Total knee recovery can be more arduous than total hip recovery. There is generally more pain after a knee replacement then with an anterior hip replacement. I think this is because we push the range of motion of the knee so soon. We do partially split the quadriceps muscle to some extent, and repair then it. It often feels tight, like it is pulling on the suture line when we push you to flex your knee. It has been my observation that the patients who start their Physical Therapy a week later seem to do better than those who start right away. This may simply be due to the recent bleeding and subsequent swelling that occurs immediately after the surgery.
I think functional rehab, like walking, is much more important early on then range of motion exercises. The motion should come easier later as the swelling goes down. Ice works well in the knee to control pain and swelling. We use sophisticated pain blocks to minimize pain initially, and our patients get a head start on functioning. It is rare for patients to not get the motion they need by 6 weeks post op. 97% of the time, the knees loosen up over time on their own. Get outside and hike, walk, climb- use the knee! It will loosen up- it wants to move!
Our total knee replacement patients are recovering faster than they did years ago. We use muscle sparing approaches, and minimize the use of the tourniquet ( used to control bleeding during the surgery). We now have an injectable medication called Exparel* that is a timed release local anesthetic – it can provide pain relief for up to 72 hours. Many patients are requiring less overall physical therapy visits. What used to be 3 times a week is now two visits a week for many patients. Our knee implants are also getting better. The new rotating platform system we use has many more sizes to fit all knees, and the plastic spacers go up in one millimeter increments for maximum accuracy and stability. It is a good time to have a painful knee replaced! Read more about total knees at www.Totalknee.org.
