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.
