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After a Total knee replacement (TKR) a person usually faces issues with walking, sitting properly or doing daily physical activities of certain kinds like, reaching up to top shelf for cereals on their own strength, playing soccer or basketball -basically things which require the knees to be strong. There is no denying the fact that TKR is performed only when somebody has faced a very painful joint disease. Some of the reasons for performing TKR is osteoarthritis, and also for other knee diseases such as rheumatoid arthritis and psoriatic arthritis. We go for such surgeries to reduce the possibility of disability.
In the United States (US) and Spain Length of Stay (LOS) is estimated to be around four days after knee replacement. This surgery is a very expensive affair in these countries. In the US TKR costs around $45,000 and $70,000. And the rate of primary TKR is projected to increase from 100,000 in 2018 to > 500,000 by 2030 in US. Therefore, it is very important to have enhanced recovery after surgery from partial or total knee replacement. There are various surgical methods to preserve broken joints and knees and according to recent studies done in the area. But we have here listed the protocols to follow for the patient and their family about his/her condition as an outpatient.
It is time, especially because of COVID-19 pandemic now with the lack of healthcare architecture, that we have “reset” pathways when we know about the limited capacity and increased demand of post-operative outpatient care that may help to drive positive changes. For successful recovery from knee replacement is when there is no need for furthering LOS for the patient.
Things Not Do After Knee Replacement,
Partial knee replacement or cemented, mobile-bearing unicondylar knee arthroplasty (UKA) yields good functional results, better than TKR, according to results obtained on postoperative Kearns-Sayre syndrome (KSS) by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Knee Score (OKS) and Fiber Optic Jacket Stripper (tool FJS) scores. In the same study, at a mean follow-up of five years (range, 3-7 years), implant survival was 97.1% (95% confidence interval, 91.1-99.1%), according to Knee Surgery, Sports Traumatology, Arthroscopy (2021) study.
After a TKR surgery the most common complaints are “complications ranging from pain and swelling, to implant rejection”. There are chances of infections occurring in the region right after surgery. Commonly known, knee replacement recovery time is 3 to 6 weeks. It may take 4 to 6 months or up to an entire year to fully recover. The total benefits of knee replacement surgery is unknown, but many people do start driving after six months and even play football again (maybe after a year).
Knee Replacement,
All-in-all, do check out for yourself- which knee replacement you want to go for. There are many kinds of orthopedic ailments noted today. There is IBD (Inflammatory bowel disease associated arthropathy) -associated arthropathy is considered a subtype of seronegative spondyloarthropathy. Knee replacement is often advised for Hemophilia and von Willebrand disease and Mseleni Joint Disease etcetera too.
Many times, there are side-effects of medicines approved by Food and Drug Administration, like Fluoroquinolones, these have 2 groups, based on antimicrobial spectrum and pharmacology: Older group: ciprofloxacin, norfloxacin, and ofloxacin and newer group: delafloxacin, gemifloxacin, levofloxacin, and moxifloxacin. If you have been taking these meds, do inform your doctor while you are explaining the problems you are facing with your knee/joints. The doctor may also ask themselves these questions.
In this article we will discuss things not to do after total knee replacement, things you can’t do after knee replacement, what to avoid after knee replacement, and remember the biggest mistakes in recovery from TKR.
Before we get to the points, it is important that the patient is aware that they shouldn’t put too much pressure on their wounds, right away. It is an incremental recovery process we are talking about here.
They must try to remain in a comfortable posture after a (total or partial) knee replacement surgery. Avoid doing things which require them to raise their height. Don’t use objects like stools, sofas, soft chairs, rocking chairs, and chairs that are too low. Most satisfied patients say, when getting up from a chair, one should slide toward the edge of the chair, and use their arms of the chair, and walker, or crutches for support to get up.
Following are the guidelines given by National Health Services, United Kingdom (UK) to be followed after the procedure of knee replacement (surgery).
Here’s How You Get “Back To Normal After Knee Replacement
1. DEALING WITH THE PAIN
Pain is there after keyhole knee surgery usually, and you need to have painkillers as prescribed by the doctors in charge. Not more, not less. Knee operated legs are not completely immovable but the toe and the knee coordination may not be the same as before, for some time.
2. BLOOD CLOTS
It’s also important to avoid blood clots so start to move around. Walk at first. Don’t keep lying on the bed because of the knee pain, the blood will pool up in your legs and make clots. After this surgery, you don’t want to have the Deep Vein Thrombosis (DVT). But in case, you don’t know, it can get serious and then TKR will take you 2-3 extra weeks or months to recover.
3. CARE EQUIPMENT
You need special stockings too, to wear after surgery to help with your blood circulation. These should be worn till you are able to move freely on your own- that is full six weeks. Depending on your age or the one in need of this, there must be somebody to help them with these stockings every time they have to wear and remove them, like going to the washroom and coming out after a bath. The nurse, after TKR most often instructs the patients well about this during their discharge. So, don’t worry too much about this one.
