Over time, knee cartilage can deteriorate due to years of wear and tear. Since the knees take an enormous amount of pressure and stress as we move about, cartilage loss can lead to disabling knee pain, stiffness and inflammation.
The first line of defense is strengthening muscles that support the knee, losing weight and potentially getting injections.
Knee replacement surgery is a last resort. The invasive procedure to install an artificial joint comes only after all efforts to cope with worn out knee cartilage (osteoarthritis) have failed to relieve disabling pain.
If your doctor determines you’re a good candidate for knee replacement surgery, here’s what to know about the procedure and the recovery process.
[READ: Knee Arthritis: Types, Signs and Treatments]
Types of Knee Replacement Surgery
There are two main types of knee replacement surgery:
— Total knee replacement
— Partial (or hemi) knee replacement
Total knee replacement
A total knee replacement sounds like it involves getting an entirely new joint, but it’s a bit of a misnomer.
“It’s more of a knee resurfacing, like getting a crown for your tooth. Dentists shave down the tooth and put a cap on it,” says Dr. Adam Sassoon, a hip and knee surgeon at UCLA Health. “That’s similar to what we do with the femur (thigh bone), tibia (shin bone) and patella (kneecap). We remove about 9 millimeters of the surface of each bone to fit a cap (implant) on there and give the bone a new, smooth surface.”
Artificial knee parts are made of metal and plastic. Installing them requires an orthopedic surgeon to make an incision about 6 to 10 inches long, cut out one or more major ligaments, separate the femur and tibia from the knee, and sometimes cut into the quadriceps muscles.
“When you cut off the top of the tibia, you have to sacrifice the anterior cruciate ligament in the center of the knee,” says Dr. Seth Jerabek, a hip and knee surgeon at the Hospital for Special Surgery in Manhattan. “The implant then makes up for the ACL to stabilize the joint, but really, there’s no way to make it perform like an ACL, so it can be harder after knee replacement to pivot and twist in activities like soccer or basketball.”
Whether you’re a good candidate for a total knee replacement depends on the severity and location of the cartilage loss. The more damage you have, the more likely it is that you’ll need a total knee replacement.
[READ 8 Tips for Choosing an Orthopedic Surgeon]
Partial knee replacement
When the cartilage loss is limited to one part of the knee, you might be a candidate for a partial knee replacement. The most common scenario is arthritis isolated to the medial compartment, or inner side of the knee between the femur and tibia, closer to your other leg.
“Those patients do well with partial knee replacements,” Jerabek says.
Like a total knee replacement, a partial knee replacement involves an incision approximately 4 or 5 inches long, as well as the removal of damaged cartilage and bone and the installation of replacement parts.
“The parts are smaller, thus less bone is removed and the implants are not inserted as deep into the bone,” Jerabek notes.
Because the parts are smaller and limited to one location, doctors don’t have to remove knee ligaments either.
“That’s better for people who are more active,” Sassoon says.
However, even if you’re a great candidate for a partial replacement, it doesn’t mean you’ll avoid further knee problems.
“The potential problem with a partial knee replacement is that you can still get arthritis in the other knee compartments that weren’t replaced, so some patients elect to have a total replacement rather than a partial knee replacement,” Jerabek says.
Partial vs. Total Knee Replacement: A Comparison
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[READ 15 Questions to Ask Your Orthopedic Surgeon During Your First Appointment]
Total Knee Replacement Recovery Timeline: What Happens Week-by-Week?
The recovery process for surgery after a total knee replacement procedure is generally longer than a partial replacement.
Whether you’re having a partial or total knee replacement surgery, here’s what you can expect for the weeks following the procedure:
Week 1
Day of surgery
— Surgery typically lasts 1 to 2 hours under regional or general anesthesia.
— After the procedure, you’ll be taken to the recovery room and monitored as you wake up from anesthesia.
— Pain management begins post-surgery with nerve blocks or other modalities.
— Your surgery team will likely get you up and walking as soon as a few hours after surgery.
Knee replacement surgeries are typically done on an outpatient basis at either an ambulatory surgery center or hospital-based outpatient department, with most patients going home the same day. People with underlying medical conditions, such as an irregular heart rhythm or kidney problems, will likely have to be monitored overnight in a hospital for a full knee replacement.
