I had the opportunity to experience recovery from a TKA through the eyes of a close family member, who I, as a joint replacement surgeon was the primary caregiver. This experience gave me a new appreciation of what our patients experience in the weeks after TKR. I will break this up into segments: pre-op, day of surgery and the first day of recovery, day 2- day 6, weeks 2-6, and 2 recovery perspectives.
As a joint replacement surgeon, it was very enlightening to be the primary caregiver for a family member undergoing knee replacement surgery. What were the key takeaways from my perspective?
First, the patient must try non-operative treatment as, for mild to moderate arthritis, this is often very successful. As the arthritis advances to the point where the knee has end-stage arthritis, i.e. bone on bone changes, operative intervention is a consideration. Additionally, getting in as good of shape as possible makes your recovery easier.
Second, picking a high volume joint replacement surgeon to whom you can relate well can optimize your outcome.
Third, lining up full time help the first 4 to 7 days is really important. Patients often say, “My family/kids/friends are too busy to help.” Well, as a surgeon, I’m really busy too but I took a week off work to make this recovery as smooth as possible.
Fourth, being well-informed with what will take place in surgery and beyond is important. DUring recovery, using an ice machine or gel packs is extremely helpfu,l as is elevating the leg (as shown in an earlier blog). Reassuring the patient during downtimes the first week can make the recovery more tolerable. The pain is significant but with the modalities outlined, plus the medication, it’s tolerable and it gets better each week.
If you have significant arthritis before surgery then the pain after surgery seems less intense as compared to before you had your surgery.
The Patient’s Perspective:
By the time I made the decision to have a total knee replacement, I was more than ready. My world had shrunk significantly. By this I mean I no longer was able to do much of what brought me pleasure on a daily basis. Even the mundane chores of life had become difficult to keep up with.
Knowing that my surgery was scheduled, I used the two months prior to surgery getting myself into the best shape I could, given my limitations. Immediately after surgery, there was pain, however with the proper use of all of the medicines I was instructed to take it was manageable. I was amazed that it was even possible to get up and walk immediately post -surgery. The icing of the knee immediately after surgery was crucial.
My family was a key component to the next phase of my recovery. As a patient, you are very limited with what you can do, so you have to rely on those around you for help. Getting to and from the bathroom was a significant burden in the beginning and help was needed. A walker is a must to get you up and walking as much as possible. To alleviate the swelling and achiness, an ice machine was my best friend. You are far more tired than usual, so resting with your leg elevated and using the ice machine were key.
I found it both challenging and painful to do the exercises required about 5 times a day, but the gains I noticed kept me going. Physical therapy is a strongly suggested component and I found it very helpful. You are ready to get out and get moving and the therapist’s knowledge of moving you through this process was comforting.
I kept up the multi-modal pain management from the start and was able to function by week three without the use of narcotics. My husband would remind me as I was stretching and wincing that it was only pain and I was not going to hurt my new knee! I moved rather quickly from the walker to a cane for stability. I found shortly thereafter, that relying on the cane caused me to limp and I had gained enough confidence in my knee and my strength to be on my own.
During these next few weeks, the sharp pain was no longer a factor, just more of dull achiness which then gave way to a feeling of tightness across my knee. The more stretching and prescribed exercises I did, the less apparent the tightening became.
I can’t stress enough how important it is to stay diligent with your exercise, icing and elevating, if you want to achieve the goals set by your doctor for your range of motion. I found that the longer I walked each week, the better my knee and my spirits felt, as exercise does wonders for your healing and your endorphins. I am now just over 6 weeks post op and couldn’t be happier with my decision to have had total knee replacement. My quality of life has improved so much in these short few weeks that I have a bright future. I thank my surgeon and the caregivers involved and my family for their role in my recovery. It takes a village!