BoneSmart® Hip / Knee Replacement Forum
Joint Replacement Patient Advocacy
and Online Community
  1. RATE YOUR SURGEON ON OUR NEW JOINT SURGEON LOCATOR

    Your opinion matters so please click on this announcement to find out how to rate the surgeons you have worked with

    You could also go to the Surgeon Locator via the blue nav bar at the top - find the tab "Surgeon Locator"

    Dismiss Notice

TKR FAQs (Frequently Asked Questions)

Discussion in 'LIBRARY Knee Topics' started by Jamie, Jul 23, 2017.

  1. Jamie

    Jamie ADMINISTRATOR Administrator
    Thread Starter

    Member Since:
    Mar 24, 2008
    Age:
    70
    Messages:
    54,953
    Gender:
    Female
    Location:
    Kansas
    Country:
    United States United States
    [​IMG] Below is a list of frequently asked questions (FAQs) regarding knee replacement surgery. Click on the question link and you will be provided with an answer and links to additional information on the subject.

    For even more information, please visit the BoneSmart Library, or for topic by topic information, see the BoneSmart Library index.

    [​IMG]Our thanks go to BoneSmart member Roy Gardiner for initiating this thread.
    _______________________________________________________________________________________

    Knee Replacement FAQs

    What will my recovery be like?

    What are the most important things to do during recovery?

    What are the most important things NOT to do during recovery?

    How soon can I return to work?

    I can't afford to be an invalid for weeks. How can I speed up my recovery?

    I can’t straighten my leg properly or bend as much as I want to. What should I do?

    What is an MUA?

    My recovery is stalled and my surgeon is recommending MUA. Should I have it?

    I'm worried about becoming dependent on prescription pain medication. Should I wean myself off gradually or go cold turkey?

    My family and friends are giving me lots of advice which goes against what’s said on BoneSmart. Who should I believe?

    I feel so guilty at sitting around doing nothing for days and weeks in recovery. I have things to do! How can I cope?

    My physiotherapist tells me I have a limited “window of opportunity” to regain range of movement and that I should push through the pain barrier during exercises. Should I take extra pain medication to cope with this?
     
    • Like Like x 3
  2. Jamie

    Jamie ADMINISTRATOR Administrator
    Thread Starter

    Member Since:
    Mar 24, 2008
    Age:
    70
    Messages:
    54,953
    Gender:
    Female
    Location:
    Kansas
    Country:
    United States United States
    What will my recovery be like?

    How long is the proverbial piece of string?​

    No two recoveries are alike. It's important not to compare your recovery with another's and especially not to be discouraged if someone else appears to be doing better. Here is a general idea of what you can expect with your recovery:​

    at1_gstatic_com_images_c32601d5ed6495e650e0915b20b5f96f._.jpg
    2 days - 1 week:
    * Walking short distances with walker or crutches​
    * Using the bathroom independently​
    * Going up and down stairs one foot at a time a few times a day​
    * Discharged from hospital or rehab center​

    at3_gstatic_com_images_8f3563549028c77acde88c812dcd9056._.jpg
    2nd week - 1 month:
    * At home​
    * Learn that 'less is more' and to work smarter, not harder
    * Apply the principle of no pain, more gain
    * Find your limits and the right balance between activity and rest; it will change on a daily basis​
    * Expect a roller coaster ride where some days you move forward; others you take steps backward​
    * Sleeping habits will be interrupted; rest when and where you can​
    * Apply RIMES (see below) and to do as little as possible except rest and recuperate​


    at3_gstatic_com_images_152715b2585eb8d688394f335f58f3ac._.jpg
    1-2 months:
    * People often suffer from 'post op blues', as they feel (incorrectly) that recovery is stalled and they wish they'd never had surgery​
    * Hang in there, recovery is progressing even if you can't see it​
    * Gradually increase activity while still getting plenty of rest​
    * Transition from walker to crutches to cane as long as you are stable and not limping​
    * Continue to take pain medication on a set schedule if pain/swelling are present​


    at3_gstatic_com_images_6691cd7d7fb362d9d488a09953ed8c25._.jpg
    About 2 months:
    * Walking better, starting to feel better​
    * You may be able to reduce pain medication -- but don't set targets, it's important to keep taking medication until you no longer need them.​


