You can replace aching joints. You can’t replace precious moments. Deciding to have a knee replacement is a big decision, but in this podcast, Dr. Christopher Grayson will guide you through the process and share what to expect following a knee replacement.
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What to Expect After a Knee Replacement
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Dr. Grayson grew up in southern Louisiana and obtained his undergraduate degree in biological science at Louisiana State University. During his time there, he worked as an assistant to the LSU football team orthopedic surgeon, conducted research and developed a love for Louisiana cooking. While obtaining his degree, Dr. Grayson also developed a passion for joint replacements after his father had both knees replaced.
He is a member of various professional organizations including the American Association of Orthopaedic Surgeons (AAOS), the American Association of Hip and Knee Surgeons (AAHKS) and the Florida Orthopaedic Society.
Dr. Grayson is the author of multiple articles which have been published in peer reviewed journals including PM&R, the scientific journal of the American Academy of Physical Medicine and Rehabilitation, and the Journal of Arthroplasty. He also conducted research on the effect of blood transfusion on the clinical outcomes after total joint replacement. He has presented his research at AAOS, AAHKS, the University of Florida, the University of Indiana and the Alachua County Medical Society.
Dr. Grayson was named an emerging leader in orthopedics by the Florida Orthopaedic Society. He is currently the Director of Orthopaedics for the Mease Hospitals and the Chairman of the Adult Reconstruction subcommittee of the orthopedic service line for the BayCare Health System.
Learn more about Christopher Grayson, MD
Christopher Grayson, MD
Dr. Grayson is board certified by the American Board of Orthopaedic Surgery and completed his fellowship training in Adult Reconstruction at Indiana University Health. He focuses on anterior hip replacement, partial knee replacements and specializes in same-day total joint replacement surgery. He also takes care of patients with failed or infected joint replacements.Dr. Grayson grew up in southern Louisiana and obtained his undergraduate degree in biological science at Louisiana State University. During his time there, he worked as an assistant to the LSU football team orthopedic surgeon, conducted research and developed a love for Louisiana cooking. While obtaining his degree, Dr. Grayson also developed a passion for joint replacements after his father had both knees replaced.
He is a member of various professional organizations including the American Association of Orthopaedic Surgeons (AAOS), the American Association of Hip and Knee Surgeons (AAHKS) and the Florida Orthopaedic Society.
Dr. Grayson is the author of multiple articles which have been published in peer reviewed journals including PM&R, the scientific journal of the American Academy of Physical Medicine and Rehabilitation, and the Journal of Arthroplasty. He also conducted research on the effect of blood transfusion on the clinical outcomes after total joint replacement. He has presented his research at AAOS, AAHKS, the University of Florida, the University of Indiana and the Alachua County Medical Society.
Dr. Grayson was named an emerging leader in orthopedics by the Florida Orthopaedic Society. He is currently the Director of Orthopaedics for the Mease Hospitals and the Chairman of the Adult Reconstruction subcommittee of the orthopedic service line for the BayCare Health System.
Learn more about Christopher Grayson, MD
Transcription:
What to Expect After a Knee Replacement
Intro: This is BayCare Health Chat, another podcast from BayCare Health System.
Scott Webb: You can replace aching joints, but you can't replace precious moments and deciding to have a knee replacement is a big decision. But in this podcast, Dr. Christopher Grayson will guide You through the process and share what to expect following knee replacement. This is BayCare Health Chat. I'm Scott Webb. And Dr. Grayson, it's nice to have you on. I'm assuming the pain control is probably the number one priority for most after knee replacement surgery. So what are the options?
Dr. Christopher Grayson: Pain control is actually been one of the biggest advancements we've made in joint replacement over the last say 10 to 15 years. I think patients usually expect that some of the things we're doing with the robotics or advanced technology in the surgery is what's making the big difference, but it's actually been the postoperative care that has improved our outcomes and allowed us to go from staying five days in the hospital to often having these knee replacements done on an outpatient basis now.
The way we do that is instead of what we used to do, which was really people got large quantities of IV narcotics in the hospital, they might have a pain pump where they could click the little clicker and get some IV pain medicine whenever they hurt, we have tried to transition away from solely using narcotics as our pain relievers and using a combination of different medications to help control the pain. We really refer to that technique is a multimodal pain management, and it consists of using lots of different medications.
