In Health

The road to deciding

knee surgeryDeciding it’s time to get a knee replacement is a big step. Unless this isn’t your first patellofemoral rodeo, the idea of going into a big surgery on a part of your body you’ve had and used for your entire life isn’t the most comfortable idea for anyone. It’s perfectly natural to be hesitant to move forward with something so big, especially if you aren’t sure yet that your problem is bad enough to warrant a surgical procedure. It’s a decision you should make with your doctor and after much consideration, but in the end it’s one most people wish they’d made much earlier. More on that later.

What happens to joints over time

Your joints, which hold your bones together and allow your muscles to move them around, aren’t indestructible. They can become sick, damaged, or just worn down with a lifetime of use. When this happens and the cartilage layers cushioning your knee bones become too thin (or worn away) you have developed arthritis. When bone rubs on bone (instead of smooth, low-friction cartilage) it hurts. Though bones seem dry they are actually one of the most vascular and innervated organs, and so bone pain is no trivial matter.

Different types of arthritis

Osteoarthritis is when the cartilage of your knee is worn down by use over the years. Unfortunately this isn’t always something that can be avoided, and osteoarthritis is something many people over fifty or sixty years old have to deal with. One type of osteoarthritis is post-traumatic arthritis (PTA), where the damage to your cartilage is not caused by slow wear but a significant injury, triggering bone spurs or other complications. In contrast, Rheumatoid Arthritis is caused by an auto immune disease that results in chronic inflammation of the joints and similar structural damage over time. There are other variations too. Gout is yet another type of arthritis, caused by high uric acid levels and the development of uric acid crystals in the joints (and the body’s response to them).

It just hurts

Whatever the source, arthritis is painful. Bone on bone rubbing causes considerable pain, and leads to joint stiffness and decreased range of motion, further exacerbating the problem. The more bone rubs on bone the more the area becomes inflamed, swollen, and painful. Every person’s situation is unique and you should always talk with your doctor about what you’re experiencing to arrive at a clear diagnosis and to plan the best course of action.

The road to recovery and feeling like yourself again

Once you’ve made it through surgery you’ll begin focusing on recovery. It’s not always easy, but the hardest parts are temporary and the relief of finally being pain free is immense. For the most part people are surprised at how quickly they are up and walking after knee replacement. Though many people will use a cane, walker, or crutches at first, many are able to walk normally within a few days to a couple weeks. Though it seems like knee replacement, like heart surgery, should leave you with a difficult recovery paradoxically that’s not the case. The hardest surgeries to recover from usually involve soft tissues, like the abdominal muscles or skin. Because bone is stable and doesn’t flop around like your stomach muscles there isn’t nearly as much pull and twisting on the surgical site, making recovery much faster. Ask someone who had both abdominal and knee replacement surgery which had the more difficult recovery. You’ll be surprised.

Scar tissue is enemy #1

When your body undergoes this type of surgical procedure it begins to heal the injured (cut) tissues. When tissues aren’t close enough together for full repair the body will fill in the gaps with a fibrous, inflexible material called scar tissue. Scar tissue is the enemy of all major surgical recoveries, and having a plan in place to limit scar tissue formation – or at least its limitation on motion – should be one of your most important goals after the procedure.

Regular physical therapy and exercise are key. You need to aim for maximal flexibility and range of motion from the beginning. If your knee sits idle and doesn’t move you are almost guaranteed to develop scar tissue that will lock your knee up and severely limit bending. And once scar tissue is formed it is very hard to correct since it doesn’t flex or stretch. You pretty much have to break the strands with constant therapy to make progress – better to prevent it in the first place.

Meet with a qualified physical therapist as soon as possible after your procedure and make as much of an effort as possible to fight through the pain and do the hard work early on. You’ll save yourself months if not years or trouble by doing so.

Other considerations

Seeing how you won’t be as mobile immediately post-surgery, rearranging your house can be a big help. Stairs can sometimes be difficult, especially without handrails to hold onto, and installing something similar for a shower or bath might make you less prone to a fall. Making sure that you will have comfortable seating options with means of elevating your leg beforehand is something you might be grateful for too. Here are a few tips recommended by experts on rebuilding your strength.

The bottom line

The vast majority of people are happy with their new knee and the absence of the chronic pain they’ve suffered with for so long. It’s a very important decision to make, but today, with modern surgical techniques and modern joint replacement technology, the results tend to be excellent. Speak with your doctor; there’s no need to suffer year after year when relief and often full recovery are possible.