Recently, my husband and I had total knee replacement surgeries… his left and my right. Even though I have a PhD in nursing I was stunned how much I didn’t know about it and wanted to share our lessons with you. Aging causes arthritis to develop, destroying the joint cartilage that separates bones. Pain follows and one wonders if surgical repair is needed? What’s involved? How long before I’m back to normal? What are the complications? What can I do to have a positive outcome?

When Is Surgery Needed?
At first the damage is barely noticeable. It’s annoying but overtime the pain worsens. It’s a good time to see an orthopedic physician to learn strategies to protect the knee to delay surgery. Various injections ease the pain for a very short time, but it returns when the drug wears off. Physical Therapy helps to strengthen the muscles around the damaged joint to reduce pain and discomfort. Braces are also recommended to support and strengthen the injured knee. Ultimately a knee replacement operation may be required. When the pain begins to interfere with sleeping or normal daily activities, it’s a good time seek options.

10 Point Questionnaire
Our surgeon Dr. Joseph Bowen developed the Measuring Impact of Diagnosis 1 to 10 scale to help determine if we were ready for surgery. The lower number 1 meant – Nothing will keep you from the activity while 10 meant –  The pain is so bad that you avoid the activity. I loved to go for walks while listening to music but eventually that ended (10). I hated entering big box stores for fear of pain from long walks finding an item (8). The 1 to 10 scale provided clarity. If I answered a 1, 2 or low number the surgery would probably be more traumatic than helpful. Other strategies would be more useful. However, if I answered 8, 9 or 10 the surgery would improve my quality of life.

Physical Therapy (PT)
The most challenging and least understood aspect when facing a knee replacement operation is what one will face in the post operative period. Immediately after surgery healing begins and scar tissue forms which can freeze or limit range of motion (ROM) in the joint. Strategies are employed to start moving the impacted leg. While some activity begins immediately after surgery, you can expect to start outpatient PT at the center within a few days after surgery.

The battle continues to prevent scar tissue adhesions from forming. Each day the activity increases as healing occurs. The goal of the PT session is to bend and straighten the surgical leg and lasts 2 months, generally twice a week and is invaluable! I was shocked to learn that some orthopedic surgeons don’t even order it. However, if you want to get back to an active life… you must get the range of motion back and that takes work. Life will return to a more normal routine after 2 months but allow 3 months before you’re able to help someone else. 

The Best Surgeon
The first most important step is to find the best orthopedic surgeon in your area. We had 2 opinions which were covered by insurance. Ask other healthcare providers who they would have do the surgery. The second appointment was invaluable. We found an amazing surgeon. Literally everywhere we went nurses and other staff told us, He is the only one who’d do my surgery. Do they treat you kindly and answer all your questions? How many do they do in a year? You want someone who focuses primarily on the knee for the best outcomes. 

Importance of Protein for Healing
Another orthopedic surgeon told me to begin drinking a protein shake daily 1 month before surgery to promote healing. My appetite was poor after surgery. The daily supplementation provided the extra nutrition needed. It’s also important to increase fluid intake as well. However, if you have any kidney, heart or diabetes disease be sure to get clearance from your healthcare provider before you push fluids and protein.

Pain Control
The post operative pain was well controlled. Between the numbing agents used prior to surgery and the narcotics given during the operation, pain was greatly reduced for 24 hours. Tylenol and Tramadol were ordered around the clock every 6 hours initially. Oxycodone which is a strong narcotic is used for breakthrough pain. Despite taking Tylenol and Tramadol, if the pain consumes you and it’s all your thinking about…it’s time for an Oxycodone. I weaned myself down to ½ which took the edge off when the others weren’t working.

However, during PT at certain points in the bending and straightening… pain returns. It’s a helpful idea to premedicate before PT to get the most motion and progression out of it.

Tramadol and Oxycodone are addictive. Opinions vary on how long it may be needed following knee replacement surgery. Our surgeon wanted us using the pain meds, so we’d do the PT to keep the knee bending and straightening. It’s a good conversation to have with your surgeon.

Reduce Swelling
Swelling limits motion and increases pain. It’s important to focus on reducing it as much as possible. Our physical therapists highly recommended above the knee compression stockings. My husband is 6’4” tall and it was difficult to find them long enough. A wonderful company in North Carolina sent them out which fit him perfectly.

Everyone recommended ice after any kind of PT activity for 20 minutes applied above and under the knee. Our PT team recommended 2 Comfort Gel packs (from Amazon). In addition, several orthopedic surgeons recommended the continuous Breg Polar Care Circulating Cold Water Flow system. It doesn’t damage the skin like direct contact from ice but keeps cool water circulating to reduce swelling and pain. You can insert frozen water bottles in the Breg Cube instead of ice.

