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What to Expect After a Knee Replacement
If you're facing knee replacement, you may wonder what you should expect once the joint is replaced. Dr. Jeffrey Stambough, UAMS orthopaedic surgeon, discusses what to expect after knee replacement.
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Learn more about Jeffrey Stambough, MD
Jeffrey Stambough, MD
Jeffrey B. Stambough, MD was born in Philadelphia, PA and grew up in Cincinnati, OH. He matriculated to Cornell University, where he graduated with a Bachelors of Arts in Biology & Society studies and earned Honors with Distinction. He received his medical degree from the University of Pennsylvania and subsequently completed his orthopaedic residency at Washington University in St. Louis/Barnes-Jewish Hospital. Most recently, Dr. Stambough completed his adult reconstruction fellowship at the OrthoCarolina Hip & Knee Center in Charlotte, NC.Learn more about Jeffrey Stambough, MD
Transcription:
What to Expect After a Knee Replacement
Bill Klaproth (Host): Knee replacement surgery is becoming more and more common, but what is normal and what is not normal when it comes to life after knee replacement surgery? So, let’s find out with Dr. Jeffrey Stambough, UAMS Assistant Professor, Department of Orthopedic Surgery at the University Of Arkansas for Medical Sciences.
This is UAMS Health Talk from the University of Arkansas for Medical Sciences. I’m Bill Klaproth. Dr. Stambough, than you for your time. So, how would I know if something if wrong with my knee replacement?
Jeffrey Stambough, MD (Guest): Well Bill, while the majority of patients over 95% do very well after a knee replacement; there are a small percentage of patients who will experience a complication. These complications can happen – it can develop later that immediately after surgery and they can kind of be insidious and slow progressing. So, if a patient were to have something like ongoing pain that is worse or different than their pain that lead them to a knee replacement or had persistent swelling or issues with feelings like the knee is going to give way; that could be an indication that after three to six months that maybe something isn’t right.
Host: Okay so you mentioned swelling. If my knee is swelling, what is a normal timeframe for that knee to swell?
Dr. Stambough: Yes, it is very common, and it’s actually expected; we counsel patients that after knee replacement, your knee will be more swollen than your other knee. And that it will slowly decrease. But it really take about six months for it to go back down and some people, it can even be up to a year until you say heh, this is my contour that I’m going to get back to match the other knee. Now, what swelling is normal and expected versus what swelling is abnormal or pathologic to suggest something is wrong or not right; that can be difficult to differentiate and should definitely be discussed on an individual basis with the surgeon but if there is more swelling than say preoperatively or if you have noticed your swelling has gone down slowly over the first few months and then all of the sudden it increases again and is associated with other factors or symptoms such as you get fevers, the wound becomes more red and hot or there is increasing pain; then those are the worrisome ones that we ask patients to be on the look out for and to let us know.
Host: All right. Those are really good indicators to watch out for. So, what about movement then. What does it mean if my knee would give out when I try to get up from a seated position or even going down stairs?
Dr. Stambough: Yeah, well most patient do very well from knee replacement and even in the recovery period, the first four to six weeks is really focused on regaining the strength in your quadriceps which is that muscle in your thigh, in the front of the thigh that allows you to straighten your leg. That muscle, it does take a little while to recover, because you have to cut into it to do a knee replacement to some degree. So, say it’s after those four to six weeks and you are a patient still having difficulty where they feel like their knee shifting or they can’t trust it; that could be indicative of something where they have what’s called instability.
And instability can be due to mismatch of the implants or a ligament could have worn out or there could just be imbalance in terms of the tension of the ligaments when the knee is straight versus when the knee is bent.
Host: If there are some issues like instability as you were mentioning or potentially even something that would need further surgery; is there something someone can do to try to avoid a further surgery?
Dr. Stambough: Yes, as you alluded to, other things we worry about are obviously infection and that probably comprises the one to two percent of problems that people see. But the other one is this instability that you talked about. And instability can come about from a variety of reasons that I just mentioned but what patients can do to deal with it is when they come back and see their surgeon, usually depending on how severe that instability is; will dictate what can then be done.
So, if they have subtle instability in certain positions; there’s potential that therapy can improve this by strengthening the muscles around the knee to give them better proprioception or balance in the knee. Or there’s other devices such as maybe even a brace that can help like your knee cap tracking if there’s instability in your patella femoral region which is where your kneecap goes on the knee while it bends.
