Total Knee Arthroplasty

Understanding Your Total Knee Arthroplasty (TKA)

A total knee arthroplasty (TKA) is a transformative surgical procedure designed to alleviate chronic knee pain and restore function. During the surgery, the damaged cartilage and bone are precisely removed and replaced with a new, artificial knee joint composed of a medical-grade cobalt-chromium or titanium alloy and a highly-durable polymer bearing. This new joint is engineered to replicate the natural movement of a healthy knee.

Following the procedure, your body embarks on a complex healing process. Physiologically, the bone and soft tissues begin to integrate with the implant, a process known as osseointegration, which firmly secures the new joint in place. This phase is crucial for long-term stability and success.

Physical therapy (rehabilitation) is an essential component of the recovery process. Guided by a physical therapist, you will perform specific exercises aimed at reducing swelling, improving range of motion, and rebuilding the strength of the muscles supporting your knee. The prognosis for a TKA is generally excellent, with studies showing significant pain reduction and improved mobility for the vast majority of patients.

The timeline for recovery is unique to each individual but typically follows a general progression. Initial healing and the most significant gains in function are often seen within the first three months. While full recovery can take up to a year, the early and consistent effort in rehabilitation is key to a successful outcome and a return to the activities you enjoy.

What to Expect: A Recovery Timeline

First Week:

Your focus will be on managing pain and swelling, and safely mobilizing. You will begin walking with the assistance of a walker or crutches, often on the day of or the day after surgery. You will start gentle range-of-motion exercises, such as ankle pumps and knee bends, to prevent stiffness and promote circulation. Rest and elevation are crucial during this initial phase.

Sixth Week:

By this point, you will likely be walking with minimal or no assistance, such as a cane. The intensity of your physical therapy will increase to focus on more challenging strengthening exercises. Swelling and discomfort will have significantly decreased. You may be cleared by your surgeon to return to driving (for a left knee) and to a sedentary job.

Twelfth Week:

Most patients experience significant functional improvement by 12 weeks. You should have a much greater range of motion and strength in your knee. You will progress to more demanding exercises and may be able to return to low-impact activities like cycling or swimming.

Six Months:

You will likely be able to perform most daily physical activities with greater ease and less pain. You will continue to build strength and endurance. Any residual swelling should be minimal.

One Year:

While the most dramatic improvements are in the first few months, your knee will continue to heal and strengthen for up to a year. At this stage, you should have achieved a full recovery, allowing you to return to most, if not all, of your pre-surgery activities.

Caring for Your Incision

After Bandages/Staples are Removed:

Staples or stitches are typically removed about two weeks after surgery. Once cleared by your surgeon, you can gently wash the area with soap and water and pat it dry. Avoid scrubbing. Do not apply any lotions, creams, or ointments to the incision unless specifically directed by your doctor. Submerging the wound in water should still be avoided until it is completely closed and healed.

Reducing Infection Risk After Surgery

• Keep your incision clean and dry at all times.
   
• Wash your hands thoroughly before touching the wound or changing dressings.
   
• Avoid submerging the knee in water until fully healed (no baths, pools, or hot tubs).
   
• Monitor the incision for redness, warmth, increased swelling, or discharge, and report any concerns to your surgeon immediately.
   
• Follow your surgeon’s instructions regarding antibiotics or topical treatments, if prescribed.

What Not to Do

• High-Impact Activities: Avoid jogging, running, jumping, and contact sports. These can put excessive stress on your new joint and lead to premature wear or loosening of the implant.
   
• Prolonged Sitting: Avoid sitting in one position for more than 45–60 minutes. Get up and walk around to prevent stiffness and reduce the risk of blood clots.
   
• Forcing Movement: Do not force your knee to bend beyond what is comfortable or what your physical therapist has instructed. Pushing too hard can cause inflammation and slow down your progress.
   
• Skipping Physical Therapy: Your rehabilitation is not optional. Skipping sessions or neglecting your at-home exercises will hinder your recovery and may result in a stiff or less functional knee.
   
• Ignoring Pain: While some discomfort is normal, severe or increasing pain, especially with redness or warmth around the incision, can be a sign of a complication. Do not ignore these symptoms.

Best Methods for Excellent Recovery

• ICE: Ice therapy is your best friend for managing pain and swelling. Apply an ice pack (wrapped in a towel to protect your skin) to the knee for 20 minutes at a time, especially after exercise or a long day.
   
• MOVEMENT: Regular, controlled movement is essential. Perform your prescribed exercises daily to regain range of motion and strength. Walk frequently, even for short distances, to improve circulation and prevent stiffness.
   
• PAIN MEDS: Take your pain medication as prescribed by your doctor. Staying ahead of the pain will allow you to participate more effectively in physical therapy and daily activities. As your pain decreases, you can gradually reduce the dosage as directed.
   
• ELEVATE: Whenever you are sitting or resting, elevate your leg so that your ankle is above your heart. This will help reduce swelling.
   

Sleeping Tips

• Sleep Position: The best position is on your back with your leg elevated on a pillow or foam wedge. This keeps the knee straight and reduces swelling.
   
• Pillow Placement: If you need to, place a pillow under your calf and ankle, but never directly under your knee. Putting a pillow under your knee can cause it to remain bent and lead to a contracture.
   
• Medication: If you are taking pain medication, consider timing your last dose about an hour before bedtime to help you sleep more comfortably.