Part One | Part Two
Part 2 – Recovery
By: Jean Johnson for Knee1
According to the associate chief of knee service at the Hospital of Special Surgery in New York City, Steven B. Haas, M.D., 90 percent of those who had knee replacement surgery in the early 1980s are still enjoying their man-made joints.
Also, throughout the 1990s and into early 21st century, continued improvements in materials used to replace damaged cartilage and bone are expected to make for even better results in today’s patients.
| Covering sex to airport detectors, the following are postsurgery tips from the American Academy of Orthopaedic Surgeons:
If your left knee was replaced and you have an automatic transmission, you may be able to begin driving in a week or so, provided you are no longer taking narcotic pain medication.
If your right knee was replaced, avoid driving for six to eight weeks. Also remember that your reflexes may not be as sharp as before your surgery.
The sensitivity of metal detectors at airports varies, and it is unlikely that your prosthesis will cause alarm. You should carry a medic alert card indicating you have an artificial joint, just in case.
Sexual relations can be safely resumed in approximately four to six weeks after surgery.
Depending on the type of activities you perform, it may be six to eight weeks before you return to work.
Walk as much as you like, but remember that walking is no substitute for the exercises your doctor and physical therapist will prescribe.
Swimming is also recommended; you can begin as soon as the sutures have been removed and the wound is healed – approximately six to eight weeks after surgery.
Acceptable activities include dancing, golfing (with spike-less shoes and a cart), and bicycling on level surfaces.
Avoid activities that put stress on the knee: Tennis, badminton, contact sports like football and baseball, squash or racquetball, jumping, squats, skiing or jogging.
Do not do any heavy lifting of objects.
By being fully prepared for the recovery phase of joint replacement surgery, people can maximize their chances for a good experience from which they will emerge ready to resume a full life. That said, leaving no stone unturned is more difficult than a person often thinks going into a new situation.
To help, we at Knee1 compiled tips related to the recovery process. Presented in checklist fashion, complete with anecdotal information from “one who has gone before,” we hope our findings empower future patients and their friends and family.
We think it’s important to appreciate that a patients’ approach to their own rehabilitation is a way they can partner with their surgeon to achieve the goal of a good outcome and high prospects for a long future of good knee function.
Skilled nurses and therapists carry the burden of care during the immediate period after surgery while patients are in the hospital. However once that honeymoon is over, things can become a bit more complicated as Clyde Burton found out.
“If I’d known then what I do now,” said Burton, “I would have questioned my doctor way more about what happens after you leave the hospital.” Seventy five-year-old Burton goes on to explain that he and his wife had some rough days.
“Me and the missus, we’re not that young any more, you know. And everything went so smoothly in the hospital that I guess we got to thinking it was going to be pretty easy, her taking care of me and all,” Burton said, pressing his lips together and shaking his head at the memory.
“But there I was flat on my back in bed forever it seemed, and that made for more work for my wife than she was up to. We had to get someone to come in and help. If I had it do over again, though, I would have just gone to a nursing home for a couple weeks,” he said. “Nobody wants to go near those places, and I’m just like the next guy. But since it would have just been temporary, I think it would have been for the best.”
Burton was in the hospital for a week, a period that mirrors what the American Academy of Orthopaedic Surgeons (AAOS) notes in its literature. Anywhere from three to seven days is the average length of time it takes people to meet the common criteria for hospital discharge: To get in and out of bed by oneself, make good progress in bending and straightening the new knee and walk with a walker or crutches. The most nimble in the group can often even manage two or three stairs within these first days after their surgery.
As Burton noted, most patients will need help for several weeks following their surgery. Indeed, patients fresh from surgery find that their world turns on a very circumscribed set of procedures: taking care of their incisions, making sure they get their medications, consuming lots of fluids and a healthy diet, and doing their exercises. All in all, it’s a deceptively simple routine.
Usually the sutures or staples holding the incision into place are removed 10 days following the knee surgery. Until then the goal is to keep the wound clean and dry; thus patients are advised against showering or bathing during this time and have to make do with what Clyde Burton calls “a lick and a whistle.”
“We had a whole grocery bag of stuff to change the dressing with,” he said. “That was quite the ordeal since my leg was swollen, and the missus had to watch for signs of infection. And then there was the ice bag routine – that went on forever, seems like. She got to where she even used bags of frozen peas when the other ice packs hadn’t had time to freeze up.”
