So you just got the news, you have to have a total knee replacement (TKA). Authors of the most recent clinical practice guidelines provided by the APTA (American Physical Therapy Association) write that the number of TKAs performed — an estimated 662,545 in 2013 — are predicted to grow by 855% between 2012 and 2050.1 You’ve heard stories and talked to your friends or family about their experience but you still have questions. This is the initial blog post of a 3 part series outlining a TKA. I hope to answer some common questions, ease your nerves, and help set you up for success. We will start with some common questions I often get in the clinic:
“Will it hurt?”
With every major surgery there is an expected level of pain. It is important to be optimistic yet aware of the expected pain following your TKA. Most people experience the greatest pain levels within the first 2-3 weeks; however, with good physical therapy compliance, pain levels may vary and be elevated during exercise/stretching (this is normal and a good thing)! The best and first advice I give is to be sure to take your medications as prescribed by your doctor and if possible, time your medications with your physical therapy sessions.
“How long before I am back to my normal self?”
The answer to this question is dependent on many variables. Some of the variables that play a role in your recovery include: weight, age, physical therapy compliance, comorbidities, and physical condition prior to surgery. Another factor that may influence your recovery to “normal” is what you consider normal to be. People that would like to return to strenuous activity such as hiking/running, long distance bike riding, or physical manual labor may take longer to recover. If a timeline had to averaged, most people are feeling much better and back to their normal self anywhere from 3-6 months.
“Can I return to running? What about kneeling?”
In most cases running and kneeling following a TKA are not recommended. Every surgeon has specific guidelines for care of your knee following surgery and this would be a good question to ask your surgeon.
“When can I return to work?”
This is another common question that is not simply answered. Everyone’s occupation varies with regards to physical expectations. To keep this answer simple, if you have a laborious occupation it will take longer for you to return to your normal duties vs someone who may be in an office setting. A good rule of thumb is testing your work tasks with your physical therapist and getting clearance from your physician prior to returning to work.
“Will I need crutches or a walker after surgery?”
Most people require an assistive device of some sort following surgery. This is usually determined by your physical therapist during your recovery at the hospital. The most common assistive device is a walker. A walker allows you to walk with greater safety given its benefits of improving your balance and allowing you to absorb your weight as needed.
“How long and often will I be going to physical therapy?”
The typical frequency for PT visits is usually 2-3x a week for the initial sessions. After time has passed and you are regaining mobility/strength your PT frequency may be decreased to 1x a week for home exercise updates and to check on progress. A typical physical therapy timeframe ranges from 2-5 months following your surgery to allow you to meet all your goals, progress with range of motion, and improve strength.
“What type of physical therapy treatment should I expect following my TKA?”
Typically your first few physical therapy treatments will focus on knee mobility and easy strengthening exercises. Your physical therapist will likely perform passive movements of your knee with light stretching throughout. It is important for your therapy to focus on your range of motion during the early stages of recovery to allow for maximal motion and full mobility. As you recover, your therapist will appropriately progress your stretching and strengthening exercises to return you to full function. A home exercise program (HEP) will be established early in treatment and progressed as needed. My personal goal when working with a patient is to return you to a state where your knee feels like surgery never occurred in the first place.
The questions above are some of the most common questions I receive on a daily basis from my TKA patients but these are just a starting point. I encourage you to reach out to your physical therapist and discuss all questions you may have. In the next blog post of this 3 part series, we will be discussing preoperative exercise and the benefits associated with exercise pending knee surgery.
Jake Miller, PTA
Citations
1. Jette, D., Hunter, S., Burkett, L., Langham, B., Logerstedt, D., Piuzzi, N., Poirier, N., Radach, L., Ritter, J., Scalzitti, D., Stevens-Lapsley, J., Tompkins, J. and Zeni Jr, J., 2020. Physical Therapist Management of Total Knee Arthroplasty. Physical Therapy.