#treatment - Knee

Knee replacement – top tips!

Total knee replacement surgery is a complex operation. The healing process takes time and the post-operative rehabilitation is tough and should not be underestimated. You should regard the operation as just the first step in a long road towards regaining full function in your knee.

One of the biggest determinants of successful patient outcome after knee replacement surgery is the mental attitude of the patient themselves. Patients who are determined and commit fully to the post-operative rehabilitation that is required generally tend do well. So, the advice I always give my patients is make sure you to put everything you’ve got into your post-op recovery. That means working hard at getting your knee to bend (flex) and straighten (extend) to restore the movement and flexibility in the knee joint. It also means committing to regular physiotherapy. The more effort you put into your rehab, the quicker you’ll achieve your final result.

No-one knows the ins and outs of what’s involved with having a knee replacement better than a patient who’s actually had the surgery themselves. The top tips below have been provided by London Sports Orthopaedics patient MaryWolff-Ingham [CLICK HERE to see Mary’s testimonial] who had her right knee replaced with a ConforMIS iTotal custom-made knee [CLICK HERE to read more about Conformis knees]. Her advice should be considered essential reading for anyone contemplating and recovering from knee replacement surgery.

Get a physiotherapist

Getting your knee to function properly post surgery is challenging, but a good physiotherapist will help you. Your physio will help get your knee to bend (flex) and straighten (extend) and also reduce post op swelling with massage therapy. If possible, use a physio that also offers hydrotherapy, as exercising in a warm pool is much easier and less painful. Ideally, locate a physio before surgery and book your sessions to start as soon as you leave hospital. You will probably need to have at least two physio sessions a week for 12 weeks post surgery – possibly even longer. Your surgeon will give you the gift of a new knee. Your physio will make sure you maximise knee function and get the best possible outcome from your surgery post op.

Practice R.I.C.E.

Post op, your knee (and possibly the whole of your lower leg and foot) will be bruised and swollen. This is perfectly normal. The trick is to do everything possible to reduce the swelling, by practicing R.I.C.E.

Rest. Post surgery, you need to exercise and move around as much as your knee can tolerate, but it’s also really important to rest your knee sufficiently in between. When resting, make sure you elevate your leg and preferably ice it at the same time.

Ice. To make any impact on the swelling, you need to ice your knee regularly. Ideally up to 5 times a day, but with a break of two hours between each application. This is particularly important immediately post surgery. The optimum time to ice is for 20 minutes. Doing exercises can aggravate the knee and result in more swelling, so make sure you have an ice pack at the ready to use immediately after exercising.

To be effective, when icing, you must make sure that your knee is higher than your hip, otherwise icing won’t make much of an impact. This makes sure that all the excess fluid can drain in to your lymph nodes which are in your groin.

Compress. The easiest way to do this is with a Game Ready System (www.gameready.co.uk). This cools and compresses the knee at the same time so is very effective at reducing the swelling. You can hire one and have it delivered to your home for when you come out of hospital. It’s well worth the investment, as it does get terrific results, and fast.

Elevate. Prop up your knee so it rests above the level of your heart. In the daytime, lie on your sofa or bed and place a stack of cushions/pillows under your lower leg/foot. At night, raise the foot of your bed (circa.10cm) by tucking a few blankets/towels under the mattress. This will automatically elevate your leg and means that the fluid in your knee/leg can drain away during the night whilst you’re sleeping.

Manage the pain

Taking pain killers is the only way to get through the post operative pain. If you don’t like ‘popping pills’ your instinct will be to try and come off the pain killers as soon as possible, but this can be counter-productive. You’ll feel so much better during your rehab (particularly immediately post op) if you keep the pain under control. That does mean taking the pain killers regularly (e.g. every four hours). Ideally don’t wait for the pain to kick in before you take them. Managing the pain in this way will keep you as mobile as possible, enable you to do your knee exercises without too much discomfort and also help you get a good night’s sleep, which are all really important for a successful recovery.

Sleep well

Post surgery, it’s quite common to have trouble sleeping. The tips below might help.

Take your pain killers just before you go to bed & during the night. Try to time when you take your pain killers during the day so you can take one just before you go to bed. This should hopefully give you four hours sleep. You’ll probably wake up in pain in the early hours of the morning, so have a single dose of pain killers next to your bed and take them as soon as the pain kicks in. This should hopefully give you another four hours.

