I’m scheduled for a right knee replacement in November ’23 because of my athletic sports lifestyle so I wanted to do some research and this is what I found.

My surgeon explained to me that I’m a candidate for either a partial knee replacement or a complete knee replacement.   After talking to my doctor and doing the research I decided on the partial knee replacement. 

What to Expect after a Knee Replacement Surgery – my personal experience

1. Make sure all your insurance paperwork is in order! Double check!
2. Make sure all your hospital paperwork is in order! Double check!
3. Understand that most insurance coverage covers a 1-night stay in the hospital or as they call it “outpatient or 23 hours in the hospital”.
4. No one tells you about the pain you are going to experience- it’s going to be substantial. After the nerve block wears off that your anesthesiologist gave you, that’s when you will really know where your real pain level is going to be. The first 2 weeks will be the toughest.
5. Your insurance will more than likely cover 2 weeks of in-home PT and then you’ll be going to do outpatient PT somewhere.
6. I experienced bruising in my toes, calf muscles, quads, and hamstrings. Your knee, calf, and foot will be swollen. Elevate your leg and use ice often.
7. My doctor prescribed Percocet for pain. After 4 days of taking 8 ea a day, I was done with that. I was nauseous all day so I called my doctor and he prescribed oxytocin which worked better for me.; I was always thirsty because of the drugs so I had to drink a lot of water and had to get up often to use the restroom a lot.
8. One of my big issues was getting sleep. The first few days I did not sleep at all. Still having issues sleeping and this is day 15. So you’re going to be tired and not going to feel like not doing much. I ended up binge-watching Bosch on Amason and Yellowstone.
9. Do as much PT at home as possible and get off your ass and walk around the block a few times a day.
10. more coming

 

The knee joint is one of the largest and most complex joints in the body. It is constructed of 4 bones and an extensive network of ligaments and muscles. It is a bi-condylar type of synovial joint, which mainly allows for flexion and extension (and a small degree of medial and lateral rotation). 

https://www.physio-pedia.com/Knee

What is a knee replacement?

One of the most widely performed surgeries nowadays is knee replacement surgery. Knee replacement surgeries are done for more than 700,000 people in the United States every year, and most of them experience a noticeable improvement in the durability of the joint and its capability of flexing and extending. Knee replacement, which is also called arthroplasty, is a well-known surgical procedure and is done all over the world nowadays. Knee replacement results in pain relief and retaining the joint’s ability to smooth movement by replacing the most affected and weight-bearing part of the joint with an inert and safe material.

The first knee endoscopy was done by a physician from Denmark called Dr. Severin Nordentof in 1912, while the first recorded knee arthroscopy was done forty-three years later by a Japanese surgeon called Masaki Watanabe He removed a solitary giant cell tumor from a knee joint during the procedure. Two years later, Dr. Watanabe shared his knowledge and experience and published The Atlas of Arthroscopy which is still considered the basis of modern minimally invasive knee arthroscopy.

Many studies were published to sum up the causes that may lead to knee replacement. However, we are going to cover the most frequent roots. Osteoarthritis is the most common cause of knee replacement. It is a chronic condition in which bones or cartilage of the joint are inflamed for some reason.  Many studies say that symptomatic knee osteoarthritis (confirmed by a radiologist) especially in its late stage affects nearly 3.8% of the population all over the world. This inflammation may potentially cause serious impairments. Pain and stiffness generally progress and get worse, so in the early stages, alternative non-invasive methods of treatment are available in most cases and can resolve osteoarthritis in most cases.

Symptoms of osteoarthritis include limited motion, joint pain with activity, redness, and swelling of the knee. Making efforts such as carrying heavy weights, climbing stairs, bending, or squatting becomes much harder and exacerbates the pain. The damaged tissues in tendons, ligaments, and bone mostly give the patient no choice except a total knee replacement. Severe deformity from trauma or late-stage arthritis may lead to knee replacement surgery. Autoimmune diseases such as rheumatoid arthritis may damage the articular parts of the knee joint which will eventually lead to a knee replacement surgery to restore the joint smoothness. Osteoporosis isn’t considered by many orthopedics as a potential cause so it does not typically cause deformity or inflammation and is not a reason to perform knee replacement. Other minor causes are cartilage defect and ligamental tear which are less frequently reported than the previously mentioned causes.

 

 

Knee replacement surgery is a very well-established surgery that has been performed regularly since the 1970s, though technology has obviously evolved.  The number of knee replacements done on an annual basis continues to increase each year.  However, it is not without risk and can be an uncomfortable experience in the immediate post-operative time.