[Read: Ambulatory Surgery Centers vs. Hospital Outpatient: Key Differences, Costs & How to Choose]
Days 1 to 6
— If you’re not discharged on the first day, you may stay in the hospital overnight for one to three days.
— You’ll begin physical therapy and start walking with assistance of a walker or crutches.
— Pain management medication options are available.
— Elevating your leg and icing your knee may help reduce pain and swelling.
— If your surgeon uses waterproof dressing, you may be able to shower immediately; otherwise, post-op instructions may guide you to avoid showering for five to seven days.
— You may receive instructions on changing or removing your surgical bandages.
Once at home, you’ll have to be on the lookout for infection, blood clots and partial knee stiffness, which are all risks of knee replacements.
The most important aspect of recovery is physical therapy, which you do at an outpatient physical therapy center a few times per week. Regular exercise to restore strength and mobility to your knee and a gradual return to everyday activities are important for your full recovery after total knee replacement.
“For a total knee replacement, most people are in formal physical therapy for three months,” Jerabek says. “For partial knees, you bounce back faster — probably around twice as fast as a total knee replacement — because we’ve removed less bone and kept all of the ligaments, and we didn’t have to dislocate the tibia from underneath the femur.”
Your physical therapist may recommend that you exercise for 20 to 30 minutes daily, or even 2 to 3 times daily; and walk for 30 minutes, 2 to 3 times daily during your early recovery. The American Academy of Orthopaedic Surgeons offers a total knee replacement exercise guide.
[Read: At-Home Exercises for Knee Pain.]
Weeks 2 to 4
— Depending on individual factors, by weeks 2 to 3, many patients are able to walk without the support of a walker or cane.
— Continue regular physical therapy.
— Although you can begin showering now, avoid taking baths or soaking the incision site, as this could lead to infection.
— By week 4, many patients are cleared to drive after surgery, especially if your left leg was operated on.
Weeks 6 to 12
— Continuing physical therapy for up to three months following a total knee replacement may be beneficial, according to the American Association of Hip and Knee Surgeons. However, this will depend on your condition before surgery, recovery progress and overall health.
— You’ll begin to incorporate more normal activities to your routine, like walking. Strenuous or physically demanding activities that impact the knee should still be avoided.
— You’ll notice decreased pain and swelling as time goes on.
Months 3 to 6
— After three months, you’re likely able to return to most activities.
— If full range of motion hasn’t returned, your surgeon may recommend continuing physical therapy.
Months 6 to 12
— Most patients take from six months up to a full year to make a complete recovery.
[READ: How to Prepare Seniors for Surgery: Anesthesia Risks and More]
How to Prepare for Knee Replacement Recovery
Advanced planning and surgery prep will go a long way to help ease the challenges in the weeks following your surgery. The stronger you can be before surgery, the faster you will recover.
Prepare your home
Before you go in for your procedure, prepare your home for recovery and gather some necessary items to have on hand:
— Get supportive equipment. Purchase or install supportive equipment, such as a walker, safety bar in the shower or raised toilet seat.
— Consider cold therapy. Have plenty of ice packs on hand in the freezer. If you’re able to, get a cold therapy machine, an optional recovery device that circulates water through an ice reservoir and makes it simpler to ice your knee after surgery. This helps reduce swelling and inflammation to help speed up recovery.
— Prepare meals. Prepare and freeze meals in advance to avoid spending too much time on your feet or moving about the kitchen. If you’re looking for inspiration, the Mediterranean diet, DASH diet and flexitarian diet are the top eating approaches for bone and joint health, according to U.S. News’s Top Diets for Bone and Joint Health.
— Arrange home for easier, safer access. Set up a bed and living space on the first floor of your home, as stairs may be challenging or restricted in the first few weeks of recovery.
— Remove rugs. Remove loose rugs or other items that could cause disruptions or tripping hazards when trying to move around.
Gather a support system
Once at home after surgery, you’ll likely need someone who can help take care of you for a few days or more and assist with medications, bandage changes and food preparation.