Host: Right. All right so this may be a silly question, but I would imagine knee replacement recipients need to avoid certain activities like heh I was out playing flag football doc and now my knee hurts. I mean, heh, not a good idea to do that. That’s probably why, is that a good question? Should people avoid certain things, right?
Dr. Stambough: Yeah, we classically counsel patients that while returning to certain activities such as hiking, walking, even like double’s tennis is permissible and even like skiing and waterboarding and doing water sports activities, those are permissible as well; but certain activities like you said, these higher impact things running, cutting, doing heavy lifting, even construction or farming work and that jumping activities can really put stress on the implants. Now there are newer materials and newer techniques that are always being used and they are constantly evolving; so those recommendations can change and be specific to patients. But generally, I tell patients whatever you were doing beforehand, our goal is to get you back to close to that but it’s unlikely to think that you will get to be more active than you were a few years before your arthritis set in. If you weren’t a marathon runner beforehand, it’s unlikely that you will be one afterwards.
Host: Right. So, if someone does enjoy high impact sports, as you were saying earlier, then strengthening around that knee would certainly help too.
Dr. Stambough: Yes, and that’s all in like the preoperative, before pursuing arthroplasty. Joint replacement arthroplasty is one of the last – is should be kind of the final stop on your journey of dealing with knee problems in terms of there’s always therapy, noninvasive modalities, nonnarcotic pain medications that can be used and other sort of devices to help give your knee that stability and performance it needs to do the activities you desire.
But at some point, that becomes unlikely and there are other types of knee replacements such as partial knee replacements that may be more suited for these higher impact patients, provided they have the correct anatomy and indications.
Host: Okay so, that would be really good to know pre-surgery. But say someone does need revision surgery, what does that entail Dr. Stambough?
Dr. Stambough: So, revision surgery can vary quite differently. There are many different flavors for whatever revision surgery entails. There is more simplistic revisions where you can just change part of an implant out if something is worn out or there is instability in multiple planes, whereas other type of revision procedures are more invasive and arduous where we have to remove all the implants that are currently in there and kind of start fresh in terms of rebalancing the knee or realigning the knee with more constrained implants. And these more constrained implants will hopefully make one’s knee feel a little more sturdy and be more solid to allow them to resume their activities and get back to their lives.
Host: And that is what’s most important and Dr. Stambough, thanks for your time today.
Dr. Stambough: Yeah, thank you for having me.
Host: And if you’d like more information please visit www.uamshealth.com or you can call Dr. Stambough’s clinic at 501-526-1046, that’s 501-526-1046. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is UAMS Health Talk. Thanks for listening.
What to Expect After a Knee Replacement
Bill Klaproth (Host): Knee replacement surgery is becoming more and more common, but what is normal and what is not normal when it comes to life after knee replacement surgery? So, let’s find out with Dr. Jeffrey Stambough, UAMS Assistant Professor, Department of Orthopedic Surgery at the University Of Arkansas for Medical Sciences.
This is UAMS Health Talk from the University of Arkansas for Medical Sciences. I’m Bill Klaproth. Dr. Stambough, than you for your time. So, how would I know if something if wrong with my knee replacement?
Jeffrey Stambough, MD (Guest): Well Bill, while the majority of patients over 95% do very well after a knee replacement; there are a small percentage of patients who will experience a complication. These complications can happen – it can develop later that immediately after surgery and they can kind of be insidious and slow progressing. So, if a patient were to have something like ongoing pain that is worse or different than their pain that lead them to a knee replacement or had persistent swelling or issues with feelings like the knee is going to give way; that could be an indication that after three to six months that maybe something isn’t right.
Host: Okay so you mentioned swelling. If my knee is swelling, what is a normal timeframe for that knee to swell?
Dr. Stambough: Yes, it is very common, and it’s actually expected; we counsel patients that after knee replacement, your knee will be more swollen than your other knee. And that it will slowly decrease. But it really take about six months for it to go back down and some people, it can even be up to a year until you say heh, this is my contour that I’m going to get back to match the other knee. Now, what swelling is normal and expected versus what swelling is abnormal or pathologic to suggest something is wrong or not right; that can be difficult to differentiate and should definitely be discussed on an individual basis with the surgeon but if there is more swelling than say preoperatively or if you have noticed your swelling has gone down slowly over the first few months and then all of the sudden it increases again and is associated with other factors or symptoms such as you get fevers, the wound becomes more red and hot or there is increasing pain; then those are the worrisome ones that we ask patients to be on the look out for and to let us know.