Some things like Tylenol, which believe it or not, has actually been shown in studies to work really well for pain, especially when used in conjunction with other medications. Also anti-inflammatories as long as it's acceptable for the patients. Some patients who are on blood thinners or have kidney disease aren't able to use those medications. But for those patients that are, they can be very powerful pain relievers. By helping relieve the inflammation, they are actually helping treat the cause of the pain instead of just blocking the pain signal, going to the brain.
We use nerve blocks and injections, during the surgery and before the surgery and those help control the pain. And then, in the patients that need it, we do give some narcotics, but we've tried to give the patients many different options to control their pain and allow the patient to have something to reach for besides the narcotic when their pain gets worse.
Scott Webb: That's good to know. And interesting as you say that people just sort of assume because you're using either computer-assisted or robots, that it's really the technology that's keeping the pain, you know, down, but actually it's really the pain management itself. And also good to know that you've really reduced the role of narcotics for people, because as we know that's been a huge epidemic in this country. So all good stuff there.
And, as I mentioned, my son just had surgery on his hand yesterday. So I had a long conversation about the importance of keeping the swelling down. But for those who didn't just have surgery yesterday, why is it important to keep the swelling down post-op?
Dr. Christopher Grayson: Swelling is actually the thing that I would say is the most common thing that my patients are really worried about, that me as the surgeon is not really worried about. It is a normal process and it is how the body is healing the area by bringing increased blood flow to the area and delivering the growth factors and nutrients that the body needs to heal from the surgery.
But what it also does as a side effect of that is as the swelling increases, it causes stiffness in the knee and worsens the pain. And these are both things that are kind of fighting against us as we're recovering. I want my patients to be mobile and moving and getting their range of motion back as quickly as possible. And so swelling management is a very key thing. Kind of like Tylenol seems like it's not going to do a lot, but it's actually been shown in research to be very effective after surgery.
One of the best things my patients can do for themselves is to be aggressive with their icing and elevating the knee. And what I mean by that is ice over the front of the knee with something in between the skin and the bag of ice for 30 minutes at a time. And then while doing that, elevating the leg. I like to have my patients get the leg above the heart. So getting three pillows from the heel to the calf, never behind the knee because we don't want that knee resting in a bent position. But from the calf to the heel, with the leg out straight, getting the leg in the air, helping the body get that fluid back towards the core into the heart. And that's going to be really effective for helping get the swelling down and will in turn have a significant effect on the patient's pain.
My patients who are most aggressive about doing that, if you can get about six times a day of sitting there for 30 minutes, really will get the range of motion back. They'll be moving around faster and they stop taking the pain medications earlier.
Scott Webb: I know physical therapy can be tough after knee surgery. My mom had knee surgery and it was definitely her least favorite part of having had knee surgery, but it's so important to recovery. And so I want to have you talk about that. Let's talk about PT.
Dr. Christopher Grayson: PT in the knee replacement, unlike almost any other surgery, is really a team effort between the patient and the surgeon. My job as a surgeon is to do a great job during the surgery and really set the patient up for success by putting the implants in in a perfect way, getting the knee balanced, making sure that we close the skin so it heals well.
But after the surgery, the patient really needs to work aggressively on getting the range of motion back. We have about an eight to 10-week period when we can really regain the range of motion that is lost sometimes from the arthritis before surgery and then sometimes just from the surgery. And it's imperative that we get it back in that time period because after the scar tissue is fully formed, we really have lost the opportunity. And some patients may be left with a knee that is very stiff and doesn't function appropriately.
Scott Webb: And you did mention in there about the wounds. Is there anything special we need to do for wound care?
Dr. Christopher Grayson: In the past five or so years or maybe a little longer, we have really moved towards dressings that stay on much longer. It's very common now to use skin glue to seal the incision. That's what I use for most of my knee replacements. So there is no longer staples or sutures that need to be removed. And by getting that seal on the wound, we're able to have a dry wound almost immediately. And so we don't really do repetitive dressing changes any longer. I usually use a bandage that stays on for about one week after surgery, and then it's peeled off by either the patient or the therapist, and then we leave it open to air. The skin glue kind of acts as a base sealant for the wound and so we can leave it open to air at that point.
