KEY POINTS:
- The most common reason for needing a knee replacement is arthritis.
- The average age for receiving a knee replacement is 67.
- It can take several weeks to recover from knee replacement surgery.
Judy, age 67, lives alone in her condominium with her three cats. Judy has had osteoarthritis of her knee for about ten years now. She enjoys playing tennis. However, knee pain and swelling have hampered her ability to participate in the sport. So, three weeks ago, she had her right knee replacement surgery.
Unfortunately, three days after discharge, Judy had significant pain and swelling and was admitted to the hospital for observation. Her orthopedic surgeon was concerned about a potential blood clot. Though no blood clot was found, Judy was discharged with strict instructions to wear a compression boot to prevent blood from pooling in her leg, take blood thinners, and participate in physical therapy.
Judy’s friend Mary has been staying with her for the past three weeks. Mary and Judy anticipated that Judy would be on the mend by now, and Mary needed to return home to care for her family.
When do you need a knee replacement?
Judy, an avid tennis player, had increasing pain and limited movement in her knee. After trying medications and physical therapy, her orthopedic surgeon determined that a knee replacement was the only option to restore her knee function.
In 2017, more than 750,000 Americans had a knee replacement. In 2018, the average age for a knee replacement was 67 years old. Sixty percent of those who had knee replacements were female, and 40 percent were male.
The most common reason for needing a knee replacement is arthritis: especially osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis.
Osteoarthritis
Osteoarthritis is a degenerative arthritis that develops secondary to a lifetime of wear on the cushioning in the joint. It is more common in adults over age 50 but can occur at any age. As the cartilage that cushions the bones wears away, the bones in the knee bump and rub against each other. Pain, swelling, decreased range of motion and joint instability develop as osteoarthritis becomes more severe.
Rheumatoid arthritis
Rheumatoid arthritis is an inflammatory arthritis that occurs when the immune system mistakenly attacks healthy tissue. It is an autoimmune disorder that damages the synovial membrane surrounding the joint, causing it to become inflamed and thickened. Cartilage can also become damaged as the disease progresses, which causes increased pain and stiffness.
Post-traumatic arthritis
Post-traumatic arthritis occurs after a serious knee injury. Damage to the bones and ligaments surrounding the knee will change gait and joint mechanics, eventually causing damage to the cartilage in the knee.
How long does it take to recover from knee replacement surgery?
The initial pain after a knee replacement lasts an average of two to four weeks. Milder pain will last longer as the soft tissue around the knee heals. Inflammation may last two to three months and stiffness up to six months. Full recovery may take 12 to 18 months.
After knee replacement, most people can get around with a cane or walker, but it takes several weeks for them to be able to manage cooking, shopping, laundry, and personal care.
Mary was able to help Judy for the past three weeks, but Judy is recovering more slowly than she anticipated. As a result, she will need help to stay in her home. Otherwise, she will need to stay in an extended care facility until she recovers and can care for herself.
What are the most commonly reported problems after knee replacement surgery?
All surgeries have risks, including knee replacement surgery. These are the most common complications after surgery:
- Mechanical complications: Most implants should last about 20 years or more. The American Association of Hip and Knee Surgeons report a 0.5 to 1 percent chance that an implant will fail each year.
- Pain: Pain is the most common complication after knee replacement surgery. Some degree of pain may persist for up to six months after surgery. However, even after successful surgery, approximately 20 percent of people report chronic pain, defined as pain three to six months after surgery.
- Infection: Infection at the surgical site is a serious complication and is the leading cause of implant failure as it damages muscle and bone. In a study of over 6000 patients undergoing knee replacement surgery, 116 became infected. Of these, 86% had deep infections. Major infections may require surgery and removal of the knee replacement. Symptoms of infection include pain, swelling, stiffness, fever, redness around the surgical site, drainage, and fatigue.
- Surgical complications: The surgical procedure can cause damage to blood vessels and nerves surrounding the knee.
- Blood clots: Blood clots are one of the most common complications from knee surgery. Deep venous thrombi (DVT) can form in blood vessels in the leg, break free, and travel to the lungs. Orthopedic surgeons use multiple strategies to prevent this complication.
Does having a knee replacement shorten your life?
In a study involving over 300 Japanese patients who had a total knee replacement for osteoarthritis, those who had a knee replacement had a similar life expectancy to those who did not. In the study, the two factors that most influenced lifespan after a total knee replacement were age and whether both knees were replaced.
Those who have knee replacement for osteoarthritis tend to live longer than those who have rheumatoid arthritis. In addition, some studies have shown that having both knees replaced led to a better long-term outcome than one knee replacement because having a single knee replaced leads to an average of a 14-pound weight gain.
What should you do or not do after knee replacement surgery?
You are likely to be discharged from the hospital only after you can:
- Get into and out of bed by yourself
- Be able to eat, drink and use the bathroom
- Get around with a cane, crutches, or walker on a flat surface and be able to climb up and down two to three steps
- Be able to do the exercises prescribed by physical therapists
- Know what complications to watch for and have your pain at an acceptable level
After knee replacement surgery, it is important to decrease your risk of falls. Steps you can take to decrease your fall risk include:
- Wear properly fitting non-skid footwear
- Increase lighting throughout your home
- Remove obstacles such as loose carpet and cords
- Remove coffee tables and footstools
- Have safety bars or handrails installed in your shower or bath
- Ensure all staircases have rails on both sides
- Only use stable, non-mobile chairs
- Add a toilet seat with risers
How can home healthcare help after knee replacement surgery?
Judy thought she would recover from her knee replacement surgery more quickly than she did. Her friend Mary has since returned home. Judy has been able to get around in her condominium. She has her groceries delivered and a friend who can take her to her medical appointments, but she is unable to manage many of her daily household chores, and she is very concerned that she might fall and damage her knee.
Judy does not want to leave her cats, and she does not feel like she needs to move to an extended care facility to recover. Judy called Sunland Home & Medical Care to arrange to have a registered nurse assess her fall risk and check on her surgical site. She also arranged for a Sunland caregiver to come to her home three times a week to help with personal care, housekeeping, and meal preparation.
Sunland Home Care & Medical can:
- Manage wound care.
- Screen for signs of infection.
- Monitor nutritional status.
- Administer antibiotics and other medications.
- Clean wounds and change bandages.
- Work with your wound care doctors.
- Monitor skin for signs of infection or dead tissue.
- Prepare meals.
- Do light housekeeping.
- Provide transportation to social events and medical appointments.
- Do wellness checks.
- Assess fall risk.
- Identify social services and programs that can help.