Host: All right. Those are really good indicators to watch out for. So, what about movement then. What does it mean if my knee would give out when I try to get up from a seated position or even going down stairs?
Dr. Stambough: Yeah, well most patient do very well from knee replacement and even in the recovery period, the first four to six weeks is really focused on regaining the strength in your quadriceps which is that muscle in your thigh, in the front of the thigh that allows you to straighten your leg. That muscle, it does take a little while to recover, because you have to cut into it to do a knee replacement to some degree. So, say it’s after those four to six weeks and you are a patient still having difficulty where they feel like their knee shifting or they can’t trust it; that could be indicative of something where they have what’s called instability.
And instability can be due to mismatch of the implants or a ligament could have worn out or there could just be imbalance in terms of the tension of the ligaments when the knee is straight versus when the knee is bent.
Host: If there are some issues like instability as you were mentioning or potentially even something that would need further surgery; is there something someone can do to try to avoid a further surgery?
Dr. Stambough: Yes, as you alluded to, other things we worry about are obviously infection and that probably comprises the one to two percent of problems that people see. But the other one is this instability that you talked about. And instability can come about from a variety of reasons that I just mentioned but what patients can do to deal with it is when they come back and see their surgeon, usually depending on how severe that instability is; will dictate what can then be done.
So, if they have subtle instability in certain positions; there’s potential that therapy can improve this by strengthening the muscles around the knee to give them better proprioception or balance in the knee. Or there’s other devices such as maybe even a brace that can help like your knee cap tracking if there’s instability in your patella femoral region which is where your kneecap goes on the knee while it bends.
Host: Right. All right so this may be a silly question, but I would imagine knee replacement recipients need to avoid certain activities like heh I was out playing flag football doc and now my knee hurts. I mean, heh, not a good idea to do that. That’s probably why, is that a good question? Should people avoid certain things, right?
Dr. Stambough: Yeah, we classically counsel patients that while returning to certain activities such as hiking, walking, even like double’s tennis is permissible and even like skiing and waterboarding and doing water sports activities, those are permissible as well; but certain activities like you said, these higher impact things running, cutting, doing heavy lifting, even construction or farming work and that jumping activities can really put stress on the implants. Now there are newer materials and newer techniques that are always being used and they are constantly evolving; so those recommendations can change and be specific to patients. But generally, I tell patients whatever you were doing beforehand, our goal is to get you back to close to that but it’s unlikely to think that you will get to be more active than you were a few years before your arthritis set in. If you weren’t a marathon runner beforehand, it’s unlikely that you will be one afterwards.
Host: Right. So, if someone does enjoy high impact sports, as you were saying earlier, then strengthening around that knee would certainly help too.
Dr. Stambough: Yes, and that’s all in like the preoperative, before pursuing arthroplasty. Joint replacement arthroplasty is one of the last – is should be kind of the final stop on your journey of dealing with knee problems in terms of there’s always therapy, noninvasive modalities, nonnarcotic pain medications that can be used and other sort of devices to help give your knee that stability and performance it needs to do the activities you desire.
But at some point, that becomes unlikely and there are other types of knee replacements such as partial knee replacements that may be more suited for these higher impact patients, provided they have the correct anatomy and indications.
Host: Okay so, that would be really good to know pre-surgery. But say someone does need revision surgery, what does that entail Dr. Stambough?
Dr. Stambough: So, revision surgery can vary quite differently. There are many different flavors for whatever revision surgery entails. There is more simplistic revisions where you can just change part of an implant out if something is worn out or there is instability in multiple planes, whereas other type of revision procedures are more invasive and arduous where we have to remove all the implants that are currently in there and kind of start fresh in terms of rebalancing the knee or realigning the knee with more constrained implants. And these more constrained implants will hopefully make one’s knee feel a little more sturdy and be more solid to allow them to resume their activities and get back to their lives.
Host: And that is what’s most important and Dr. Stambough, thanks for your time today.
Dr. Stambough: Yeah, thank you for having me.
Host: And if you’d like more information please visit www.uamshealth.com or you can call Dr. Stambough’s clinic at 501-526-1046, that’s 501-526-1046. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is UAMS Health Talk. Thanks for listening.