, the vast majority of patients agree that it is worth it – and many regret not doing it sooner.

Sean Childs, MD, is the Medical Director of Orthopedics for Rochester Regional Health’s Eastern Region and has performed knee replacements on thousands of patients. He explains the process leading up to the surgery itself, how the recovery process unfolds, and how a team of supportive providers help every step of the way.

What happens before knee replacement surgery

Meeting with an orthopedic surgeon does not always mean you must have surgery. Orthopedic surgeons treat the full spectrum of osteoarthritis and often start with non-operative treatments and therapies.

Once these treatments have reached their limits and the surgeon deems you to be an appropriate surgical candidate, the surgery is outlined in detail to ensure it is the right decision for you.

After agreeing upon the surgery, you will work with a scheduling assistant to set a date for a pre-admission & testing appointment, as well as a date for surgery.

At the pre-admission appointment, patients will undergo:

• a physical exam
• full medical history
• bloodwork
• EKG (as indicated)

Orthopedic scheduling assistants also coordinate with any specialty providers in regards to management chronic medical conditions.

“If a patient sees a cardiologist, for example, we require clearance from that cardiologist prior to undergoing the surgery,” Dr. Childs said. “Our offices reach out to the cardiology office to ask for relevant information such as any applicable blood thinners and how long we can hold them for perioperatively. We also talk with the cardiologist to ensure that it's safe to proceed with surgery.”

You are also encouraged to meet with an outpatient physical therapist 1-2 times ahead of the surgery. Doing exercises ahead of the procedure has been shown to lead to better post-procedure outcomes. It also helps to establish that patient-physical therapist relationship that will continue during post-surgical recovery.

“Establishing that relationship early on creates a lot of logistical improvements so it doesn’t become another thing the patient has to figure out after they are operated on,” Dr. Childs said.

What happens after knee replacement surgery

Once the day of the knee replacement arrives, you will arrive at the hospital to be prepped for surgery. Arrival and surgery times are typically set the day before surgery and coordinated by the hospital or surgical center. Joint replacement surgery teams often use spinal anesthesia for knee replacements, which helps to minimize post-operative nausea and drowsiness, decreases pain, and often helps earlier mobility in the hospital.

With the surgery and anesthesia combined, a total knee replacement typically takes 2-3 hours. Orthopedic providers with Rochester Regional Health use innovative technologies to ensure appropriate positioning of the implant, which also improves patient outcomes and satisfaction.

Most people are able to go home on the same day as long as their medical team signs off on their discharge and there is a plan in place. This is carefully coordinated by our in-house physical therapists and social workers. Before leaving the hospital, you will work with physical therapists who will need to clear physical therapy prior to discharge, demonstrating that you are safe and can mobilize appropriately. Physical therapy often begins 2-3 days after surgery, and may involve visits at home for some patients, if appropriate or necessary. In-home physical therapy, if utilized, is often limited to 2 weeks. After that time, patients are encouraged to go to outpatient physical therapy.

Physical therapy is vital in both strengthening the surrounding musculature and improving knee range of motion after surgery.

“The more motion we see from the start, the better the patient’s outcome in the end,” Dr. Childs said.

Other important tips to keep in mind for knee replacement patients as they recover:

• If you are sitting or lying down, you should be icing and elevating your knee and leg.
• Too much activity early on can negatively affect your outcome. Allow the body to heal and rest after surgery, just like any other injury.
• Avoid forceful or vigorous leg movements.
• Avoid submerging the incision in a bathtub or pool until after the incision is fully healed. Talk with your surgical team about this.
• Do your best to avoid falling in any way. Falls lead to skin incisions reopening and risk of fractures.

Driving restrictions are in place for those who are using prescribed narcotics after surgery. Otherwise, driving can resume as long as you are able to safely operate both the accelerator and brake. If you have a total knee replacement on your right knee, it will typically take 4-6 weeks to resume driving.

“Modern knee replacement recovery strategies focus on reducing use of post-operative narcotics, using various techniques to reduce patient pain and optimize compression and elevation,” Dr. Childs said. “The sooner we can get their swelling and symptoms controlled, the sooner they can return to normal activities.”