Sleep with a pillow between your knees. Finding a comfortable sleeping position post surgery can be tricky. If you’re used to sleeping on your side, then try sleeping with a pillow between your knees. This provides some additional protection and padding for your knee and might be more comfortable. NB. If you’re used to sleeping on your back, don’t be tempted to put a pillow under your knee as this will hinder your recovery as it will prevent your knee from fully extending.

Buy a lightweight duvet. Post op, your knee/foot might be sensitive to touch and the weight of your existing bedding uncomfortable and painful. Having a really lightweight duvet can help. Siberian goose down is the best. It’s so light, you can hardly feel it, but still cosy and warm. Pricey, but definitely worth it.

Avoid constipation

Taking pain killers will make you constipated, so ideally try and prevent it before it happens. The remedies below will help, but don’t try them all at the same time!

Psyllium Husks.   These are a natural form of fibre and taking two capsules before every meal will help to keep things moving. You can buy them from Health Food Stores (e.g. Holland & Barratt) or online.

Senna tea. Senna is a herb and an excellent non-prescription laxative. You can buy it as loose leaves or teabags from most health food shops (e.g. Neal’s Yard). Just brew like a normal tea.

Prune juice. You can dilute with water to make it more palatable. Available from health food stores and most big supermarkets.

Syrup of figs. Contains figs and senna and similar in taste to prune juice. Take two 5ml spoons just before going to bed. Available from most chemists.

NB Some of the above remedies may interact with the other drugs that you might be taking, so read the instructions/contraindications carefully before trying any of them.

Do your knee exercise regularly

What you achieve in the first two weeks post surgery in terms of knee bend (flex) will determine the range of movement you’ll have in your knee in the long term. So exercising regularly immediately post surgery is really important.   Your surgeon will tell you what degree of knee bend (flex) you should aim for.

You will also need to aim for a 0 degree extension to get a straight leg. Your physio or surgeon will explain what this means and looks like. Achieving this can be tough, particularly if your leg wasn’t straight before surgery. It can take up to 12+ weeks, but your physio will help you by stretching your leg, using weights & massage therapy.

To see any real benefit, you’ll need to do your knee exercises regularly. That means every day – and ideally more than once a day – even when you don’t feel like doing them, which will be most of the time. You’ll probably get to point when you plateau in terms of your progress and find it hard to stay motivated and stay committed to doing the knee exercises regularly after that. Even though you’ll be tempted, try not to give up. Try and visualise what you want to be doing in three/six months (e.g. cycling, hiking or dancing) when your knee is fully functional and you’re free from pain.

Minimise scarring

Having knee surgery will mean that you will have quite a big scar. It will fade and become smooth with time. Once your stitches have come out/or dissolved and the wound is fully healed you’ll need to regularly massage your scar to reduce the redness and break down any lumps & bumps. Bio-oil is excellent for this (available from most chemists and some supermarkets). Using the correct massage technique is important. As a general rule, massage across the scar in a horizontal movement, not lengthways and knead the bumps. Your physio will show you the correct technique. Try and commit to doing this daily. Over time your scar will slowly begin to fade and begin to look so much better.

Read more

To find our more, CLICK HERE to read a case study written by Mr Ian McDermott about ‘Custom-made knees for younger and active older patients’.

To learn more about the technicalities behind Custom-made knee surgery and to see Mary talking about her experiences at The London Custom-Made Knee Meeting in November 2015, CLICK HERE.

Patient feedback

To feedback on any of these top tips or share your own knee replacement rehab tips please email fiona.bell@sportsortho.com

Other patients’ comments:

“The top tips have given me some great information and I’ve found them so useful. It has put my mind at rest that what I’m going through is normal and nothing to worry about. I’m sleeping better now and also getting around well. Very many thanks.”

“Prune juice works wonders for constipation :-)”

“The Game Ready has been invaluable. It was delivered last Friday and by Saturday the swelling was considerably better. I can’t thank you enough for your advice.”

“I can’t thank you enough for your tips. I’ve started physio and exercises in the hydrotherapy pool and feeling so much better.”

“The Game Ready is due to go back next week, but I’m thinking of holding on to it for another month as it really keeps the swelling down.”