Sports Medicine

Tips For Successful Total Knee Replacement

When it comes to successful total knee replacement (TKA) surgery, the procedure itself while obviously very important, is just one step of the process. There are several variables that outcomes. We have assembled a team that will set you up for success. What happens after the surgery - the recovery in the hospital and the rehabilitation with physical therapy - is just as essential to the overall success of the procedure. Here are some tips and strategies to help guide you through the process from deciding to get your knee replaced to finishing rehab.

  1. The goal of knee replacement surgery is to allow the patient to return to full function 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 operative team including the physician. Make certain that your goals are compatible with Dr. Branam's goal prior to surgery. If there is something specific that you are hoping to do postoperatively, make certain that you discuss this preoperatively.
  2. Pick a time to have surgery when the first month after surgery will be the least inconvenient. There is no optimal time to have surgery but sometimes are better than others. The more you can plan for your surgery, the more smoothly your recovery will be. There is a "total joint class" that you might elect to attend prior to surgery at the West Chester Hospital that will guide you through the inpatient process. You do not have to attend this class but you might elect to participate. We are happy to give you the information regarding this class if you would like to attend.
  3. Knee replacement surgery is one of the best surgeries we have in Orthopedics, allowing patients to return to an active lifestyle. However, complications do happen and we need to do our best to avoid them. Infrequent complications 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 a medical complication (example: heart attack). The complication rate is low, however, every patient needs to go to their primary care physician to make certain they are healthy enough for surgery and they are medically optimized. This may include going to a dentist to make sure dental hygiene is optimized prior to surgery. Dr. Branam may ask you to lose weight prior to surgery to make you a better surgical candidate.
  4. The goal of surgery is for patients to obtain full range of motion and function. The biggest predictor of postoperative motion is preoperative motion. Occasionally we may send you to preoperative physical therapy for range of motion and strengthening exercises, although most of the therapy will be postoperatively. The specific activities that patients are allowed to do are variable from patient to patient. Please discuss your specific goals regarding postoperative activities and desires with Dr. Branam before surgery.
  5. This is an inpatient procedure. You will stay in the hospital approximately 48 hours after surgery. Upon discharge you will go home with home health or some patients may go to a rehabilitation facility for a short time. This is largely determined by how mobile you are postoperatively and how much help you have at home. If you think there is a reasonable chance or any chance that you will go to a rehabilitation facility upon discharge after your knee replacement, we ask you to have several facilities in mind where you might to go postoperatively prior to having your knee replaced. The postoperative period in the hospital is busy with rehabilitation and this is a difficult time to be choosing a rehab facility.  Whereas we have resources set in place to help you, we like for you to go visit the potential rehab facility prior to surgery and confirm that the facility takes your health insurance. This is very important in making sure the process goes smoothly after surgery. Again, we like you to focus your inpatient attention on your rehabilitation and not on focusing where you might go. We do have contact information for the social worker on the 4th floor of the West Chester Hospital where most of our total joints are admitted postoperatively. She can certainly help you with recommendations in terms of where you might like to go based on where you live the type of insurance that you have.
  6. On the morning of surgery please show up on time. You will meet with lots of different people who will ask you lots of different questions including the Anesthesiologist. Please ask your questions specifically that you have for Dr. Branam prior to the date of surgery. As much as possible we try to avoid last minute questions on the morning of the operation.
  7. Postoperatively you will begin physical therapy on the afternoon of surgery. The therapist will teach you strategies to improve your range of motion. It is very important to work on your range of motion right away to avoid postoperative stiffness. There are several techniques that we have to help you straighten and bend your knee. 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 allows your knee to go straight. Gravity will take your knee straight over time. When you are sitting up in a chair we encourage you to bend your knee.  Sit towards the front of the chair and allow your knee to hang over the edge of the chair. You could even use your non-operative leg to gently pull back on the ankle of your operative leg.  This encourages your knee to bend. These 2 techniques will allow you to get your knee to the range of motion 0-90 degrees prior to leaving the hospital. It is very important to actively participate in physical therapy postoperatively in order to restore your range of motion and strength.
