Knee replacement recovery and rehab
Recovering From Surgery
What can I expect after surgery?
3–6 weeks after surgery:
Most patients will still have discomfort, or report “not being able to get their leg in a comfortable position at night.” This begins to dissipate around 6–8 weeks after surgery.
6–12 months after surgery:
Patients usually report that they feel their knee replacement has become ”a part of them” and less like a piece of metal in their body.
Why am I so bruised?
Unfortunately, bruising is one of the most common issues after surgery. Some people bruise easily and so significantly that the entire leg may appear black and blue. This is usually worst at 5–7 days after surgery but be reassured it will settle. We use a combination of blood thinners after knee replacement
surgery which can make for some dramatic bruises. Your body will completely resorb the bruises by 2–3 weeks. This is normal and will take a few weeks to resolve. Just like the elite athletes, we recommend the use of ice, compression and relative rest to control the bruising.
Why am I so sore?
After any injury or surgery, it’s normal to trigger a pain response and this varies widely. Some people seem to skip through with nothing more than a paracetamol (e.g. Panadol) and a bag of frozen peas, while others who are not so lucky find themselves struggling for many months. We use a layered, or multimodal, approach that is individualised by your anaesthetist, our physician Dr Granger and the Acute Pain Service while in hospital.
Going into surgery, it is important we establish a baseline to better work out what is right for you and your recovery.
After surgery, in addition to baseline meds such as paracetamol, ice and anti-inflammatories, we usually use a background slow-release pain killer such as tapentadol (Palexia) with immediate release for breakthrough pain or acute discomfort. These are just guidelines, and your anaesthetist will discuss this with you in some detail.
Why is my leg swollen?
Swelling after surgery is due to a lot of factors. Your lymphatic and venous drainage system can be impaired during the first few weeks, even causing swollen ankles. Elevation, moderating your exercise and gentle massage will help. Rest assured it will settle but, in some patients, it can persist for up to 9 months. This is normal.
How can I manage my swelling?
Elevate! Elevate! Elevate! It is very normal to have pain and swelling after surgery and this may be around for up to 3 months. Less swelling makes it easier for you to bend your knee. Focus your efforts on elevating your operative leg higher than your heart. Remember “TOES ABOVE YOUR NOSE”.
You may put pillows behind your operative knee, to help raise it enough so that your knee is higher than your heart.
Gentle compression can help to reduce swelling. It should feel snug but not tight like it’s cutting off your circulation. Early cryotherapy/ice and compression can also be extremely helpful. Options include:
My knee is warm and tender. Is this normal?
You may not know it, but you have two scars. One on the skin and a separate one on the inside of your knee. This internal scar may get inflamed, causing heat as well as some discomfort. If the swelling and the heat increase, be sure to let us or your GP know. Don’t forget to ice, compress, and elevate.
Why is part of my knee numb?
The outside half of your knee is typically numb post-surgery. This is because of a small skin nerve that is cut during your surgery to allow access into your joint. Unfortunately, this cannot be avoided but the good news is that it only affects a patch of skin about the size of the palm of your hand and will shrink over time.
I’m worried I have an infection, what do I do?
Contact us or your GP as soon as possible if you have increasing redness, heat, pain, swelling or any signs of pus around your joint. It’s common to have reactions to the dressing or sometimes patients develop a suture granuloma (a mass of tissue around the wound) which should settle with time. It’s important we know either way.
My knee is still swollen months after surgery – is that normal?
Unfortunately, some people may experience thickening and swelling of the joint lining. This “synovial vascularisation” can take years to settle and is largely influenced by the state of your knee prior to surgery.
It’s not all doom and gloom if you are unlucky enough to be in this group as we have an algorithm to help guide your recovery. This can include careful aspiration to remove fluid from the joint, and cortisone injections or newer vascular microembolisation techniques.
Why do I have to take aspirin for 2 weeks post op?
Deep Vein Thrombosis (DVT) is a blood clot that occurs in a deep vein, that is, a vein that is not on the surface of the skin. DVT can occur anywhere in the body but is most often seen in the leg. The most serious complication of DVT is pulmonary embolism, which is when a piece of the blood clot breaks off and lodges in the lung. This causes a serious illness and is potentially life-threatening. The main signs of DVT are pain and swelling in the affected area, usually your calf or thigh.
You will be discharged with aspirin (if you are not on any other blood-thinning medication) to help thin the blood and reduce the risk of a DVT. Please continue to finish the packet you have been discharged with.
If any symptoms arise, please contact your GP or our rooms immediately to get further testing, such as an ultrasound, to confirm the presence of a DVT and receive appropriate treatment if needed. Please avoid any massage to the area until cleared.
My pain is OK during the day but bad at night – how do I manage it?
It’s quite common to have neuropathic (nerve-related) discomfort at night. This is normal and will settle. Neuropathic pain is often worst at night because we lack the normal daytime stimuli and signals that distract our brain. With no distractions at night, full attention is turned to your joint which, for some people, results in deep discomfort and many early-morning hours watching the clock.
A good sleep routine (regular bedtime, dark environment, cool temperature, avoiding blue light from computer screens) and heat such as a hot shower and a heat pack over your muscles (but not the joint so soon after surgery), and slow-release medication should help. Spasm and cramping at night gradually improve and typically take 6–8 weeks to resolve. You can try taking magnesium (200 mg once a day) to help.
Can I rub creams on my wound?
The delicate healing of your wound can be upset if you rub it too hard or rub in the wrong compounds. Please seek nursing or medical clearance before you use creams on your wound.
How can I prevent constipation?
It is very common to have constipation after surgery, especially when taking pain medication. Kiwi fruit (skin and all) is great for constipation. Taking an over-the-counter stool softener, such as Coloxyl, is also a good way to prevent this problem. If this is not enough, you can add senna twice a day. Please make sure you’re staying hydrated and drinking plenty of fluids. You can try prune juice in addition to water. Some patients have found Smooth Move, a senna-based tea, to be helpful in relieving constipation.
Take these medications until you have regular daily bowel movements, then decrease to once a day. You should not use these medications if you experience loose stools or diarrhoea. If you develop severe abdominal pain/bloating and cannot eat or tolerate fluids, please present to the Emergency Department for evaluation.