Transcription:
Functional Expectation after Total Knee Replacement

Introduction: Progressive, respectful, mentoring, compassionate. These are the values of Palmdale Regional Medical Center. And now we proudly present Palmdale Regional Radio. Here's Melanie Cole.

Melanie Cole: Welcome to Palmdale Regional Radio. I'm Melanie Cole and today we're discussing functional expectation after total knee replacement. If you get a new knee, what can you expect from it? Joining us is Rebecca Reynolds. She's a physical therapist with Palmdale Regional Medical Center. Rebecca, thank you so much for joining us again. Let's talk about the most common causes of knee pain. What types of conditions caused the knee to break down?

Rebecca Reynolds: Hi. Yeah, a number of different things can cause the need to break down. The most prominent one that many people are familiar with is osteoarthritis, which can be caused by a number of different things such as previous injuries, muscle imbalances, where one muscle gets stronger over time and creates different stresses, and as well as you know, having previous surgeries as well can all lead to further breakdown of the joint.

Host: So if someone has knee pain, surgery is not the first thing that we jumped to. So what's the first line of defense? Tell us a little bit about some nonsurgical treatments, physical therapy, INSEDS, bracing, icing, whatever you might try for someone with knee pain.

Rebecca Reynolds: Absolutely. Usually before someone goes to the doctor, they'll try the standard methods like trying to ice or heat, using over the counter creams, such as Icy hot or Bengay, as well as they may go to see a massage therapist, cause that always makes us feel better. And then once you go to see your doctor, they may often recommend a steroid injection to help bring down inflammation and pain in the knee, as well as often trying therapy to bring down your symptoms.

Host: So when the discussion does turn to a knee replacement, and people have found that there's just none of these nonsurgical techniques that will really, really help. What do you want patients to know that are considering knee replacement? What questions should they ask their surgeon before they go through with this?

Rebecca Reynolds: Biggest questions to ask their doctor are what to expect after surgery. How long therapy is to last? How long it's going to take for them to return back to work? How long it's going to take for them to return to driving? Different medication discussions for pain management after surgery. Those would probably be the most important questions to ask.

Host: Well then let's answer some of those questions. Rebecca, what realistic expectations does a patient need to have? Tell us about after the surgery and answer some of the questions you just posed for us.

Rebecca Reynolds: So biggest one is expectation of recovery. Typically it takes about a year to fully recover from the knee replacement. It is a very traumatic surgery to the knee. And so it's going to take some time for your body to adjust break down scar tissue that's accumulated, and to build up your strength. Again, typically after surgery, you are in therapy for average of two to three months. Some people are on the smaller timeframe. Others take longer for various reasons, but that's the average. Additionally, the other things we suggest that you be aware of is you will be using a Walker for the first several weeks just to kind of support you cause you won't have the same mobility you had prior to surgery and you will also be on medications for a bit. So no driving. You probably won't want to return to work for a couple of weeks if you are still working. And to be aware that sometimes patients have a surprisingly significant level of pain afterwards. So they are in more pain. There is going to be a lot of swelling. And so the first week or so it is all about just finding comfort, keeping the knee, moving, keeping the swelling down as best as you can.

Host: Well then let's talk about that, Rebecca. I'm glad you brought up after the surgery. How is pain managed? Because today people are much more aware and, and concerned about using opioids for pain. Give us some of the pain management techniques that you and your team look to.

Rebecca Reynolds: We're all about using ice. Ice is your best friend after surgery. Not only does it help to bring down the swelling, it also does help to kind of numb the area a bit. And so you're not feeling those sharp pains or deep aches that you typically feel after surgery. We also typically will recommend your doctors will be giving you pain medications. Now you don't have to take them forever. They are to help with the more severe aspects of pain afterwards, but some people will, you can use it for up to about four weeks or so. Some people less, some people longer, it just depends again. But each, you know, every time you see your doctor, you're under, you're being monitored for those symptoms. And they're constantly watching you. I know the opioid crisis is very prominent on our mindset, but being on pain medications for a short period of time, such as for a knee replacement is okay.

Host: So then when does therapy start, and what does that look like as you're trying to regain that functional movement that you had before? Give a little lesson on what physical therapy after knee replacement really entails. What's an appointment like?