  8. Pain control is very important. We will give you abundant pain medicines after surgery. However, it is also important to note that while we will give you pain medicines, we will not be able to completely eradicate your pain. You may be uncomfortable, especially early on, but we will do our very best to keep this at a reasonable level.
  9. Every patient after surgery will go on some sort of DVT prophylaxis. This will depend on your risk profile in terms of bleeding and clotting and often times simply involves taking a regular strength aspirin twice a day; however, sometimes the medical therapy may include injections.
  10. On the afternoon of surgery, the social work team will begin planning on your discharge. Again, it is much easier for the social worker to get you to a facility that you desire to go to if you have already determined which facilities might work best for you. This is variable and very patient- and insurance-driven. Your physical therapist will also make recommendations upon what will be the best fit for you. If you are mobile and have help at home, you are probably going to do better at home. If you do not have significant help at home or are not quite as mobile, you will probably be better off going to a rehabilitation facility. The determinant of whether you go home with home health or to rehab will be largely determined by your physical therapist based on your progress in the hospital.
    If you go to a rehab facility you will have therapy at the rehab facility upon discharge. If you go home, you will have a physical therapist that will come to your house to help you work on your range of motion for the first 2 weeks postoperatively. It is very important that you use the strategies and tactics that you learn in the hospital to help you regain your motion. It is also important that you do your exercises several times per day, especially on days when you do not have therapy.
  11. Two weeks postoperatively you will return back to the office for an office visit with Dr. Branam's physician assistant, Nick Reist. At this point we will check your wound and remove your staples. We will also get you into outpatient physical therapy. IF YOU ARE UNWILLING OR UNABLE TO PARTICIPATE IN POSTOPERATIVE PHYSICAL THERAPY, YOU SHOULD NOT HAVE YOUR KNEE REPLACED AS YOU WILL LIKELY BE WORSE THAN YOU WERE PREOPERATIVELY.  It is really important to work on obtaining full extension and to prove to yourself every day that you can get your knee fully straight.  The faster you regain your motion the less likely you are to have postoperative stiffness which is time dependent.  This means that early aggressive range of motion is imperative.
  12. The outpatient physical therapy that you will have beginning at 2 weeks postoperatively is absolutely critical. We have a list of therapists that we know and trust and we think that they can get you a more optimal outcome. You certainly may choose your therapist if you have a therapist that you know. Given that this is a very important 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, this may result in significant postoperative stiffness or a suboptimal outcome. Please discuss this with your surgeon in detail if you elect to choose your own therapist.At 6 weeks postoperatively you will return to the office. We would expect you to have 90% of your range of motion back and to be progressing nicely.  A good goal would be a range of motion 0-120 degrees.  At this point if you are doing really well, we might elect to transition you to a home exercise program and to stop doing formal physical therapy. Please discuss this with your therapist and Dr. Branam before you elect to do this.
  13. At 3 months postoperatively we expect that you would have 90% of the outcome that you will get. The 10% improvement in your function from the end of month 3 to the 1-year postoperative mark is not insignificant. Please be patient during this time. We think you will continue to get better up to 1 year postoperatively.

As you can see, there are multiple variables that affect the outcome of a total knee replacement. We feel that we have assembled a team that will help you succeed. It is very important that you know that active participation is required on your part. If you are unable or unwilling to do therapy postoperatively, then you should not have your knee replaced. If there are concerns you have with the ability to participate in your own care postoperatively, please discuss this with us preoperatively. While certainly we cannot guarantee you any kind of an outcome, we believe that if you are diligent in your exercises, most patients are exceedingly happy with their knee replacements. Please contact us with questions or problems prior to surgery or at any point postoperatively. We are here to help you and again we have assembled a team that we think is outstanding. Please visit our website for further patient education or to read the many testimonials that we have from really happy patients!!!

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