When quantifying how much pain there is after surgery, it is relative to the patient. The pain after a knee replacement is typically no worse than one of your worst days before you had surgery. However, you can feel this way for the first two to three weeks after the day of surgery.  The amount of pain after surgery is usually manageable by the pain control plan you develop with your surgeon, but to think that surgery will be pain-free is unrealistic.

One of the biggest improvements with joint replacements over the years has been pain management before you go into the operating room, during surgery, and post-operative care.

The day of surgery you may be started on an anti-inflammatory to help with pain.  Sometimes you are given a narcotic before the start of the case as a preemptive strike on the pain.  The anesthesia department will typically talk to you about an adductor canal block.  This is an injection of some long-acting numbing medication that is placed above the femoral nerve, and which can decrease the body’s pain perception after your surgery.

During your surgery, there are several things that your surgeon will do to help decrease the amount of pain. Using smaller incisions and careful handling of the soft tissues around your knee can help decrease the amount of pain. Decreasing the amount of time that a thigh tourniquet is inflated can also help with pain after surgery. Your surgeon may also opt for an injection of narcotic and numbing medication in and around your knee joint once the knee replacement is done.

After surgery, the nursing staff will start putting ice on your knee. It will take four to five days before your knee will start to swell. Putting ice on the joint right away will help with the swelling that will occur later.  Icing your knee four to five times a day is recommended during the first three weeks. Icing and elevating your knee regularly can help keep the swelling down, which in turn helps with reducing your pain and improving your range of motion.

The nursing staff will also use a combination of Tylenol and narcotics to help control your pain. Over-the-counter Tylenol taken at the correct dosage and used on a regular schedule can help with pain.  Narcotics can help with breakthrough pain that the ice and Tylenol do not control.  Research has shown that managing your pain with several different options is better than just using one technique.

The first two to three weeks post-op is generally the time patients feel most discouraged due to the pain. It’s hard to get up from a chair, it’s difficult going up and down stairs, you’re moving slowly and you have to use a walker because you have no strength or balance.  It does get better, but most people during this time are not thinking that the surgery was a great idea.

At four to six weeks, you should be doing much better. You are taking little or hopefully no narcotics by this point.  You are starting to sleep better at night. The simple activities of walking and getting up from the toilet are much easier. Your knee is starting to look more like a knee and your range of motion is improving. People are starting to think about going back to work if they do desk work. The biggest issue at six weeks is that your strength and endurance have not yet fully returned and that can be frustrating.

At three months, life is typically much better. Your knee has not functioned this well in a long time.  Most patients are no longer seeing their surgeon anymore. You have returned to work by now. Patients are doing the extra things of life: going for walks, going to the gym, and getting out of the house regularly again. Your knee will still have some soreness, but it is very tolerable. You may get tired if you are on your feet for long periods of time, but strength can continue to improve with time.  This is still some swelling in the knee, but it is usually better than before surgery.

At between six months to one year after surgery, you are fully recovered. Whatever swelling or pain or motion you have will likely be it. A knee replacement is not a perfect surgery. Your new knee will not feel like the knee you had when you were twenty, but it is better than before you started this journey. The goal of the surgery is to take away eighty to ninety percent of the pains, aches and stiffness that you had before you started.  Knee replacements allow you to walk two miles for exercise, run errands around town, and go to sporting events. When fully recovered, most patients will say that it was the best thing they ever did and would do it again if need be.

If you decide to undergo a knee replacement, there is going to be pain after surgery.  However, your surgeon is going to use several different medications to try and keep that pain tolerable so that you are able to complete your rehab and function in the way you need to get through the tough days right after surgery, which means you can enjoy life again further along in recovery.

Here are some common causes of knee pain:

MEDICAL CONDITIONS

• Arthritis — Including rheumatoid arthritis, osteoarthritis, lupus, and gout
• Baker cyst — A fluid-filled swelling behind the knee that may occur with swelling (inflammation) from other causes, such as arthritis
• Cancers that either spread to your bones or begin in the bones
• Osgood-Schlatter disease
• Infection in the bones around the knee
• Infection in the knee joint

INJURIES AND OVERUSE

• Bursitis — Inflammation from repeated pressure on the knee, such as kneeling for a long time, overuse, or injury
• Tendinitis — Inflammation of the tendon with change in activities, can be related to overuse or deconditioned tissue
• Dislocation of the kneecap
• Fracture of the kneecap or other bones
• Iliotibial band syndrome — Injury to the thick band that runs from your hip to the outside of your knee
• Patellofemoral syndrome — Pain in the front of your knee around the kneecap
• Torn ligament. — An anterior cruciate ligament (ACL) injury, or medial collateral ligament (MCL) injury may cause bleeding into your knee, swelling, or an unstable knee
• Torn cartilage (a meniscus tear) — Pain felt on the inside or outside of the knee joint
• Strain or sprain — Minor injuries to the ligaments caused by sudden or unnatural twisting

 

 

 

 

Knee pain is a fact of life. It affects about 25% of adults, according to the American Academy of Family Physicians. It can deter us from participating in activities like skiing, tennis and basketball, and affect basic tasks like walking up and down steps.