Rebecca Reynolds: So typically therapy will start anywhere from about maybe two to three weeks after surgery. I have had individuals come in as soon as a week after surgery, if they don't have access to home health. Then our first appointment is usually just sitting down, seeing how things have been going for the patient since surgery, looking to see where they're at right at that moment, how much flexibility they have, how swollen is the knee, how strong they are. And then we get them started on a light exercise program to do at home. A home exercise program is the most important thing after surgery, because while you come into therapy, you know, two or three times a week for an hour or so each time you're actually at home more than that. And it's important to continue to work on those exercises even outside of the therapy clinic.

Host: So do you help them to figure out what exercises that they're supposed to do? Not everybody knows what to do. Tell us a little bit about how you help, not only the patient, but even their families so that they can help and their support system can be involved.

Rebecca Reynolds: Typically we work on just doing gentle, bending and straightening exercises. Those are going to be the most important things to kind of help you get back onto your feet. Not feel like you're walking around on a peg leg. We also work on very gentle. We call them isometric exercises where you're just kind of gently turning on the muscles around the knee to prevent them from getting weaker, but to help them to stay active. Additionally, the first day we're discussing, you know, the icing techniques what to look for in case your knee might become infected because it is a large incision down the front of the knee. So, you know, informing caregivers about swelling, heat to the area, mild fever, those kinds of things, to make sure that, you know, it does not become infected and become a further issue. And just monitoring, you know, the pain medications, that you try and stick to a schedule and also trying to time it. So you take a pain medication right before you come into the therapy clinic about a half an hour, 45 minutes or so.

Host: So important to stay ahead of the pain. So I'm glad you brought that point up. What about prehab? Does that help patients to have a better functional outcome after knee replacement?

Rebecca Reynolds: Absolutely. I actually did some research prior to our discussion and there were quite a few research articles going all the way back as the early nineties discussing how important it is to have prehab, prior to your surgery. One article from 2006 mentioned a 20% increase in strength after you're done with surgery compared to someone who did not have any therapy beforehand. Another article that I found from 2017 stated that you had better functional outcomes and better lower extremity, quadriceps strength, having therapy beforehand, compared to after. And one of the biggest ones that I found interesting was another study found that by having therapy done before your surgery, you are likely going to spend less time in the hospital or not have a need to go to an acute rehab facility right after your surgery.

Host: What a great thing for patients to know. And thank you for, you know, telling us about those statistics. As we wrap up Rebecca, this is just such a great topic. And so many people have knee pain. Tell us about your team at Palmdale Regional Medical Center and what you'd like patients to know about keeping healthy knees. And if they do have to have a knee replacement, what can they expect? What's their functional expectations? How soon can they get back to their normal activities?

Rebecca Reynolds: Our team here is amazing first off, we have about five or six therapists on staff in our outpatient facility. And additionally, we have a large number of therapists, both in the hospital as well. That will usually see you either the same day or the day after your surgery, getting you up out of bed to help you get mobile before you go home. Once you're here, everyone here is very qualified. We look at each other's notes and kind of bounce ideas off of each other, since we all come from different backgrounds and have different educational experiences. Now, as for what to expect after surgery typically you will have home health depends on your insurance and your doctor, but home health is a more common occurrence now where they'll come in to your home couple times for a couple of weeks and help you kind of get started with some therapy exercises and some basic strengthening. When it comes to getting back to your normal activities, I say it usually occurs around the six to eight week mark, just because it takes a while for the swelling to go down.

We're working on getting you more flexibility in your knee and more strength. And by the eight week mark, which is the two month mark it, you start to feel a little bit more normal. It's not such a prominent aspect in the forefront of your mind going, wow, I just had surgery and instead you're feeling a lot more like yourself. As the year goes on, you'll find that, Oh, it doesn't hurt me to walk as long or to sit for long periods and that'll continue to get better over the course of the year. With regards to returning back to work, it depends on the type of work that you do. Some people work at a desk, so they can go back to work probably a little bit sooner versus someone who has a lot more of a strenuous or high-impact job. And with regards to physical activity, it usually just depends on the person. So consult with your therapist, when you have one, and say, Hey, when can I do go back to my normal activities? But usually we kind of monitored it and do it based off of your symptoms and how well you're doing it therapy at that point.

Host: What great information. So informative. Thank you, Rebecca, for joining us again and telling us what we can expect if we do have to have a knee replacement and telling us about your team at Palmdale Regional Medical Center. That concludes another episode of Palmdale Regional Radio with Palmdale Regional Medical Center, please visit our website at palmdaleregional.com for more information, and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other Palmdale Regional Medical Center podcasts. Physicians are independent practitioners who are not employees or agents of Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. I'm Melanie Cole.