    at3_gstatic_com_images_76b510ff7292a0a9315f6ab688568194._.jpg
    3 months:
    * Walking is improving; keep using a cane until you do not limp​
    * Pool therapy may help you move without stressing tender soft tissue​
    * Stamina and tiredness will still be a problem until around 12 weeks​
    * Probably can resume work on a phased-in schedule at 10-12 weeks. This seems a long time, but TKR takes it out of you physically and mentally, and going back too soon can slow your recovery.​

    at1_gstatic_com_images_3b7c2f59d0af6aa0702b98452ddf41d2._.jpg
    6 months:
    * You are well into your recovery and past the stage of wishing it never happened​
    * Medication is reduced or eliminated entirely.​
    * You are beginning to resume your normal activity level as shown on the BoneSmart recovery chart


    at0_gstatic_com_images_a81274821b3b9fab671bd0289d7c2084._.jpg
    1 year:
    * Life now generally pain-free and much better than before surgery​

     
    • Like Like x 2
  3. Jamie

    Jamie ADMINISTRATOR Administrator
    Thread Starter

    Member Since:
    Mar 24, 2008
    Age:
    70
    Messages:
    54,953
    Gender:
    Female
    Location:
    Kansas
    Country:
    United States United States
    What are the most important things to do during recovery?

    RIMES -------- Rest, Ice, Medicate, Elevate, Stretch


    Rest: Don't stand if you can sit; don't sit if you can lie down. Your knee has been assaulted and damaged by surgery and it needs to heal. Rest is the best thing. Sit in the most comfortable chair you can manage, as much as you can. Watch TV. Read a book. Snooze. This is your recovery time. Do NOT feel obligated to do things for your family or your household. For some of us who are used to doing for others and being in control, this can be quite a challenge! Work should be out of the question for at least a couple of months....longer if you can manage it.​


    [​IMG]
    Ice: Ice applied to the knee will greatly help in reducing pain and swelling. Icing can be done simply by using bags of frozen peas. Or there are a variety of ice packs and equipment or machines to make the process easier and more comfortable. Icing is critical to recovery and in the early days you may spend many hours with ice packs applied to your knee. It is impossible to ice too much as long as you keep a cloth buffer between your skin and the ice source. Many people even sleep with ice on both the front and back of their knee.​


    at1_gstatic_com_images_01dc59df206817576c772a806fb69efd._.jpg
    Medicate: Pain control is essential. The very fact of being in pain can slow your recovery. Take your prescribed medications by the clock, don't wait until pain starts - the BoneSmart pain chart explains how to "stay ahead of your pain." Do not worry about becoming addicted to pain medication, it is a myth. People taking medication for pain over a long period of time may find their body is "dependent" on the medication. But this is not "addiction" and you can ease yourself off the medication gradually over a period of weeks with no side effects.​


    [​IMG]
    Elevate: Fluid accumulation and swelling are the body's normal reaction to the injuries that have taken place to your knee. Inflammation can further increase the amount of fluid present and also increase pain levels. Elevation - "toes above nose" - helps in reducing swelling by helping the body to remove fluid from around the knee. Check the right and wrong ways to do it.


    at1_gstatic_com_images_7965cf5d585e6c260bda030d38a6dc02._.jpg
    Stretch: You should do gentle stretching and bending exercises to increase your leg's range of motion (ROM). ROM is measured with numbers representing the bend (flexion) and leg straightening (extension). But it is not a good idea to try and set performance goals for your ROM. Your knee will get there in its own time. You can gain ROM for up to a year or more, so there is no hurry! Here are some ideas for exercises that fall into the "gentle" category and another approach that may be helpful to you. See also Five "P’s" of knee recovery
     
    • Like Like x 1
  4. Jamie

    Jamie ADMINISTRATOR Administrator
    Thread Starter

    Member Since:
    Mar 24, 2008
    Age:
    70
    Messages:
    54,953
    Gender:
    Female
    Location:
    Kansas
    Country:
    United States United States
    What are the most important things NOT to do during recovery?

    Don't hurt yourself, or allow others to hurt you.