 

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Soleus Heel Raises

Why: The soleus is the deeper of the two calf muscles and is primarily activated when the knee is bent. It plays an important role in plantar flexion, the movement that occurs at the ankle when we point the foot downward. It also helps stabilize the knee.
How: Sit on a chair’s edge so the knees are bent at 90 degrees and feet are flat on the ground. Use a dumbbell or your hands to put pressure just above the right knee and slowly raise the heel against the resistance, then lower back down. Perform two to three sets of 10 to 15 reps per leg.
Options: If you work out at a gym, Mr. Moschkin suggests performing this on a seated heel-raise machine. It can also be done with your heels hanging off a raised surface, like a pad, in front of a Smith machine—a rack with a barbell attached to a sliding track. Hold the rack, sit your hips back and perform heel raises. 

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90/90 Hip CARs (Controlled Articular Rotations)

Why: Hip mobility allows the athlete to access the muscles on the back side of the body for explosive actions, reducing the jarring load on the knees, Mr. Moschkin says. This drill, sometimes called shin box rotations, takes the hip through the full range of external to internal rotation.
How: Start seated in a 90/90 position: Your right leg will be in front of you, creating a 90-degree angle at your knee and hip joints so that your shin is perpendicular to your body, or as close to your thigh as is comfortable. Now, bend your left leg behind you, making 90-degree angles at the knee and hip joints, and keeping your leg as flat on the ground as possible. To transition to this position, keep feet planted and torso tall while the knees come off the ground and hips rotate the other way. Take a deep inhale and exhale before switching directions. You can extend your arms in front of you to help with balance. Perform five to eight reps per side.

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Staggered-Stance Romanian Dead Lift

Why: This exercise for the glutes and hamstrings allows for minimal knee flexion, so you can increase load without irritating the knee. Focusing on one leg minimizes the chance of compensating with the stronger leg when you are recovering from an injury.
How: Start in a staggered stance, feet hip-width apart, with the front foot flat and trail leg slightly back, planted on the ball of that foot. You can hold weights in both hands or the hand of the front foot. Bend at the hips as you lower the weight or weights with straight arms until your torso is almost parallel to the floor. Maintain a flat back throughout the movement to engage the glutes and hamstrings, keeping the feet stationary, with minimal knee flexion. Return to standing. Perform six to 12 reps.

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Spanish Squat Iso

Why: Going right into a dynamic exercise that involves movement, like a squat, may irritate injuries, Mr. Moschkin says. Isometric exercises, where you hold a position rather than moving through a range of motion, will set the stage for pain-free movement later in the workout, he says. This exercise works the quads.
How: Anchor a resistance band (or bed sheet or bathrobe belt) to a sturdy post at about knee height. Face the anchor, step inside the band and place it just below the back of the knees. Take a step back until you feel tension on the band. Sink your hips back into a squat. Lean into the band and hold the bottom position. The knees should be at about 90 degrees and torso as vertical as possible. Hold for 45 seconds. Return to standing. Repeat four to five times. 
Option: When body weight feels easy, hold dumbbells or a kettlebell. 

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Reverse Sled Drag

Why: After performing the Spanish squat iso, the body is prepped to perform this isotonic exercise, which requires the muscles to resist weight throughout a range of motion. This is a great quad-development exercise in general, but can be particularly helpful for working through physical therapy, since you can do it at high volume without creating the same muscle soreness that a weighted lower-body lift might.
How: Attach a harness or belt around the waist, with the other end anchored to a sled about 3 to 5 feet away weighted to about 25% of your body weight. Lean back against the harness and walk backward with the weight, concentrating on smooth toe-to-heel transitions and full knee extension on each push-off. The torso should stay vertical. Progress to two times your body weight as strength increases. Perform five to 10 sets of reps ranging from 50 to 300 feet, or 30 seconds to two minutes.
Option: If you don’t have a sled, you can use resistance bands anchored to a weight or walk backward on a treadmill at a low incline and low speed, holding the rails for balance, if needed.

Mr. Gill pulls a weighted sled in reverse.

 

more info at:

https://en.wikipedia.org/wiki/Knee_replacement

 

 

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