In knee replacement surgery, surgeons cut away damaged bone, cartilage, and a ligament or two and add an artificial joint made of metal and plastic. For people who’ve suffered years of pain and limited mobility—not being able to climb stairs or bend down to tie their shoes—a brand-new knee can be life-changing. “People come in crippled; they can’t even go from the waiting room to the operating room unassisted,” Lajam says, “and then they walk out of the hospital two days later. It’s amazing.”
1. You might not be a good candidate.
A study published last year by researchers from Virginia Commonwealth University in Richmond questioned the value of knee replacement for some of the people rushing to get it. After analyzing data from a large study of men and women who had the operation, the researchers found that fully one-third of them were not actually good candidates for the surgery, which is why they got only a very modest benefit—a 2-point improvement on a common measure of knee function, compared with a 20-point improvement for people who started out with really bad knees.
“Pain that doesn’t go away and moderate to severe arthritis are necessary for a knee replacement to do its job,” Lajam says. “If you have the surgery, but it’s actually a problem of nerve pain, hip pain, or circulation, it’s not going to help you.” The advice here is not to wait until your knees are completely destroyed before seeking surgery, but to make sure that you’ve tried other measures first (namely, physical therapy to strengthen the joint) and that you meet both criteria—consistent pain and advanced arthritis. (Learn how to solve your chronic pain with Total Recovery by Dr. Gary Kaplan.)
2. It hurts more than you imagine.
“People compare it to hip replacement, but knee replacement is a lot more painful early on,” says licensed physical therapist Robert Fay, clinical director at Armonk Physical Therapy and Sports Training in New York. “It really can be difficult, especially the first few weeks, and it’s definitely something people don’t expect.” A 2014 study from New York City’s Hospital for Special Surgery found that women, especially younger women (age 45 to 65), were more vulnerable than other patients to serious pain following knee surgery. Fortunately, there are new pain management strategies to dial down the misery. Surgeons have begun placing a mixture of pain medicines inside the soft tissue around the knee before sealing the new joint into place. “The first 2 days are the worst, but the level of pain is so much better than it was even 5 years ago,” Lajam says. Request this strategy specifically to significantly minimize postop pain.
3. Recovery is a bear.
Expect to see your knee swell up to the size of a grapefruit and for swelling and bruising to last 3 months or more. “I expected it to be bad, and it was bad—but I didn’t expect how long it would really take to regain my strength,” Minutaglio says. “The most surprising thing for me is that after 6 weeks you’re supposed to have a lot of range of motion and I didn’t. I was like, ‘Whoa, I’m not healing as fast as I could be.’ ”
Here’s what recovery looks like: “For the first 3 to 4 weeks after surgery, it’s like a full-time job,” Fay says. “You’re icing your knee every hour, taking your pain meds every 4 to 6 hours, and doing your exercises 3 times a day for a half-hour to an hour.” And you’ll be keeping up the physical therapy anywhere from 8 to 16 weeks. Ultimately, your recovery rate will depend on how bad your disability was to start. Lajam says that people who are active and in robust health may go back to work 3 weeks after surgery; more like 6 weeks if they came from a sedentary job; and usually 3 months if they started out in bad shape or they have a physically demanding job. You certainly won’t get behind the wheel for at least 6 weeks if you had surgery on your right leg. For most people, Fay adds, it’s a year before you’ll say, “I’m 100% glad I did the surgery.”
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