5 Things You May Experience Following Knee Replacement Surgery
While some issues are common to knee replacement recovery, others are lesser known
At my pre-surgery appointment for a partial knee replacement, the physician's assistant held up a color-coded calendar of medicine I'd need to take after the surgery. She talked about which nerve blockers, blood thinners and painkillers I could ingest at what times.
I felt woozy just thinking about it all. They'd be watching for infection, and she told me about blood clots, injuries from falling and other nasty symptoms. I left with a hefty folder and a lump in my stomach.
Post-surgery, you'll often be advised to walk a little, ice a lot, and bend and straighten your knee.
A few weeks later, the surgery went well. I left the hospital with a long list of instructions and a wish of good luck. As the days of recovery passed, I worked with my doctor to avoid blood clots, infections and falls. Meanwhile, a different set of issues arose. Issues I hadn't realized were so integral to a healthy post-surgery recovery. Here are five essential things to know.
1. Bending Your Knee Is Key
Post-surgery, you'll often be advised to walk a little, ice a lot, and bend and straighten your knee. While my doctor rightfully encouraged me to bend as much as possible to reduce pain and avoid scar tissue, I didn't realize how serious the consequences were if I didn't.
If you don't work on fully bending and straightening your leg, you develop arthrofibrosis, or stiff knee syndrome, which can permanently alter how you walk. Arthrofibrosis occurs when the knee joint heals but creates extra tissue that pulls on your ligaments and tendons. You, in turn, feel pain when walking and hence, limp.
"The best way to avoid stiff knee syndrome is to start your mobility and physical therapy right away," says Kirstin Fosberg, a therapist at Seattle Physical Therapy. "Don't baby the knee, even if physical therapy feels uncomfortable."
2. Be Active, But Not Too Much
A week after my surgery, my recovery felt quick. I could walk with a cane, drive a car and hobble up our hallway stairs. Life felt somewhat normal. When I was on ibuprofen, it felt great! So, I resumed most of my pre-surgery activities: riding a stationary bike, grocery shopping, cleaning and even walking through big box stores.
If you don't work on fully bending and straightening your leg, you develop arthrofibrosis, or stiff knee syndrome, which can permanently alter how you walk.
Then one night, while emptying the dishwasher, my knee started throbbing. The pain forced me to sit down. I saw a yellow and purple bruising mass when I lifted my pant leg. I'd done too much too soon.
As I lay on the couch with a bag of ice on my knee, I thought about my doctor's words: "Don't overdo it." But where is the sweet spot between being lightly active and too sedentary?
"The ideal amount of activity is the prescribed amount of physical therapy from one to three times a day," Fosberg says. "Light activity like walking around the house, getting up and moving several times a day in the first couple weeks is best. Then be cautious and gradual with increasing the amount."
3. Stay Hydrated Every Day
A few weeks after surgery, my husband and I shared a delicious dinner with wine on the patio. At the meal's end, a muscle spasm shot through my calf. When I shifted my position, the pain erupted again. My husband helped me to the couch, where I rested in utter stillness. If I moved an inch, the pain would strike like lightning.
My muscles only finally relaxed after a dose of oxycodone. Later, I learned from my physician's assistant that while overuse, weakness, or stress can trigger muscle spasms, the most common source is dehydration. Spasms can also come from a lack of potassium or too much sitting.
It was no coincidence that I had sat for a long time eating a saltier-than-usual meal and drinking alcohol before the spasms occurred. However, Dr. Tamara Huff, an orthopedic surgeon with Vigeo Orthopedics in Georgia, warns if calf pain and swelling persist, call your surgeon immediately.
"Especially with a personal or family history of blood clots," she says. "This may represent a serious condition called venous thromboembolism (blood clot)." So, monitor any spasms you experience.
4. Physical Therapy May Feel Draining
Because I wanted my previously arthritic knee to finally work well, I went diligently to physical therapy. After my usual set of exercises every session, my therapist would help me bend my knee as far as possible.
If I bent my knee to 90 degrees, she would gently move my ankle to reach 95. But pain surged. My heart raced. I braced myself. During one session, I cried out. Afterward, I felt exhausted and emotionally drained. More than once, I went home, rolled up in a blanket, and shut out the world.
"You won't only get back to the point where you were before surgery, you'll likely feel much better than you did before."
This is not uncommon. You may feel stressed by your therapy session. Your impulse is to protect the healing knee, so when that's challenged, your body tenses. You resist the pain. But Fosberg says breathing and relaxation can help.
"Remember, the pain is temporary and necessary for making things functional," she says. "Icing afterward goes a long way in reducing pain."
5. Depression Is a Risk
About a month after surgery, I was eager to explore my favorite hobbies. I tried getting on my road bike, but the pain prevented peddling. I tried weeding my garden, but I couldn't kneel. I even tried doing laundry, but carrying a heavy basket was unsafe. I felt disappointed at being unable to do these leisurely activities.
Those small experiences of defeat, with recurring pain and a lack of uninterrupted sleep, chipped away at my psychological well-being. I became more reluctant to exercise and walk. That, in turn, made me feel like I couldn't participate in the regular world. Discouragement increased until I felt truly hopeless. At times, I quietly shed tears.
Later, I learned I wasn't alone. Some hip and knee replacement patients experience new-onset depression after surgery. "Any time your normal routine (especially your independence) is disrupted," Huff says, "feelings of anxiety and depression can arise. If you have a personal history of anxiety or depression, it is a good idea to have an appointment with your mental health professional prior to your joint replacement to discuss coping strategies."
Luckily after about two months, I felt a considerable decrease in pain, which helped me resume my usual activities and bounce back psychologically.
The Bottom Line
No two knee surgeries are alike. One person's recovery might be long and painful; another's quicker and easier. Fosberg says she often sees an overall pattern, though. "Usually the first three weeks are the hardest, then you turn a better corner at about seven weeks."
Now that I'm four months past my surgery, my body feels relatively healthy, and my mind is hopeful. Standing is no longer a painful chore, and walking feels comfortable! The best feeling was removing that medicine calendar from the fridge.
"I always encourage people to keep their eyes on the prize," Fosberg says. "Remember, you won't only get back to the point where you were before surgery, you'll most likely feel much better than you did before."