    Imagine that you had a broken leg. You wouldn't consider attempting to walk on it before it's fully healed. It's the same with your knee. Exercising to the point of pain will set you back, not help.​

    at1_gstatic_com_images_68720c84a76d83b7d5ff6f309af8e248._.jpg
    "No pain, no gain" is something you might hear from your doctors, your therapist, friends or family members. It simply is not the case. You will be far more likely to benefit from rest and gentle stretches and bends than you will from someone pushing you to the point of real pain.​

    The so-called "Window of opportunity", also a myth. It is possible to gain range of motion (ROM) for many months and even over a year after your knee replacement. It is counter-productive to push hard on a painful knee to try to improve ROM. All you will get is more pain and swelling.​

    Remember:
    - If it hurts, don't do it.​
    - If your leg swells or gets stiff in the 24 hours after doing something, don't do it.​
    - If you won't die if it's not done, don't do it.​
    - Don't stand if you can sit; don't sit if you can lie down.​

    Don't worry about Range of Motion. Many therapists and doctors will choose to measure your progress by your ROM numbers. That's okay, but all recoveries are different, and it can take weeks or months to get to a certain level of motion. Listen to your body. It will tell you when you can step out and try some new and more strenuous activity. Until then, keep doing RIMES and the results will come.​

    ai21.photobucket.com_albums_b286_flagady15_BoneSmart_kneeROM.jpg
    Don't worry about numbers or progress, especially in the first weeks. This is serious surgery. You will feel bad from time to time. This is normal. Try not to let the bad feelings dominate you. Yes, that's easy to say; hard to do. But however bad you feel, it is most likely that you are recovering normally. It REALLY IS a difficult surgery to recover from! Time and a great deal of patience are required in most cases.​


    at3_gstatic_com_images_bed4fdb5f575aa4410c249b103505167._.jpg
    Don't be swayed by comments from friends and relatives trying to "help." Without realizing it, those who care about you can put you on a guilt trip with comments about your lack of progress or by telling a story of someone they know or heard about who bounced back in "a couple of weeks" following a knee replacment. Smile and immediately forget those comments. Rely on the input from those who have actually HAD a knee replacement. They are really the only ones who know what you're going through.​
     
    • Like Like x 3
  5. Jamie

    Jamie ADMINISTRATOR Administrator
    Thread Starter

    Member Since:
    Mar 24, 2008
    Age:
    70
    Messages:
    54,953
    Gender:
    Female
    Location:
    Kansas
    Country:
    United States United States
    How soon can I return to work?


    at0_gstatic_com_images_1a977cea5ebc49ff4963d900c68f5e39._.jpg
    Expect 10-12 weeks. Normally 10-12 weeks is recommended before planning to return to normal activity and work. You should plan for a phased return. If your job is extremely active such as construction, retail or other professions that require a lot of time on your feet or kneeling, squatting, and lifting you may need even more time for your muscles to recover strength and flexibility.​

    Work is stressful both physically and mentally and returning too early can be counterproductive. It's not that you can't push yourself and go on to work, but you'll experience a slower overall recovery and one with a lot more pain and swelling if you do. Remember, this is YOUR time. You need time to heal properly. Your employer may not be happy with the length of time you need, but chances are good that he would prefer to have you at 100% when you DO come back.​

    Because the results of surgery are so variable, and people have such varied work, it is almost impossible to make more general rules, except that you need to have the full co-operation of your workplace. Please ask specific questions on the forum.​
     
  6. Jamie

    Jamie ADMINISTRATOR Administrator
    Thread Starter

    Member Since:
    Mar 24, 2008
    Age:
    70
    Messages:
    54,953
    Gender:
    Female
    Location:
    Kansas
    Country:
    United States United States
    I can’t afford to be an invalid for weeks. How can I speed up my recovery?

