Is Knee Replacement the Only Option?
Many patients come to us after being told that they need to have knee replacement surgery. Although there are times when knee replacement surgery is the best option, many patients benefit from the Shelbourne Knee Center’s directed rehabilitation program and are able to avoid surgery.
Recently, we studied 50 patients with stiff, weak knees. These patients were treated with physical therapy that mainly focused on range of motion. 41 of these patients had arthritis and many had been told by other doctors that they would need a knee replacement. 84% of the patients in this study significantly improved with physical therapy.
In situations when total knee replacement is the best option, this same rehabilitation (focusing on range of motion) before surgery allows for a faster recovery. If you think you need a total knee replacement (or have been told you do), call us at 1-888-349-5633 for a second opinion to explore your options.
We view total knee replacement surgery as a process rather than just a procedure. We work hard to provide patients with comprehensive care that includes preoperative planning and continues through surgery and recovery. We believe it is important for the physical therapists and doctors to work closely together to make this process as smooth as possible. We also believe it is important for the patient to work with the same physical therapist throughout all phases of this process. We will work together to provide patients with the information they need to plan for surgery.
Patients benefit from working with a physical therapist to maximize their range of motion (ROM) before total knee replacement surgery. We feel that this is a key component of a successful outcome. Rehabilitation before surgery will also focus on decreasing swelling and improving gait (walking).
We start by improving knee extension (straightening motion) first. Once movement in this direction is maximized, we work on improving knee flexion (bending). Finally, some gentle strengthening exercises may be used. Patients are also instructed in the use of a Cryo/Cuff to reduce pain and swelling.
Before surgery, patients will be educated about the surgery process, caregiver assistance required after surgery, and postoperative recovery and rehabilitation.
Patients will be asked to select a family member or friend who can provide full-time help for the first 7-10 days after surgery. This caregiver will be included in the education process before surgery so they know what to expect. Most of the help is needed to minimize the amount of walking and standing that the patient must do (meal preparation, self-care activities). Caregivers will also help keep track of daily exercise sessions and medications. If a caregiver is not available, we can help you arrange for extended care.
Surgery and hospital stay:
Total knee replacement surgery is done to resurface the bones that have been damaged by arthritis.
A thin layer is removed from the end of the bones of the knee joint. The surface is replaced with components made of metal and plastic. The x-ray above shows an arthritic knee before surgery and after total knee replacement surgery.
Postoperative rehabilitation is started the day of surgery. Many exercises will be familiar to the patient from before surgery. Most of our patients (75%) spend 2 nights in the hospital after knee replacement surgery, but about 20% have gone home after one night in the hospital. A small number of patients have stayed 3 or more nights.
Patients will continue with their exercises at home for the first week after surgery. Patients will use a walker for the first 1-2 weeks after surgery, and many will use a cane for a short period of time after that. However, patients may begin walking without assistance as soon as they feel ready.
Physical therapy visits are usually every 1-2 weeks during the first month after surgery, and monthly visits begin during the second month. The physical therapist will advance the exercise program based on each patient’s recovery.
We believe our success with knee replacement is related to our rehabilitation program and our pain control methods. We have been able to minimize the need for narcotic pain medications through the use of anti-inflammatory medications along with compression, elevation, and cold therapy for the knee. In fact, 10% of our patients have recovered from knee replacement surgery without ever taking any narcotic pain medications.
Knee replacement patients feel better, have better function and less pain as they get motion back in their knee. Over 80% of our patients can bend their knee beyond 90 degrees at one week post-op. At one week post-op, 97% can fully straighten out their knee.
We survey our patients about the function of their knee before and after surgery. The average survey scores improved from 30 out of 100 points before surgery to 75 out of 100 points at 3 months after surgery.