In the old days, when we were doing these repetitive dressing changes, it actually caused a lot of problems because some patients have skin that's very sensitive to the tape. And so by putting a bandage on and taking it off sometimes multiple times a day, it really could lead to blisters and skin breakdown that increased the chance of infection.
And also by getting that wound sealed with the skin glue, we are able to keep anything from outside environment from getting in. And it really is important to understand that a wound that's draining after a knee replacement, if there's drainage after any longer than a week after the surgery, that's something that we should make our surgeons aware of and have it evaluated. It doesn't necessarily mean anything bad is going on, but it's something that we need to keep an eye on and ideally get that wound to seal up as quickly as possible.
Scott Webb: When it comes to walking aids, is that a sort of an as needed or do you recommend all knee replacement patients use some sort of aid at least for a period of time?
Dr. Christopher Grayson: It's still pretty common. I think all my patients are on a walker for some period of time. So working in the hospital for the first week or two weeks after surgery, most of the patients are using a walker. And I think what's important to understand is one thing that can happen after a knee injury is there's a pain neurofeedback mechanism that can cause the quad muscle to shut down and not contract when there's pain in the knee. And that can be that buckling sensation that these patients sometimes feel.
And so having that walker there that you can catch yourself as the knee gives out, especially in this first few days is pretty important. But most of the time by the patients are coming back to see me at the two-week time period postoperatively, they're off the walker and walking normally. I don't see many patients on a cane anymore, and we don't insist upon any definitive transition from a walker to a cane. And so I think using the walker early on while we're getting used to how the knee is doing and waiting for the quad muscles to reactivate, it can be very helpful and safe. Usually by the first couple of weeks after surgery, a lot of the patients have already transitioned to not using a walking aid.
Scott Webb: Doctor, this is really educational. What are the takeaways when it comes to having the replacement surgery and then managing everything that we've discussed today?
Dr. Christopher Grayson: Yeah, I think the most important thing to remember is that this is one of the more successful surgeries that exists in medicine today. So of the top three most successful surgeries are cataract surgery, hip replacement, and then knee replacement. And so even though it can be a very scary idea to be going in for a major surgery, like a knee replacement and especially a lot of our patients have seen people who had them 10 years ago before we really made the advances we have made and it was a pretty awful thing. People stayed in the hospital for three to five days. They went to a nursing home for a few weeks after surgery.
It's a very different procedure now. And patients are often going home on either the same day of surgery or the day after. They're going directly home, we're not going to nursing homes. Their pain control is much better than it was. They are quickly returning to function. And at the end of the day, they are regaining their life and their activity levels and able to continue enjoying an active, healthy life.
Scott Webb: Yeah, that's well said. And as I said in my intro, it is a big decision. But also I think for many, if not most, it turns out to be the best decision they ever make. And so great that we have surgeons like yourself to do this kind of work and all the great technologies that you have and pain management and so on. So doctor, thanks so much for your time today and you stay well.
Dr. Christopher Grayson: All right. Same to you, sir. I appreciate your time. Thank you for the opportunity.
Scott Webb: And to learn more about knee replacement surgery and all the services at BayCare, please visit baycare.org. And that wraps up this episode of BayCare Health Chat. Always remember to subscribe, rate, and review this podcast and all the other BayCare podcasts so we can share the wealth of information from our experts together. I'm Scott Webb. Stay well.
What to Expect After a Knee Replacement
Intro: This is BayCare Health Chat, another podcast from BayCare Health System.
Scott Webb: You can replace aching joints, but you can't replace precious moments and deciding to have a knee replacement is a big decision. But in this podcast, Dr. Christopher Grayson will guide You through the process and share what to expect following knee replacement. This is BayCare Health Chat. I'm Scott Webb. And Dr. Grayson, it's nice to have you on. I'm assuming the pain control is probably the number one priority for most after knee replacement surgery. So what are the options?