If you do not have a friend or loved one nearby to help out, plan ahead to ensure you have the necessary assistance and resources during your recovery.
Ask your surgeon’s office for suggested available resources to you, and consider the following:
— Home health services, like a nurse or home health aide to assist with daily activities
— Transportation services to and from the hospital and follow-up appointments
— Meal delivery services, including local community programs
— In-home or virtual physical therapy options, if getting to outpatient therapy is a challenge
— Telehealth options for follow-up visits with your surgeon
Nutrition recovery checklist
— Protein: For tissue repair
— Vitamin C & zinc: For wound healing
— Iron: To replenish blood lost during surgery
— Hydration: To prevent constipation from opioid pain meds
[READ: Senior Rehab: Find the Best Care After a Hospital Stay]
Managing Pain and Swelling After Surgery: Best Practices
Dealing with discomfort and swelling after an operation is a common part of the healing process. Learning how to manage your pain and keep the swelling down will help you recover more smoothly and get back to your normal routine faster.
Pain management tips
— Follow your doctor’s medication instructions: Take prescribed pain medication exactly as directed. Don’t wait until the pain is severe before taking the next dose.
— Use over-the-counter (OTC) pain relievers: Once cleared by your surgeon, acetaminophen (like Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) can help manage milder pain and inflammation. Be aware that NSAIDs may be restricted immediately after some surgeries due to bleeding risk. Always consult your doctor.
— Employ cold therapy (ice): Apply an ice pack wrapped in a thin towel to the swollen or painful area for 15-20 minutes at a time, several times a day. Cold helps numb the area and constrict blood vessels, reducing pain and swelling.
— Practice relaxation techniques: Deep breathing, meditation or gentle distraction (listening to music, watching a movie) can help reduce the perception of pain.
Swelling reduction tips
— Elevate the affected limb: Whenever possible, keep the surgical site elevated above the level of your heart. This uses gravity to help drain excess fluid and is one of the most effective ways to reduce swelling. For example, prop your leg up on pillows while sitting or lying down.
— Maintain light, gentle movement (as permitted): If cleared by your doctor, gentle movement or exercises can help pump fluid out of the area and prevent stiffness. Avoid strenuous activity that could increase swelling.
— Stay hydrated and manage diet: Drinking enough water can help your body flush out waste. A low-sodium diet may also help prevent fluid retention that could worsen swelling.
Always consult your surgeon or health care provider before starting or stopping any pain medication or beginning any exercise regimen.
Warning Signs: When to Call Your Doctor Post-Surgery
While minor discomfort is normal after surgery, certain symptoms require immediate medical attention. If you experience a fever above 101°F, increased pain that isn’t managed by medication, excessive bleeding or foul-smelling drainage from your incision or shortness of breath, contact your surgeon’s office or seek emergency care right away. These could be signs of complications like infection or a blood clot, which require prompt treatment.
Trust your instincts. If something feels seriously wrong, don’t hesitate to reach out to your health care provider.
Long-Term Risks and Recovery
There will always be a small risk, around 1% per year, that the new parts fail for a variety of reasons, such as loosening, stiffness, instability or infection. Therefore, it’s important to do everything you can to maximize the replacement, such as keeping up with exercises to strengthen the muscles that support the knee joint and maintain motion and avoiding putting too much pressure on the knee.
“Focus on lower impact exercises like cycling, swimming or using an elliptical machine,” Sassoon says. “You can do more with a partial knee replacement. I don’t think I’d go back to training for a marathon or sports that require a lot of jumping, but things like tennis are OK, as long as you stick to doubles with less court to cover or play on grass or clay.”
Ultimately, it’s important to enjoy being active — whatever that looks like for you.
“You can get back to doing things for the first time in a while without pain. I call it the ‘second first time.’ Maybe it’s skiing or surfing, or just walking through your house or a store,” Sassoon says. “You’ll value the feeling of function without pain.”
Once you’re back to your regular activities, you should be able to get 15 to 20 years of use from a partial knee replacement and 20 to 30 years for a full knee replacement.
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Knee Replacement Recovery: Timeline, Pain and Success Tips originally appeared on usnews.com