Burton’s memory is accurate according to the AAOS. The surgeon’s organization notes that incisions should be monitored for redness or drainage indicative of infection. The AAOS also explains that “swelling is normal for the first three to six months. Elevate your leg slightly and apply ice.”
From antibiotics to ward off infection, to stool softeners and pain pills, patients fresh from knee surgery can expect to make room for a small pharmacopeia on their beside tables or in bathroom medicine chests. Perhaps most important of these aids to healing, however, are the drugs to prevent life-threatening blood clots from forming in the affected leg where circulation is sluggish.
“You will probably be given a blood thinner to prevent clots from forming in the veins of your calf and thigh,” states the AAOS. “If a blood clot forms and then breaks free, it could travel to your lungs, resulting in a pulmonary embolism, a potentially fatal condition.”
The AAOS also says that patients with artificial knee joints need to guard against infection throughout the remainder of their lives, particularly alerting their dentists so that they can take prophylactic antibiotics in the event of tooth extractions, periodontal work, dental implants or root canals.
All the usual strictures about eating as close to the Mediterranean pyramid as possible apply here as well, with a few special exceptions. Yes, get lots of whole grains and legumes and fresh fruits and vegetables says the AAOS. But since patients are taking blood thinners to keep clots from forming, they need to avoid what the organization terms “excessive vitamin K.”
The AAOS lists foods high in vitamin K that should be eaten in moderation only: “broccoli, cauliflower, Brussels sprouts, liver, green beans, garbanzo beans, lentils, soybeans, soybean oil, spinach, kale, lettuce, turnip greens, cabbage and onions.”
Clyde Burton loved the above list when he saw it. “I’ve never been too much a fan of broccoli, so I thought, ‘great, I’m off the hook for a while at least,’” he said. “But my wife quizzed the doctor a little more closely to find out what excessive meant, and once they had their little discussion, there the darn broccoli was, back on my plate every so often.”
Along with the above common sense, the AAOS also underscores that the difficulty of getting up to use the bathroom should not discourage patients from drinking lots of water and other hydrating fluids. On the association’s list of drinks that aren’t conducive to healing are the diuretics coffee and alcohol. Skip the alcohol all together the AAOS says, and try to cut down on the java.
Finally, the subject of weight – which is never too far from joint replacement discussions – arises in AAOS literature. The equation is: Weight down = less stress on new joint. Focus on long-term prospects and try to forgo the short-term pleasure that extra calories tend to bring.
Exercises and Mobility
In a nutshell, people with new artificial knee joints can expect to have some good days and some bad ones while their stamina and endurance gradually increases over a period of six to 12 months. The key, according to the AAOS, is to avoid overdoing it and instead, like the stalwart turtle that won the race against the hare, just keep putting one purposeful foot in front of the other.
Various quadriceps exercises will be prescribed by the physical therapist along with ankle pumps, straight leg raises and exercises designed to begin working and strengthening the new knee joint.
But “proper walking,” states the AAOS, “is the best way to help your knee recover. At first you will walk with a walker or crutches. Your surgeon or therapist will tell you how much weight to put on your leg… Walk as rhythmically and smooth as you can. Don’t hurry. Adjust the length of your step and speed as necessary to walk with an even pattern.
“When you can walk and stand for more than 10 minutes, and your knee is strong enough so that you are not carrying any weight on your walker or crutches (often about two to three weeks after surgery), you can begin using a single crutch or cane. Hold the aid in the hand opposite the side of your surgery. You should not limp or lean away from your operated side.”
Clyde Burton says his experience matched that fairly closely. “Yes, except it took me a good month to get my legs back so that I could trust ‘em,” he said. “I don’t know, it’s fairly fuzzy, but seems like I did quite a bit on the exercise bike. Maybe I should have been walking then and riding less. But I don’t think so, since my wife watched all those doctor’s orders like a hawk.”
According to the AAOS, exercising on a stationary bike is an advanced exercise appropriate “once you have regained independence for short distances and a few steps.” The literature also has a raft of other more-advanced techniques to regain leg strength, like standing knee bends and using stretchy bands to create resistance when doing prone extensions and bends. It also once again underscores that slow and easy is the key, and that pain and swelling around the new joint can occur should patients try to tackle too much at once.