    You cannot speed up your recovery any more than you could speed healing of a broken leg. Your body will heal at it's own rate under normal conditions and possibly at a SLOWER rate if you push it too hard.​

    at0_gstatic_com_images_93e9b1489229b8decac6a5ab75fc1030._.jpg

    You can worsen outcomes by trying too hard or hurt yourself in attempting to make thing move along faster. Something else has to give. This is why it's so important to communicate with your supervisor early in the surgery planning process to plan for your return. You need to develop a plan that provides for you to be off work an appropriate amount of time for healing.​

    If you have specific questions related to your surgery or returning to work, post them on the BoneSmart forum. It is very likely that others have had similar "insurmountable" problems and resolved them. You will receive the benefit of their experience in posts responding to your questions or concerns.​
     
  7. Jamie

    Jamie ADMINISTRATOR Administrator
    Thread Starter

    Member Since:
    Mar 24, 2008
    Age:
    70
    Messages:
    54,953
    Gender:
    Female
    Location:
    Kansas
    Country:
    United States United States
    I can’t straighten my leg properly or bend as much as I want to. What should I do?

    at3_gstatic_com_images_6522c26e794eb287173bf4c9ff551158._.jpg

    First, don't panic; it's probable your recovery is within the normal range and that improved range of motion will come over time. You should continue with gentle stretching exercises, like this author's short list.

    Remember that it takes patience and time to get a full range of motion back. You can have swelling inside the knee compartment that you cannot see that's holding you back. Icing, elevating and taking some type of pain medication if you have pain are helpful if done on a regular basis.​
     
    • Useful Useful x 1
  8. Jamie

    Jamie ADMINISTRATOR Administrator
    Thread Starter

    Member Since:
    Mar 24, 2008
    Age:
    70
    Messages:
    54,953
    Gender:
    Female
    Location:
    Kansas
    Country:
    United States United States
    What is an MUA?

    at0_gstatic_com_images_50fcc2891eec69ca6d81a2eaa2b1c3fb._.jpg
    Manipulation Under Anaesthetic (MUA).
    Sometimes after knee replacement surgery the ligaments, tendons and muscles can stick together to form adhesions. This prevents full range of motion in the knee joint. It sometimes is referred to as "scar tissue," but it really is not the same as scar tissue that develops as part of the healing process. It is too painful to force movement and break the adhesions, so a surgeon does it while you are asleep, to attempt to gain full range afterwards. Read more about an MUA.​
     
  9. Jamie

    Jamie ADMINISTRATOR Administrator
    Thread Starter

    Member Since:
    Mar 24, 2008
    Age:
    70
    Messages:
    54,953
    Gender:
    Female
    Location:
    Kansas
    Country:
    United States United States
    My recovery is stalled and my surgeon is recommending MUA. Should I have it?

    An MUA can be an effective means to move you forward when you've hit a brick wall and cannot bend your knee any further. Usually it is not a good idea if you still have swelling in your knee, as the procedure itself can greatly irritate tender tissues and create even more pain and swelling.

    Here are some articles from the BoneSmart Library to help you decide if an MUA is right for you. The first presents some contrasting studies on the procedure and its results. The second article is an older study that indicates only minimal improvements from an MUA.

    Surgeons sometimes will recommend this procedure in the first couple of months of your recovery and that may be too early to get the results you are looking for. It should not be done before 8 weeks have passed. It can be done later. A few of our members have had successful MUA's done after 6 months and even up to a year.

    at1_gstatic_com_images_df8531843a8a6a81718033acfe5bb32c._.jpg

    Whether to have an MUA or not is something that needs to be discussed with your surgeon. When done at the proper time, they have truly made a difference for some patients.​
     
    • Funny Funny x 1
    • Creative Creative x 1
  10. Jamie

    Jamie ADMINISTRATOR Administrator
    Thread Starter

    Member Since:
    Mar 24, 2008
    Age:
    70
    Messages:
    54,953
    Gender:
    Female
    Location:
    Kansas
    Country:
    United States United States
    I'm worried about becoming dependent on prescription pain medication. Should I wean myself off gradually, or go cold turkey?

    at3_gstatic_com_images_321432e2a9e3bc95d76b279e843b68d1._.jpg

    You should do neither as long as you are experiencing pain.​

    Proper pain management is an essential part of recovery from joint replacement surgery. Unless you have a history of substance abuse then it is highly highly unlikely that you will have an addiction problem. Conversely, it is essential to control pain (more references and a detailed treatment), because pain by itself slows recovery.​

