MR. GOODEMOTE: Can you explain to me what to expect after a knee replacement? My dad is having surgery in a couple weeks, and I keep hearing horror stories. What can I do to prepare him and me?
- Becky, Saratoga Springs
BECKY: I have to give you the typical answer, though everyone is different. I know this is kind of a cop-out, but the truth is there are a lot of variables.
Fortunately, the technology has improved, allowing for more choices that an individual can make regarding the type of prosthesis. It is very important when talking to the surgeon to discuss the patient's lifestyle and to match the prosthesis to fit the individual. This is common now and should not be a major issue.
The patient plays a major role in this process. Although this sounds obvious, you would be surprised how many patients expect things to kind of just work out. I think they figure they will be able to do a little bit here and there and things will get better. Worse yet is the patient that thinks he can wait until he feels better to get started to work at it. I tell my patients they need to be ready to work on day one, and waiting until it feels better is not an option.
I have found that the vast majority of patients who work the hardest in the first six to eight weeks are the ones that have the best results. Those that find the pain too much to do what they are asked or just don't do what they are asked are the ones that struggle the most.
Next on my list of what to be aware of is the swelling component. A patient who elevates his leg "above the heart" is simply not as effective as elevating the foot so it is pointing toward the ceiling. The higher the foot/leg is in the air, the more gravity can pull the swelling down. I recommend putting the leg on the back of a couch or on several blankets and to get it as high as possible.
The surgeon plays a big role, obviously, and fortunately there are a lot of good surgeons with a lot of experience. I generally lean toward the surgeons who mostly do joint replacements when I recommend a particular doctor. My favorite surgeons for knee replacements, generally speaking, do a lot of them each year.
I also think it is important to have a surgeon whom you can talk to and ask questions about your concerns. I worked with a surgeon and understand how much they do behind the scenes. I understand the preciousness of their time. But I also know that the surgeons who take the time to explain things and answer questions really help the patient have confidence and trust the advice of the surgeon and his or her team. So don't be afraid to ask questions. I have never met a surgeon who gets offended when you ask about your concerns.
Choosing the right therapist is not as simple as just going to any therapy office, and it is a fact that the patient can and should decide where to go. So when deciding where to go, make sure, as a patient, you are comfortable with the clinic. Word of mouth is a great guide, because friends and family who have been through or know someone who has been through a knee replacement can help steer you toward a clinic and a specific therapist.
I believe it's best to go to a clinic where you are with the same physical therapist at each session or working with a team that works closely together. Find a practice that can accommodate your schedule and gives patients a lot of attention, education and the time they need to get the best results possible.
I will say, as friendly as I can, that total knee replacements are generally not comfortable, nor is it an easy surgery to have, but in most cases, when all is said and done, the patient's pain and function improve. The duration of pain is typically linked to how willing the patient is to follow the rules and do what he is asked to do by the physical therapist.
It often takes several months to really get things going to a point where you are doing what you want to do, but again this timeframe varies depending on the patient. A lot of my patients have told me it was a full year before they felt "normal." For some reason, at around a year, something happens and patients notice they are not noticing their knee anymore.
I hope this helps, Becky, and if you have any questions, please don't hesitate to contact me again.
Gloversville native Matthew Goodemote is the owner of Goodemote Physical Therapy in Saratoga Springs and Community Physical Therapy & Wellness in Gloversville. Readers may send their questions for him to firstname.lastname@example.org.