David P. Adkison, MD, St. Vincent's Orthopedics, PC
Knee Replacement FAQs: After Your Surgery (Months 1-9)
Is it normal for my knee to feel warm?
Yes, it is — for up to about 9 months. The warmth comes from your body’s reacting to and adjusting to the new components and also to the surgery itself. One of the best gauges you’ll have for knowing when the warmth should go away is when the scar completely fades to the color of your skin.
Can I do too much therapy and exercise?
Yes, you can. Oftentimes when the knee is inflamed therapy is absolutely the worst thing for your knee. When the knee feels especially hot or swollen, the best thing to do is to lay off therapy for a few days. Most people don’t need more than 3 or 4 days of therapy per week. It’s good to give yourself one easy day per week when you don’t do therapy or walking.
Is it OK to still be needing a pain pill, especially at night?
It’s very common to still require a pain pill, especially at night. At the end of the day as things begin to settle down, you begin to notice more how irritated the knee really was from the day’s activities. Some folks also require a sleeping pill for a brief period of time. Because we’re all put together differently, some folks don’t take any pain medicine after 2 weeks while others are still taking a night time pill at 3 months.
What is normal motion?
Normal motion, for our purposes is from full extension (which we call zero degrees) to at least 130 degrees, or more, if you can obtain it. We work very hard at surgery to maximize your motion. We really want you to be able to do the activities that you enjoy that require full motion such as being able to squat in the garden to pull weeds or squat to line up a putt.
When can I play golf? Or go on a cruise?
You can play golf very quickly depending on what you mean. I will usually let you have a putter and a chipping wedge back in about a month and work on your short game. Full golf swing takes about 3 months. You can go on a cruise any time after about 6 weeks.
Can I kneel?
This is a very controversial question. Some doctors prohibit kneeling. I do not prohibit kneeling but I do want to educate you to the proper way of kneeling after knee replacement surgery. The reason we don’t want you to kneel on your kneecap is because during surgery, we trim away from the kneecap. Therefore, theoretically, the trimmed kneecap is weaker than the original. Also, when kneeling a great deal of stress is put on the polyethylene cap that we’ve placed inside your knee. If you must kneel, such as to pray or perform a particular aspect of your job, we ask that you kneel on the upper part of the shinbone. You can find the area for safe kneeling by feeling your kneecap and moving your hand towards your ankle. You’ll feel a knot on your leg where the tendon attaches. That’s where we want you to put the pressure when you kneel.
Is popping in the knee normal?
We prefer that the knee be completely quiet — but popping is not uncommon. The popping is caused by scarring in the knee joint as a result of the surgery. Most of the time popping will resolve at about the same time the warmth resolves. However don’t be alarmed if you have some occasional pops for the remainder of the knee’s life.
How long will the scar be red?
Some people lose the redness by 3 months and other people take 15 months. As long as the scar is red, remember that you’re still healing and that the knee can be very irritable.
Can I do anything to prevent keloid?
The formation of keloid is determined by genetics. When we see keloid in the skin, this alerts us that there’s vigorous scarring going on beneath the skin as well and may cause problems with motion. A compound has recently been released that will prevent the widespread and "heaping up" nature of keloid. The compound is effective only on the skin and won’t work deep inside the joint. If you so desire, to prevent this condition from occurring, we will gladly refer you to Dr. Michael Beckenstein’s office to purchase this compound.
Can I go to the beach and get in the water?
Yes, you can. But be very careful of uneven surfaces beneath the waves. You may also find that until your muscles are strong enough to let you go up and down stairs you don’t want to get out past knee deep.
Is it ok to start a walking program?
Yes, it is. As soon as the knee begins to support you and as soon as your limp begins to resolve, we strongly encourage a walking program. Don’t overdo it to start with! Begin with a well padded track, such as a track at a school or a walking path. Do your best to avoid walking on concrete for long distances. Remember to start with about a half mile walk and work your way up about 10% per week.
How will I know if the knee is wearing out?
When the knee becomes painful and stays swollen with very little inciting activity, we begin to worry that the knee is wearing out. The polyethylene we use is the most advance material available but it’s the part of the knee that wears out because the other components are metal. Also, at your routine checks, we x-ray the knee and tell if there is some narrowing beginning to occur which also suggests that the polyethylene is wearing out.
Can scar tissue hurt?
Yes, it can hurt. Especially if the scar becomes pinched between the joint surfaces. When this occurs, generally the knee will take care of the scarring on its own and the scar tissue will be moved out of the way over time. But do remember — as long as the knee is red, it’s not uncommon for the scar tissue to be painful, especially with unusually increased activity.
How will I know if I need a manipulation to make my knee bend better?
The need for manipulation after total knee replacement surgery is a very rare occurrence. Generally, our motion goals are for you to have at least a 90 degree bend in your knee by 4 weeks (greater if you can achieve it). Manipulation to achieve full extension to lock your leg out straight is rarely successful and we don’t manipulate for that condition. The person who is a candidate for manipulation is someone who has had good motion and then goes backwards, losing motion and who doesn’t respond to appropriate therapy.
Can I have another cortisone shot in this knee if it hurts?
This is a somewhat dangerous thing to do because the cortisone has an unknown affect on the polyethylene. Furthermore the very act of injecting a knee does carry a slight risk of infection. Therefore, as a rule, we don’t inject knees once they’ve been replaced.
Is the arthritis gone?
Yes it is. The operation completely resurfaces the knee and resects the arthritis. This doesn’t mean the pain is completely gone early on because (as mentioned previously) there are many things that can hurt around the knee including the muscles, the capsule, the synovium and even sometimes the nerves around the knee – but yes, the arthritis is gone.
Why does my knee feel like it hyper extends?
It may be that you’re just experiencing what it feels like to have you knee lock out again. The component we use has a device which prevents the knee from hyper extending more than 5 degrees. If you look at young children, you’ll see that their knees "back-knee" just a bit (this is true even into adulthood unless the knee does develop arthritis). So, you need not worry about hyper extension unless there’s been a tear in the capsule from a car wreck or something similarly violent.
How long will it take my muscles to become strong again?
Some people regain their strength very quickly with a good exercise program and are able to do what they want. Furthermore, some people have a very high activity level in regaining muscles that allow them to pursue more intense physical activity may require a longer time. That’s another reason we check you over the first 9 months, on several occasions — to gauge your progress.
How long will I need to see you regularly?
I try to see people at yearly intervals for the first couple of years and then at least at 3-5 year intervals thereafter just to ensure that the components are holding up.
When can I get my other knee replaced?
We encourage people to wait at least three months between knee replacements and most people seem to opt for a 9-12 month spacing.
2700 10th Avenue South Birmingham, Alabama Phone: 205-933-7838 Fax: 205-933-0951