    TheBoneSmart mantra is to take your medicines by the clock on a schedule so that you stay ahead of the pain. You'll actually take less medication this way than if you are constantly trying to overcome pain that's already uncomfortable. Of course, you must follow your prescribed dosage and not exceed it. But don't cut yourself out of pain relief when you are still hurting. You will not become addicted. Any physical dependency to a pain medication can be dealt with quite successfully using a tapering off schedule over several weeks.​
     
  11. Jamie

    Jamie ADMINISTRATOR Administrator
    Thread Starter

    Member Since:
    Mar 24, 2008
    Age:
    70
    Messages:
    54,953
    Gender:
    Female
    Location:
    Kansas
    Country:
    United States United States
    My family and friends are giving me lots of advice which goes against what’s said on BoneSmart. Who should I believe?

    Unless your friends and family have some sort of medical qualifications or they have actually been through a knee or hip replacement themselves, their well-meaning opinions are probably of no value to you. Joint replacement surgery and recovery are like no other procedure. Especially for knee replacements, recovery is measured in terms of weeks and months, not days. Most people (and unfortunately, many doctors!) simply do not understand what is involved.​

    If your family and friends are upsetting you and causing you to question informed advice, then they are harming, not helping, you. Most stories of someone else's recovery are far from accurate and should not form the basis for you to measure your progress. Your recovery is YOURS and yours alone. Each of us is unique and our body will heal on its own schedule.​

    at2_gstatic_com_images_fe58f6ef25bb58dfdb9ce544b6929f87._.jpg
    When dealing with these comments, you can quietly listen and then ignore the advice or you can show them articles from our BoneSmart Library if you want to educate them. But do not allow this type of "help" to cause you to think you are somehow not healing fast enough.​
     
    • Agree Agree x 2
  12. Jamie

    Jamie ADMINISTRATOR Administrator
    Thread Starter

    Member Since:
    Mar 24, 2008
    Age:
    70
    Messages:
    54,953
    Gender:
    Female
    Location:
    Kansas
    Country:
    United States United States
    My physiotherapist tells me I have a limited “window of opportunity” to regain range of movement and that I should push through the pain barrier during exercises. Should I take extra pain medication to cope with this?

    NO. While you should take some pain medication before a therapy session, your exercises and your therapist should NEVER push you to the point of pain. No pain, no gain is absolutely wrong and it can set your recovery back.​

    at2_gstatic_com_images_01f1349e8bdf2133cb3135872a78d466._.jpg

    Your body is not weak and in need of physical training. Much like when you have a broken bone, it's in a healing state. Therapy should be designed to provide enough movement to keep you as flexible as possible during this time. It may incorporate massage to relieve swelling. But it should never make you cry out in pain.​

    If it hurts, don't do it! The therapist works for you and you have the right to give them parameters for your treatment. That should include an agreement that when you say, "Stop" they do in fact STOP.​

    Don't allow your therapist to tell you that you have a small Window of Opportunity in which to gain a specific amount of range of motion (ROM). Many people report improvements in ROM for as much as a year or more following surgery. Gentle bends and stretches will get you there much faster than pain and pushing.​

     
    • Like Like x 7
  13. Jamie

    Jamie ADMINISTRATOR Administrator
    Thread Starter

    Member Since:
    Mar 24, 2008
    Age:
    70
    Messages:
    54,953
    Gender:
    Female
    Location:
    Kansas
    Country:
    United States United States
    I feel so guilty at sitting around doing nothing for days and weeks in recovery. I have things to do! How can I cope?

    Adjust your thinking! Your main job right now is to allow your body the time it needs to heal. Relax and allow it to happen. This is your time....accept it.​

    You do yourself no favors by pushing too hard and you actually can set your recovery back by doing so. It's hard for most of us to realize we are not in control during recovery. But most of the things on your "must do" list really aren't that critical. Let them go....or have someone help you.​

    at0_gstatic_com_images_2c3aa19ccb11dc87590282df41e58646._.jpg at1_gstatic_com_images_c967e5ea86d610f3519b5ec86b9c22b5._.jpg

    Here is an excellent article from the BoneSmart Library that addresses the importance of letting those around you help you during this time. Remember....it's only temporary and then you'll be going back to your normal life. ​
     
    • Like Like x 1

Share This Page