4. BLOOD THINNING INJECTIONS
Further, to reduce risks of clots you should ask your doctor for blood thinning injections.There are anticoagulants like heparin that can break down excess clots. But only on advice of the doctor will this procedure be followed. This process is said to reduce the healing process and increase the amount of bleeding a patient experiences. Do discuss your fears with your doctor.
5. KEEP HOME READY
You have to keep the home ready for yourself or the person who is going home after knee replacement. The must have at home after knee replacement are the little things that will make life easier, like a shower sponge with a long handle. A shoehorn with a long handle, a cane, crutches, or a walker. Something like a stick used as a “reacher” would be great to pick up things from the floor, or shelves, put on your pants, and take off your socks.
Some other medical care equipment advocated after knee replacement are as follows:
- Handlebars in the bathroom to allow you to steady yourself.
- A raised toilet seat or commode will make it easier for you to get on and off the toilet.
- A toilet safety frame will make it easier for you to get on and off the toilet.
6. SEXUAL ACTIVITIES
You cannot have sex for up to six to eight weeks after a knee replacement surgery. Depending on the wound condition, it is best to avoid vigorous sex and kneeling positions for some time right after surgery.
7. EXERCISES
After a knee replacement surgery keeping muscles strong is essential to promote function and battling diseases like sarcopenia, which occurs with age. There are exercises after knee replacement according to doctors. These you shouldn’t do up to 6 months of knee surgery. Joint replacement patients can start with low-impact exercises, such as walking, biking, swimming. These exercises include use of the elliptical regions of the body. As you feel better do weight training with lower weight/higher reps.
8. LEVELING-UP
High-impact activities should be avoided. Such as downhill skiing, scuba diving, in-line skating, ice skating, softball, volleyball, speed walking, horseback riding and hunting. Baseball, basketball, football, hockey, soccer, gymnastics, jogging, rock climbing, hang gliding, parachuting and low-impact aerobics are suitable, but do include more risk.
9. BE PREPARED
There is a possibility of a second joint replacement as well if you are not doing the regular follow-ups with the doctor and your physiotherapy. But there would be no particular restrictions for the kind of activities you can do or not. It depends on how much you know your body. If you get the revision surgery there may be significant instability or bone loss and you may not be as functional as after your first TKR.
10. HAVE PATIENCE
Some people get upset and lose patience with the huge change such as TKR that just happened in their life- it can cause depression and anxiety too. In this case our advice to the patient and family would be to “be patient during the time of recovery”. The pain will eventually subside and you will be able to walk again. Use your walking aids as support till then. Don’t ignore your pain, as directed by your doctor, follow regular exercises. And, soon, you will gradually start to put all of your weight on your knee and build up your strength.
11. DON’T FOCUS TOO MUCH ON THE WOUND
After the operation with cement or cementless mobile bearing unicompartmental knee replacements’ arthropathy treatment, the patient and his family is advised to stay up-to-date with post-discharge “follow up check-ups”. These can be conducted via telephone or video follow up.
12. DON’T PICK ON THE WOUND
Patients with keloids have increased odds of risk of arthrofibrosis (a buildup of scar tissue around a joint) following primary TKA. In this case, keep the incision clean. Avoid touching the wounded site, do not pick or scratch your incision. If you keep your incision dry it will perhaps heal much faster.
13. ASK YOUR QUESTION TO THE DOCTOR
Don’t forget to ask any personal questions to the doctor during the patient discharge. This is your right, to become aware. In the US, 46 states have “Assisted outpatient treatment (AOT)” that is, court-ordered treatment by law. In this procedure doctors have to take care of the facts like, gender, age, medical history while providing instructions for discharge. Any wrong information can be used against the hospital and the doctor.
14. DON’T BE NAIVE
Don’t naively trust your rehab professionals. Do tire yourself to get better. In early healing phases, try and massage your scar for 10-15 minutes a day (2-3 times a day for 5 mins). Use a non-perfumed Vitamin E lotion or oil to your scar area and a pad of your thumb or finger to firmly massage in a circular motion. Tiny steps.
15. HOPE
Last but not the least, given the above available ideas, you should still try to depend less on pain medications, slowly try to increase walking and taking up weight incrementally, and don’t waste your time thinking that “it’s never going to happen”. Because it will. Just believe that after a knee replacement, even walking is a huge achievement! And measure how much you have achieved every week according to your own scale.
Conclusion
Knee replacement is quite common in many countries and now, there is advanced medicine and technology to help you recover faster and better after a TKR. Age plays a huge role in decision making and post knee replacement outpatient care. Arthroplasties are designed according to your knee anatomical design.
Research suggests that there is still not sufficient knowledge of missed (foot) fractures and clear communication/expectation management before elective procedures could help to improve quality of healthcare and patient satisfaction. Don’t take any risk with your injury and post-knee replacement guidelines given to you. In six months, if you want to get better, the best you can do is be aware and ask for help. Don’t lose hope and soon you will be there. If you are an athlete then surely take up exercises seriously and work on your body movements in order to increase the range of motion.
