5 Things I Wish I Knew Before Total Knee Replacement Surgery
Knee replacement surgery is a big undertaking. It's one of the most effective treatments for severe knee osteoarthritis pain, but it will undoubtedly have a major impact on your life, even with the best outcomes. Here are 5 insights and truths you need to hear before you have TKR surgery.
The Importance of a Prehab Program
What you do before surgery can be just as important as what you do afterwards. The muscles and soft tissues surrounding your knee have likely been limited in their use, simply because of your body’s natural tendency to protect anything that hurts. However, if you can get these muscles and soft tissues to start moving prior to surgery, the recovery afterwards will be faster and more effective.
I know what you’re thinking: How am I supposed to exercise when “my knee pain is so bad,” “my knee is bone on bone,” “I can barely walk without severe pain,” etc.? Unfortunately, surgery is not a miracle cure, and in order to have the best chance at the best outcomes, you need to get that knee moving. You can check out programs like GoKnee, where the exercises are all done in a sitting position with very little actual knee movement required.
Many insurance plans will cover prehab before knee replacement surgery. Talk to your surgeon and PT about a prehab program well before your surgery date. If your insurance or surgeon do not provide a prehab program for you, then try and find one for yourself.
A good prehab program will also make exercises post-surgery easier because your knee will be ready and awake, all of which will help with your recovery.
Recovery Takes Longer Than You Think
Regardless of whether you are going to have a total knee replacement, partial knee replacement, revision surgery, or any other surgical procedure, people are always surprised at how long recovery takes. You hear people talk about getting up out of bed and walking on the day of surgery. What you won’t hear is that it required the help of 1-2 people as well as the use of a walker, not to mention the fact that walking was slow, painful, and uncoordinated. They also won’t mention how long it took to be able to bend their knee.
I am always amazed when I sit down with a patient after TKR surgery and they tell me that they are expecting to walk their daughter down the aisle in a few weeks, on a beach, and they don’t want to use a walker or a cane! It is very important to have an honest and open conversation with your surgeon/physical therapist to set realistic expectations and goals for post-surgery recovery in order to avoid future disappointment and frustration.
Your recovery speed depends on a lot of factors including your age, overall health, fitness level, weight, pre-surgical knee ROM and strength, and more. Some individuals regain their mobility quickly and some take longer. Either way, you need to make a firm commitment to do your daily exercises for at least 2 months, and maybe longer. Don’t freak out—in the grand scheme of things, 2 months is nothing compared to the pain you have been enduring for years.
I find that patients who have realistic expectations about the recovery process tend to have a better outlook, which then results in a better recovery journey.
The Pain Is Real
I have been treating individuals for 25+ years and I know the sacrifices and frustrations associated with chronic knee pain. I also know that life will be better, less painful, and more joyful after TKR surgery.
The commercials tell you that you will be riding your bike and walking your dog pain-free after surgery. The problem is, for some it can take close to a year or longer to achieve those milestones.
The reality is that TKR surgery is a major trauma to the knee region and recovery will be painful. It is not the same as a hip replacement surgery. I repeat, it is not the same. Please do not compare yourself to your friends who have had hip replacement surgery and tell you how great they are doing. Knee replacement surgery is a completely different ball game!
There have been many advances in anesthesia and pain management protocols that make the first few days much more manageable than what it was in the past. The issue is that many people overdo it during this time, stop taking their pain medications too soon, or do not effectively use ice and elevation. The good news is, if you follow the advice of your healthcare team (surgeon, physical therapist, family doctor), you’re likely to have much less pain in your knees after surgery than if you didn’t have it at all. Refer to your doctor for valuable advice on how to best manage pain after the operation.
The Mental Impact Is Real
Many individuals underestimate the mental and psychological impact of chronic knee pain. Chronic pain changes everything about our daily lives. For instance, you may have changed your walking pattern or how you put your socks on because of your knee pain. Over time, these changes in routine alter your brain chemistry. People regularly go into TKR surgery thinking that it will be a miracle cure and that they will quickly regain the quality of life that they have been dreaming about. But the reality is that your brain will not trust your brand new knee. You’ve been subconsciously protecting your hurt knee for months or years, and getting used to your new knee—let alone getting it to function as best as it can—will take a while.
It is not uncommon to feel isolated, lonely, frustrated, depressed, angry, and/or disappointed after the surgery, especially if your expectations are unrealistic and the recovery does not go as smoothly or as quickly as you planned. It’s important to remember that this won’t last forever. It just takes time for your brain to accept and embrace this new knee. Your physical therapy sessions and exercises will help create a long-lasting, loving relationship between your brain and knee.
However, if your feelings of depression or hopelessness are overwhelming, please speak to your family doctor.
Exhaust All Other Options First
Knee replacement surgery is a big deal and should only be recommended if all other options have been exhausted. For example, have any of your health professionals (primary care doctor, physical therapist, surgeon) educated you on the benefits of weight loss and how it can significantly improve your knee pain? A key study published in Arthritis & Rheumatism found that of weight loss resulted in four pounds of pressure alleviated from the knees. If losing weight is an option for you, it may be a much better method of dealing with your knee pain than an invasive procedure like a total knee replacement.
Effective strengthening exercises can also help take the strain off the knee, reducing pain. There are various physical therapy techniques and modalities that can help with pain management of your knee. For instance, joint mobilizations can help loosen up your joint, which increases lubrication and provides pain relief as well as improves joint ROM.
If doing strengthening exercises hurts too much, you could consider temporarily using a cane. While it sounds inconvenient, using a cane for a few weeks takes pressure off of your knee, and it may help alleviate your pain enough so that you can begin participating in an effective exercise program. The point is there is a lot that your PT can help with before you consider surgery.
Physical therapists do physical therapy. Surgeons do surgery. So just know when you make the decision to meet with a surgeon, it is in their best interest to tell you that you will need surgery in the near future. However, there are many non-surgical treatments that surgeons can provide, and they should explain them to you and tell you if you would benefit from them. For example, cortisone, hyaluronic acid, platelet-rich plasma, and Synvisc injections have all been very successful in managing knee osteoarthritis pain.
Humans tend to look for the easy way out. Some think that TKR surgery is the easiest way, because losing weight means exercising and being compliant while risking increased pain and recovery time, if it even works. It all seems exhausting, long and hard. Unfortunately, if you just have surgery, the pain will not quickly disappear, and it will still be a long time before you can get back to doing all of the things you enjoy.
TKR surgery can be a great option but it should not be the only option and definitely should not be the first option, because you will be profoundly disappointed.
Start the work months before you ever have surgery.
Surgery is not a quick fix. Be prepared to work hard on recovery for months after your surgery.
Pain is an obvious byproduct of surgery. You will eventually have less pain than before, but that journey is not easy.
These feelings of fear, anxiousness, and worry are real and ok. They will get better.
Surgery should not be your first choice. Exhaust all other options first.
NEVER watch the surgery online. It will not help you in any way. Watching the video will only add to your anxiety, fear and nervousness and might make you question the procedure altogether.
GoKnee is clinically proven to cut recovery time in half after a knee replacement. Learn More >