Published November 26, 2024
Knee replacement surgery can help relieve pain and get people back to the daily activities they love. Yet recovery will be different for every person.
“A lot of patients have a misconception that when they do a knee replacement, everything will be solved and they will go back to how they were functioning 20 or 25 years ago and that is not always true,” said Yale Medicine Orthopedic Surgeon Elie Mansour, MD. “The expectations after knee surgery needs to be reasonable and the treatment depends on these expectations.”
Dr. Mansour says arthritis is the main reason why someone would need knee replacement surgery. Primary arthritis occurs due to time and age, and people with family history are at higher risk. Lifestyle factors and other underlying conditions such as muscle weakness and obesity can also lead to an increased risk.
Secondary arthritis occurs due to a traumatic event or injury to the knee. For example, someone who experienced a meniscus tear in their 20s may develop secondary arthritis years later. Both conditions can lead to pain, instability and limited function. Sometimes these symptoms can be treated non-surgically with therapies that may include steroid or gel injections. In other cases, surgery is the best option.
“Our focus is on the patient and their complaints and symptoms. We can have very bad arthritis on the X-rays but at the same time the patient is functional and has limited pain. So, we don’t treat the patient depending on how severe the arthritis is on the X-rays,” said Dr. Mansour. “It’s more about how much this is affecting the patient’s daily life.”
During surgery, part of the bone is removed and replaced with an implant. Sometimes the implant is attached with cement, which is a glue placed between the bone and implant, or it can be cementless depending on the patient’s needs.
The initial recovery period may be much faster than patients expect. Dr. Mansour said years ago patients needed to stay in the hospital for over a week. Now thanks to better approaches and pain management, patients can start to put weight on their leg on the day of surgery with help of a walker and some candidates can leave the same day.
Once patients return home, they will need someone to stay with them temporarily. Abnormal discharge that is not clear, as well as needing to change dressings more than once a day are red flags that would warrant a call to the care team. Patients are also at a higher risk of blood clots after surgery, so pain in the calf or stiffness in the calf should be reported immediately.
The initial recovery period lasts about two weeks during which time patients use a walker. After that they use a cane for up to six weeks post-op. Patients are 60% improved by three months and 80% improved by six months. It can take a year or more to feel the full effects of surgery.
“The recovery period is very dependent on the patient’s condition,” said Dr. Mansour. “Patients who were active before surgery have a faster recovery. Weak muscles will take a longer time to recover and that’s why physical therapy before the surgery is important.”
Physical therapy helps to build muscle strength and improve mobility, which can impact range of motion after surgery. Riding a stationary bike before and after surgery can also help with range of motion.
In addition, it is recommended patients lose weight if needed, eat a healthy diet with a good intake of protein that is low in excess carbohydrates and sugar. A healthy lifestyle will be critical in ensuring a successful recovery, but even the healthiest patients may have some limitations. Skiing and pivot games like basketball should be limited or off the table completely. That’s why patients should have an honest conversation with their surgeon beforehand. They can discuss what’s important to them and come up with a plan that works for their lifestyle.