Dr. Christopher Grayson: Pain control is actually been one of the biggest advancements we've made in joint replacement over the last say 10 to 15 years. I think patients usually expect that some of the things we're doing with the robotics or advanced technology in the surgery is what's making the big difference, but it's actually been the postoperative care that has improved our outcomes and allowed us to go from staying five days in the hospital to often having these knee replacements done on an outpatient basis now.
The way we do that is instead of what we used to do, which was really people got large quantities of IV narcotics in the hospital, they might have a pain pump where they could click the little clicker and get some IV pain medicine whenever they hurt, we have tried to transition away from solely using narcotics as our pain relievers and using a combination of different medications to help control the pain. We really refer to that technique is a multimodal pain management, and it consists of using lots of different medications.
Some things like Tylenol, which believe it or not, has actually been shown in studies to work really well for pain, especially when used in conjunction with other medications. Also anti-inflammatories as long as it's acceptable for the patients. Some patients who are on blood thinners or have kidney disease aren't able to use those medications. But for those patients that are, they can be very powerful pain relievers. By helping relieve the inflammation, they are actually helping treat the cause of the pain instead of just blocking the pain signal, going to the brain.
We use nerve blocks and injections, during the surgery and before the surgery and those help control the pain. And then, in the patients that need it, we do give some narcotics, but we've tried to give the patients many different options to control their pain and allow the patient to have something to reach for besides the narcotic when their pain gets worse.
Scott Webb: That's good to know. And interesting as you say that people just sort of assume because you're using either computer-assisted or robots, that it's really the technology that's keeping the pain, you know, down, but actually it's really the pain management itself. And also good to know that you've really reduced the role of narcotics for people, because as we know that's been a huge epidemic in this country. So all good stuff there.
And, as I mentioned, my son just had surgery on his hand yesterday. So I had a long conversation about the importance of keeping the swelling down. But for those who didn't just have surgery yesterday, why is it important to keep the swelling down post-op?
Dr. Christopher Grayson: Swelling is actually the thing that I would say is the most common thing that my patients are really worried about, that me as the surgeon is not really worried about. It is a normal process and it is how the body is healing the area by bringing increased blood flow to the area and delivering the growth factors and nutrients that the body needs to heal from the surgery.
But what it also does as a side effect of that is as the swelling increases, it causes stiffness in the knee and worsens the pain. And these are both things that are kind of fighting against us as we're recovering. I want my patients to be mobile and moving and getting their range of motion back as quickly as possible. And so swelling management is a very key thing. Kind of like Tylenol seems like it's not going to do a lot, but it's actually been shown in research to be very effective after surgery.
One of the best things my patients can do for themselves is to be aggressive with their icing and elevating the knee. And what I mean by that is ice over the front of the knee with something in between the skin and the bag of ice for 30 minutes at a time. And then while doing that, elevating the leg. I like to have my patients get the leg above the heart. So getting three pillows from the heel to the calf, never behind the knee because we don't want that knee resting in a bent position. But from the calf to the heel, with the leg out straight, getting the leg in the air, helping the body get that fluid back towards the core into the heart. And that's going to be really effective for helping get the swelling down and will in turn have a significant effect on the patient's pain.
My patients who are most aggressive about doing that, if you can get about six times a day of sitting there for 30 minutes, really will get the range of motion back. They'll be moving around faster and they stop taking the pain medications earlier.
Scott Webb: I know physical therapy can be tough after knee surgery. My mom had knee surgery and it was definitely her least favorite part of having had knee surgery, but it's so important to recovery. And so I want to have you talk about that. Let's talk about PT.
Dr. Christopher Grayson: PT in the knee replacement, unlike almost any other surgery, is really a team effort between the patient and the surgeon. My job as a surgeon is to do a great job during the surgery and really set the patient up for success by putting the implants in in a perfect way, getting the knee balanced, making sure that we close the skin so it heals well.
But after the surgery, the patient really needs to work aggressively on getting the range of motion back. We have about an eight to 10-week period when we can really regain the range of motion that is lost sometimes from the arthritis before surgery and then sometimes just from the surgery. And it's imperative that we get it back in that time period because after the scar tissue is fully formed, we really have lost the opportunity. And some patients may be left with a knee that is very stiff and doesn't function appropriately.
