When it comes to successful knee replacement surgery, the surgical procedure is just one step of the process. Recovery and rehabilitation with physical therapy is essential to the overall success of the surgical procedure.
The following are tips and strategies to help guide you through the process:
- The goal of knee replacement surgery is to allow you, the patient, to return to full function—obtaining full range of motion and strength—with little to no pain. A common reason for subjective failure of the operation is the difference in the goals of the patient and the physician. Make certain that your goals are compatible with Dr. Branam's goals prior to surgery; if there is a specific activity that you are hoping to do after surgery, make certain you discuss that prior to surgery.
- While there is no optimal time to have surgery, some times are often better than others. The more you plan for surgery, the more smoothly the recovery process will be.
- West Chester Hospital offers a “Total Joint Replacement” slide presentation. It is very informative and will help guide you through the Same Day Surgery process.
- While knee replacement surgery is one of the best surgeries in Orthopaedics, complications do occur. Infrequent complications, for knee replacement, include, but are not limited to, bleeding, infection, damage to nerves or vessels, blood clots (deep vein thrombosis/pulmonary embolism), worsening condition, need for reoperation or medical complications (ex. heart attack). Even though the complication rate is low, you will need to visit your primary care provider to make certain you are medically optimized, or healthy enough for surgery. This may include visiting your dentist, cardiologist, or other medical professional prior to surgery. Dr. Branam may also ask you to lose weight prior to surgery.
- Preoperative physical therapy is critical to the success of your joint replacement. The majority of joint replacements are performed on an outpatient basis(you will be discharged the same day as surgery). Therefore, you will have 1 or 2 visits of physical therapy(ideally with the same therapist who will be doing your postoperative rehab) preoperatively. This will allow the therapist to work with you in your own environment while you are awake and alert and pain free. That way, immediately after surgery you are not learning new techniques, but rather just implementing those you have already learned. Also, preparation often relieves anxiety. It is imperative that you not skip this step.
- If you do require hospital admission after surgery, you will be discharged after therapy on postoperative day #1.
- Please show up on time the morning of surgery. Many different people will ask you many different questions including the Anesthesiologist. Please ask your questions for Dr. Branam prior to the date of surgery. As much as possible, we try to avoid last minute questions on the morning of surgery. It should be noted your surgery time is an estimate. We try our best to start the surgery at the scheduled time, but your surgery may be slightly earlier or later than the time you were given.
- You will be discharged to your home the day of surgery if deemed appropriate. You may either have home physical therapy or outpatient physical therapy for the first 2 weeks after surgery. If you elect you have home therapy, Dr. Branam prefers Queen City Skilled Care for your home care needs.
- BE CAREFUL AFTER SURGERY!!! Fresh surgical wounds heal in about 10-14 days. Aggressive range of motion, accidents or falls put the wound at risk. Please make certain that you have appropriate assistance in the postoperative period. You will not have the capacity to care for others while you are recovering. Please plan accordingly.
- The Physical Therapist will teach you various exercises to improve your range of motion and strength—these exercises are very important to avoid stiffness. The following are two techniques that will assist you to get your knee range of motion to 0-90 degrees:
- One of the most important things to help you straighten your knee is to never place anything under your knee after surgery. We encourage you to place a rolled up towel or a pillow under your heel while you are in bed. This will allow your knee to straighten.
- When sitting up in a chair we encourage you to bend your knee. Sit toward the front of the chair and allow your knee to hang over the edge of the chair. Use your non operative leg to gently pull back on the ankle of your operative leg. This encourages your knee to bend.
- Pain control is very important. You will be given pain medications after surgery. While we give you pain medications, it is important to note that we will not be able make you pain free in the immediate postoperative period. You may be uncomfortable, but we will do our very best to keep this at a reasonable level.
- You will go home on a blood thinner after surgery—this is referred to as DVT prophylaxis. Often times this involves taking a baby aspirin twice a day. Occasionally we use injections or other more aggressive blood thinners for patients at higher risk of clotting. The more aggressive the blood thinner the higher risk of bleeding.
- Two weeks after surgery, you will return for an office visit with Dr. Branam’s physician assistant, Keith Zurmehly. Your wound will be examined and if you have staples or sutures they will be removed. You will also be given a prescription for outpatient physical therapy. It is very important to work to get your knee fully straight. The faster you regain your motion the less likely you are to have stiffness. Aggressive range of motion exercises are imperative after your wound has healed.
- Outpatient physical therapy is critical. We have a list of therapists that we know, trust and think can obtain an optimal outcome. Given that this is a very important period in time, we strongly encourage you to use a therapist that we recommend. If you chose a therapist we are unfamiliar with or a therapist who does not have experience rehabilitating knee replacements, the end result may could be significant postoperative stiffness or a suboptimal outcome.
- Six weeks after surgery you will return to the office for your second postoperative visit. We expect you to have 90% of your range of motion back and to be progressing nicely. The goal of range of motion is a minimum of 0-140. If you have reached this goal, we might decide to transition you from outpatient physical therapy to a home exercise program.
- Eight to 10 weeks after surgery we expect that you will have 90% of the total function that you will achieve. The 10% improvement in your function from the end of month 3 to 1 year after surgery is not insignificant. Please be patient during this time. We think you will continue to get better up to 1 year after surgery.
- Joint replacements are resurfacing procedures. We replace bone rubbing on bone with new surfaces. These new surfaces may give you a feeling of “clicking.” This is normal and will improve as you strengthen the muscles surrounding the knee.
As you can see, there are multiple variables that affect the outcome of a total joint replacement. We have assembled a team that will help you succeed. It is, however, very important to know that active participation is crucial for a successful joint replacement. If you are unable or unwilling to do physical therapy after surgery, then you should not have your joint replaced. While we cannot guarantee you any kind of an outcome, we believe that if you are diligent in your exercises, you will be happy with your joint replacement.
Please contact us with questions prior to surgery or at any point during this journey. We are here to help you. Please visit our website www.branammd.com for further patient education or to read the many testimonials from happy patients!
Thank you for choosing Dr. Branam with UC Health Orthopaedics and Sports Medicine.