Perhaps you are the individual who seeks out a physical therapist because they have a great deal of trepidation and the strong desire to avoid surgery after receiving a diagnosis of knee osteoarthritis or “degeneration” from your physician. Or maybe you’re attending physical therapy pre or post-operatively empowered to regain pain-free living and full function. Whichever profile you identify with, this blog will provide you the knowledge to consider before a total knee replacement.
According to the Agency for Healthcare Research and Quality on average, more than 790,000 knee replacements are performed annually in the United States.1 Furthermore, knee replacements are the most common joint replacement, and, as reported by the American Academy of Orthopedic Physicians, they are one of the most successful procedures in all of medicine.2 Additionally, since the advent of the procedure, replacement components, technique, and ability to mimic normal joint motion have improved, the length of surgery, hospital stay, and time to regain function have also decreased. Rates of same day surgery, which meet all of the above criteria, are also becoming more common. However, despite the commonality of the procedure, it is imperative to find a reputable surgeon who specializes in knee or joint replacement. It is also helpful to recognize the experiences related by friends or family after surgery may not be the same for you.
While the vast majority of patients achieve full pain-free functional recovery, the process can take longer than expected. This is easier to understand when you recognize both the length of time in which you may have been losing strength and mobility and the length of time required to regain these. From my observations, on average, most patients are able to walk shorter distances independently after 1-4 weeks, have few complaints or limitations after 3-4 months, and report the replacement is closer to “their knee” after 9 months to one year.
While it may be intimidating to learn that a knee replacement can, at least initially, be a painful
process, patients report the pain is different. This means the pain from cartilage wearing and degenerating is eliminated and the pain is the result from the surgical procedure. However, surgeons work closely with patients to develop a pain management routine consisting of ice, medication, mobility, and reduction of swelling and joint loading to help minimize pain.
Be aware of returning too quickly or at a high level. Most surgeons discourage
high impact activities such as running and downhill skiing due to the accelerated wearing of the
prosthetic components. Returning too rapidly can lengthen recovery and result in a regression
in rehabilitation. Even walking longer at a store, prolonged standing, or limping can increase the load on your knee and result in increased pain, swelling, or limited function.
The two primary reasons to avoid limping are to prevent increased loading on the recovering knee and to avoid development of an abnormal gait pattern. This may mean you will need to use a cane or walker for longer, however, adhering to this advice will ultimately improve your chance for a faster recovery by minimizing loading on the healing joint and subsequent swelling, pain, and delay in strength gains. Avoid your believed stigma of assistive devices (they are actually quite common today). Others may actually be more concerned if they see you limping. And yes, this includes grabbing onto counters and walls for stability which is unsafe and
It is rarely a requirement to have knee replacement surgery, and in fact, is also rarely
recommended when radiographs reveal degeneration, yet an individual has only minor or no
symptoms. Yet, waiting until you are no longer able to walk effectively, have significantly lost
mobility or strength, or secondary to fear, is not worthwhile as the rate of recovery and potential
for return to full function can be detrimentally reduced. And, according to post-operative
patients, it is not worthwhile to continue functioning at a lower than desired level or with
significant pain for the traded ability to regain a greater independence and, resulting return to
pain-free enjoyment of activities.
The list below, from the American Academy of Orthopedic Surgeons website is a helpful reference for when to have surgery for individuals pondering knee replacement.2 Surgery may be advisable when you have one or more of the following criteria:
Severe knee pain or stiffness that limits everyday activities, including walking, climbing
stairs, and getting in and out of chairs. It may be hard to walk more than a few blocks
without significant pain and it may be necessary to use a cane or walker
If you would like more information about rehabilitation of knee including how physical therapy can help you before and after surgery, request a Free Assessment at an Athletico Physical Therapy clinic near you. Free assessments are available in-clinic and virtually through our telehealth platform.
Physical therapy is usually the thing you are told to do after medication, x-rays or surgery. The best way to fix your pain is to start where you normally finish – with physical therapy at Athletico.
The Athletico blog is an educational resource written by Athletico employees. Athletico bloggers are licensed professionals who abide by the code of ethics outlined by their respective professional associations. The content published in blog posts represents the opinion of the individual author based on their expertise and experience. The content provided in this blog is for informational purposes only, does not constitute medical advice and should not be relied on for making personal health decisions.
1. “Exhibit 19. HCUP Estimates of the Total Number of Target Procedures.” AHRQ, www.ahrq.gov/research/findings/final-reports/ssi/ssiexh19.html.
2. “Total Knee Replacement – OrthoInfo – AAOS.” OrthoInfo, orthoinfo.aaos.org/en/treatment/total-knee-replacement/.