Scott Webb: And you did mention in there about the wounds. Is there anything special we need to do for wound care?
Dr. Christopher Grayson: In the past five or so years or maybe a little longer, we have really moved towards dressings that stay on much longer. It's very common now to use skin glue to seal the incision. That's what I use for most of my knee replacements. So there is no longer staples or sutures that need to be removed. And by getting that seal on the wound, we're able to have a dry wound almost immediately. And so we don't really do repetitive dressing changes any longer. I usually use a bandage that stays on for about one week after surgery, and then it's peeled off by either the patient or the therapist, and then we leave it open to air. The skin glue kind of acts as a base sealant for the wound and so we can leave it open to air at that point.
In the old days, when we were doing these repetitive dressing changes, it actually caused a lot of problems because some patients have skin that's very sensitive to the tape. And so by putting a bandage on and taking it off sometimes multiple times a day, it really could lead to blisters and skin breakdown that increased the chance of infection.
And also by getting that wound sealed with the skin glue, we are able to keep anything from outside environment from getting in. And it really is important to understand that a wound that's draining after a knee replacement, if there's drainage after any longer than a week after the surgery, that's something that we should make our surgeons aware of and have it evaluated. It doesn't necessarily mean anything bad is going on, but it's something that we need to keep an eye on and ideally get that wound to seal up as quickly as possible.
Scott Webb: When it comes to walking aids, is that a sort of an as needed or do you recommend all knee replacement patients use some sort of aid at least for a period of time?
Dr. Christopher Grayson: It's still pretty common. I think all my patients are on a walker for some period of time. So working in the hospital for the first week or two weeks after surgery, most of the patients are using a walker. And I think what's important to understand is one thing that can happen after a knee injury is there's a pain neurofeedback mechanism that can cause the quad muscle to shut down and not contract when there's pain in the knee. And that can be that buckling sensation that these patients sometimes feel.
And so having that walker there that you can catch yourself as the knee gives out, especially in this first few days is pretty important. But most of the time by the patients are coming back to see me at the two-week time period postoperatively, they're off the walker and walking normally. I don't see many patients on a cane anymore, and we don't insist upon any definitive transition from a walker to a cane. And so I think using the walker early on while we're getting used to how the knee is doing and waiting for the quad muscles to reactivate, it can be very helpful and safe. Usually by the first couple of weeks after surgery, a lot of the patients have already transitioned to not using a walking aid.
Scott Webb: Doctor, this is really educational. What are the takeaways when it comes to having the replacement surgery and then managing everything that we've discussed today?
Dr. Christopher Grayson: Yeah, I think the most important thing to remember is that this is one of the more successful surgeries that exists in medicine today. So of the top three most successful surgeries are cataract surgery, hip replacement, and then knee replacement. And so even though it can be a very scary idea to be going in for a major surgery, like a knee replacement and especially a lot of our patients have seen people who had them 10 years ago before we really made the advances we have made and it was a pretty awful thing. People stayed in the hospital for three to five days. They went to a nursing home for a few weeks after surgery.
It's a very different procedure now. And patients are often going home on either the same day of surgery or the day after. They're going directly home, we're not going to nursing homes. Their pain control is much better than it was. They are quickly returning to function. And at the end of the day, they are regaining their life and their activity levels and able to continue enjoying an active, healthy life.
Scott Webb: Yeah, that's well said. And as I said in my intro, it is a big decision. But also I think for many, if not most, it turns out to be the best decision they ever make. And so great that we have surgeons like yourself to do this kind of work and all the great technologies that you have and pain management and so on. So doctor, thanks so much for your time today and you stay well.
Dr. Christopher Grayson: All right. Same to you, sir. I appreciate your time. Thank you for the opportunity.
Scott Webb: And to learn more about knee replacement surgery and all the services at BayCare, please visit baycare.org. And that wraps up this episode of BayCare Health Chat. Always remember to subscribe, rate, and review this podcast and all the other BayCare podcasts so we can share the wealth of information from our experts together. I'm Scott Webb. Stay well.