Heading in for a Knee Replacement?

So it's time, you have exhausted all other options, but it's not enough and that knee is truly getting in the way of your quality of life, a joint replacement is your last option.


Now that hospitals are booking elective surgeries again (or at least Collingwood Hospital is) some of you may be getting dates and thinking that the work is done and all is soon to be resolved. There is a lot you can do to get your ducks in a row so that your outcomes are as best as possible.


Total Knee Replacements (TKR) are increasingly common and outcomes are favorable for improving quality of life, but it is not that simple. There is a lot of work still to be done to get you to where you want to be.


However, what does this mean?

Does that mean each person reached their goals?

Does it mean they all returned to a sport or activity they wanted to do?

Does it mean they stopped taking pain medication?

Does it mean they stopped seeing a therapist for the knee pain?


We don’t know the answer to those questions. Outcomes for surgeries such as TKR are based on whether there were any adverse effects of the surgery (infections etc), and were there improvements seen on questionnaires evaluating quality of life. I will say these questionnaires are good and will cover a lot of general points and activities of daily living, but they are not SPECIFIC TO YOU. A review of the research in 2016 recognized that although there were clear improvements in activities of daily living and pain relief after TKR, patient satisfaction after TKR was only “moderate” and that 54% of patients still had trouble on stairs 2.6 years (average) after surgery (Choi & Ra, 2016).


Did you also know that 20% of total knee replacements suffer from chronic pain after surgery? That's 1-in-5 people going into surgery that still have chronic pain issues afterward (Wylde et al, 2018). That's a lot more than even I thought there would be!


I hear it all too often, “I don’t need to work on my knee, it is getting replaced soon”. My response is always the same, well what about we work on the knee so that both it and you are prepared for the surgery and give you the best chance of having a great outcome? Or what about we work on some other areas of your body, and your physical health in general as that also has deteriorated as long as your knee has been an issue. And actually, you can do most of this yourself at home!


So what can you do to improve your outcomes? This is what I will suggest:


1. Get assessed.

I do not mean by your surgeon or family doctor. Get assessed by whatever therapist is going to work with you during the rehab afterward (eg a physio). It is great for us to get to know the client before surgery. It is useful to see the joint beforehand and get an understanding of what you are able to do and how it feels. This can be an indicator of how you will do after surgery as well!


2. Understand the process.

The number of times I have seen clients for physiotherapy after their TKR and they were completely surprised that they were walking on the leg the same day, and that they did not get to stay in the hospital longer! Some of them were confused about why it was even painful afterward at all, or that they would need further rehab after the surgery! Understanding the process is super important so that it gets you mentally ready for the challenge ahead. It is unlikely you would set off for a marathon without knowing the route or how far you are going... And recovering from knee surgery (or any surgery) is a marathon, not a sprint. Be prepared in every way you can so that your expectations are on point. Your surgeon should take the time to talk you through the surgical process, but also speak with your physiotherapist and rehab team about what to expect afterward, short term, medium, and long term!


3. Work on a prehabilitation program.

Prehabilitation is a term we use to describe exercise and strategies used before surgical intervention in a way to improve outcomes afterward. There is evidence in the research that even home-based exercise can improve outcomes after TKR (Jahic et al, 2018). There are a number of reasons it is said to work.


It can address major strength deficits that occur after surgery

It teaches similar if not the same exercises you will be doing after the surgery, this is a great way to teach you the technique so that you are not learning them for the first time with a knee that feels completely different and maybe doesn't move very much! It also preps you mentally for the process by helping you understand the process as I mentioned above.

20% of TKR results in chronic pain. There are risk factors associated with this and working on a prehabilitation program should identify any of these risk factors and look to address them.

6 weeks of a home exercise program improved both function and the knee pre-surgery and had better outcomes 6 months afterward (Jahic et al, 2018).


4. Set goals that are specific to you.

What are your goals?

What are your goals 3 months, 6 months, and 12 months after the operation?

Make sure your therapist and your surgeon are aware of your goals, they can help adjust timeframes and expectations if needed.


5. Organize your rehabilitation

When are you going to see your physio after the surgery, how often? How long for? How are you going to get there? Are they coming to your home? Do you need some exercise equipment or assistive devices? Everything happens so quickly, you will be out of the hospital before you know it, and the last thing you want is to then not have any physio booked to progress your rehab because they are busy the rest of the week, or you are unable to get into the clinic because no one can take you. Don’t wait, get things organized in advance, if it needs to change for whatever reason it is always easy to take appointments out of our schedules but not always possible to get them in at the most convenient time for you!


Getting a joint replacement is a big deal, don’t pretend it is not. Take the time to organize yourself, speak with professionals, and commit to the process fully. Outcomes are favorable for TKR and that is fantastic, but we should be aware that sometimes it is not favorable, and is favorable good enough for you? There are things you can do to give yourself the best outcome possible so get to it and make the process worthwhile!




References

Choi YJ, Ra HJ. Patient Satisfaction after Total Knee Arthroplasty. Knee Surg Relat Res. 2016;28(1):1-15. doi:10.5792/ksrr.2016.28.1.1


Jahic D, Omerovic D, Tanovic AT, Dzankovic F, Campara MT. The Effect of Prehabilitation on Postoperative Outcome in Patients Following Primary Total Knee Arthroplasty. Med Arch. 2018;72(6):439-443. doi:10.5455/medarh.2018.72.439-443


Wylde V, Beswick A, Bruce J, Blom A, Howells N, Gooberman-Hill R. Chronic pain after total knee arthroplasty. EFORT Open Rev. 2018;3(8):461-470. Published 2018 Aug 16. doi:10.1302/2058-5241.3.180004


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