28 December, 2013
Issues after knee replacement surgery (TKR)
Rapid Recovery depends on you
The rehabilitation after a TKR is critical in achieving a good outcome. Whilst knee replacement is a very successful procedure, studies show that 20% of patients have a level of dissatisfaction with their outcome. In the majority of cases, however, this is patient dependent - what you put into your rehabilitation will usually reflect the outcome.
The specialised surgical technique developed and used combines a proven technique with a prosthesis that has been shown in multiple studies, from many centres around the world, to have an excellent longevity. The following article outlines how you could complement this with your rehabilitation to give you the best and fastest outcome.
There are 2 targets you must achieve as soon as possible: walking and knee flexion (bending your knee). The 3 impediments to achieving this are fear, swelling and pain.
FEAR
This is usually caused by "the unknown" and is amplified by "advice" given by family or friends. Whilst this "advice" is given with the nest intentions, not infrequently it is counter-productive. The surgeon, nursing staff and physiotherapists will guide you. The angst is usually due to an unfounded fear that the wound would split open or the prosthesis would fall apart. These do not happen. The wound is sutured using multiple layers and the prosthesis simply cannot fall apart!
SWELLING
This is the bodies natural reaction to surgery. Knee replacement surgery is "big" surgery and therefore usually there is a lot of swelling; this can; last several months and often tracks down the leg when your walking increases. The best way to reduce swelling is to elevate the leg whilst lying down; "pumping" the calf by moving the ankle up and down augments the effect. In the first few days after surgery, you should do this frequently for 1-2 hours at a time, especially after exercise and walking. In the first few days, it is recommended that you walk/exercise for a maximum 5-10 minute bursts, followed by a period of prolonged elevation. This can gradually be increased after the first week as comfort allows. Whilst elevating, and whenever the opportunity allows, you should ice the knee. Over the next few weeks, you may increase your walking distance - elevation (lie on the couch or bed) and icing should continue.
PAIN
New techniques in pain control after surgery have made the first 36-48 hours (traditionally the most difficult time) very manageable with virtually no side effects. After that, regular Panadol Osteo and anti inflammatory medication (NSAIDs) are needed. Narcotic drugs are frequently used to supplement this medication. The side effects include constipation, drowsiness and dizziness; they can also cause a LOWERING of your pain threshold, making you more sensitive to pain and they may be addictive. Therefore, it is important to use them sparingly and for a short period of time. These include Endone (rapid acting) or the slow release Targin or Oxycontin. Frequently, a combination of the techniques used above (see under SWELLING) and these analgesics will allow you to rehabilitate from the surgery comfortably.
People often ask about the need for inpatient rehabilitation as they have been told that this will give you "the best" outcome. There is no evidence for this; during inpatient rehab, it is logistically difficult to undergo the rehabilitation protocol described above (i.e. 5-10 minutes walk/exercise and then 1- hours rest, elevate and ice). You are best to be in control of your own recovery and rehab with physio supervision a couple of times a week.
KNEE FLEXION
In general, you will have over 80 degrees knee flexion before you leave hospital (usually on day 3). You need to keep improving this. The most effective knee flexion exercises are by using your weight over a chair. There are 2 specific types that you will be shown. You should aim to do 10 repetitions, three times a day (followed by ice and elevation). The aim is to gradually increase the knee bend to over 110 degrees.
MUSCLE STRENGTH
Initially, you will be shown muscle strengthening exercises. However, once you start walking regularly (within the first week) walking becomes the most effective way to build up the muscles. Another good and effective muscle strengthening activity is using an exercise bike; you can gradually increase the resistance on it but should only do it for short bursts (may be a few times a day). You can start the exercise bike around 2 weeks after surgery. As you improve in the first few weeks, you can go out for coffee: park the car a short distance from the cafe and walk there. Each time, you can park the car further away.
The success of knee replacement surgery depends on you - actively embracing and "owning" the program as your responsibility augurs well for a successful outcome.