Complications
Baby aspirin is ordered to reduce blood clot formation along with hourly movement and flexing of the feet. Frequent walking is very important. Walkers are used for the first weeks to prevent falling.

Bleeding may occur but is less common due to improvements in surgical techniques.

Infection is a major concern. You will monitor your temperature and report any elevations to your surgical team. Constipation also occurs. We were given daily doses of Senokot to promote the emptying of the colon slowed down by narcotics. Two glasses of prune juice a day was ordered along with Milk of Magnesia if needed for constipation. 

Medications
Keep track of all your medications, especially the pain meds. Write the times beginning with 7am through the next 24 hours in rows on the left side of a page. Create columns across the top of the page for each medication. There will be many new ones and it’s far too easy to get confused. It’s important to be accurate. Add a 1 or 2 in the time slot for how many pills you are to take with each scheduled dose. Record when all pain meds are taken as well. You may have to print a new page each day as the pain med times may change.

If you have high blood pressure, diabetes or kidney disease work with your healthcare provider to maintain balance in your numbers. This is a major surgery with a great deal of temporary medications that can make these problems worse. Monitor those numbers and report any concerns to your doctor. 

Metal Allergies
If you are someone who developed a rash from cheap jewelry or any metal, you need to have a conversation with your surgeon. After 25 years of wearing a white gold wedding band the protective coating rubbed off and I developed a nasty itchy allergy under the ring. I was concerned about what metal would be in the orthotic implant and did a lot of homework on this issue.

Unfortunately, the information is uncertain. There hasn’t been much research on this concern. Over time orthotics may fail. One wonders, was it related to an undiagnosed allergy to the metal in the device? Some orthopedic surgeons don’t think this is a real issue. However, one surgeon told me that he uses a hypoallergenic orthotic in all his patients. Another minimized my concerns. Our surgeon listened and placed a hypoallergenic implant in me.

Metal testing is an emerging area of research. I believe one day it will be standard practice especially in people with a history of a metal allergy. An orthopedic nurse in Oklahoma told me they offer metal testing to all their knee replacement patients before surgery. You can search Orthopedic Analysis for more information on the test they use. My test showed that I was highly reactive to nickel.

Interestingly, I also developed a rash underneath the dressing the surgeons used to cover the knee. Apparently, I’m also allergic to the adhesive used to secure the dressing. Let your surgeon know if you have any tape allergies as well.

On A Personal Note
My husband developed a severe knee injury while playing basketball in college 50 years ago. Over the years he saw many orthopedic doctors and physical therapists who helped him buy time. He reinjured it last summer and finally needed it repaired. I injured my knee 8 years ago playing my first and last game of Pickleball. My severely bowed leg altered my gait causing hip pain too. We never expected to have surgery just 5 weeks apart to say the least.

Remember that this is a major operation unlike any other one you may have had because it’s a joint and bone operation. Realistically, you should have help for at least 2 weeks after surgery.

You will be working very hard to get your range of motion back and relearn how to walk with a normal gait. Most of the work is simple stretching exercises but the final bending and straitening is painful but mandatory. By week four I was doing 1 hour of PT at home or the center twice a day followed by 20 minutes of ice packs on top and below my knee. Listening to music really helped.

Interestingly, we learned that when the weather changes…knee discomfort increases, and the Lord created bodies that heal unbelievably rapidly. Each day we saw improvements.

Life is returning to normal and we’re looking forward to more active lives. If you have questions or comments, please share your thoughts and experiences. You can also email me, and I’d be happy to talk one on one as well.

May this new year  bring a more peaceful world.

For I will restore health to you, and your wounds I will heal, declares the Lord (Jeremiah 30:17).

References:

“Knee Replacement,” Mayo Clinic, (November 15, 2024). https://www.mayoclinic.org/tests-procedures/knee-replacement/about/pac-20385276.

Dr. Joseph Bowen, Kootenai Clinic Orthopedics, (2024). https://www.kh.org/.

7508613. Nguyen Pharm D. & D. Synder MD, “Tramadol and Oxycodone: What are the Differences?” Very Well Health, (July 24, 2023). https://www.verywellhealth.com/tramadol-vs-oxycodone-7508613.

Rescue Legs Medical Compression Stockings. https://www.rescuelegs.com//.

I’m a Christian nurse who helps people navigate through the murky waters of healthcare.

Paperback copies of both books for sale. Email me for details at:  ask@jenniejohnsonrn.com.