7 Costly Mistakes to Avoid After Knee Replacement Surgery
Successful Rehabilitation After Knee Replacement: Common Pitfalls and How to Avoid Them
Total Knee Replacement (TKR),
also known as
Total Knee Arthroplasty,
is a surgical procedure that replaces damaged or worn-out knee joints with artificial parts to alleviate pain and restore function.
TKR has been a game-changer for millions of individuals, helping them reclaim mobility and improve quality of life.
However, the journey to a successful recovery after a knee replacement doesn't end when you leave the operating room—it's only the beginning.
Post-operative care demands as much attention and commitment as the surgery itself.
The road to full rehabilitation requires adherence to a specific regimen that includes
PHYSICAL THERAPY
HEALTHY DIET
AMPLE HYDRATION
PLENTY OF REST
But sometimes, despite our best intentions, we fall into patterns of behavior that can hinder our progress rather than help it.
This blog post aims to shed light on some common yet costly mistakes people often make during rehab after a knee replacement surgery.
These include
Resting with a pillow or a rolled-up towel under the knee
Neglecting to work on knee extension
Toe-down walking
Neglecting “Ankle Pumps” exercise
Not walking enough
Not utilizing ice therapy
Not drinking enough water
By being aware of these pitfalls and understanding why they are detrimental, you can avoid these errors and streamline your recovery process.
Read on to gain insights into these mistakes and the best strategies to ensure a successful and smooth recovery after your total knee replacement surgery.
The mistakes discussed below and the strategies to avoid them are also valid for rehabilitation after Partial Knee Replacement surgery.
Mistake # 1: Resting with a Pillow/Rolled-up Towel under the Knee
Let's dive right into our first post-operative mistake.
Picture this: you've just returned home from the hospital,
you're settling into your favorite chair,
and naturally, you're inclined to place a pillow under your knee for comfort,
especially if you're feeling a bit sore.
This seems like a reasonable thing to do, right?
Unfortunately, this seemingly innocent act can have unintended consequences.
While resting with a pillow under your knee can temporarily provide a reprieve from soreness, it can inadvertently set the stage for problems down the line.
The issue arises when this position leads to a condition known as
knee flexion contracture,
where the knee stiffens in a bent position due to the shortening of muscle tissues.
When you place a pillow under your knee, you're essentially allowing your knee to remain bent for prolonged periods, which hinders its ability to extend fully.
Achieving full extension of the knee is critical to restoring your normal gait and movement.
If your knee is constantly bent, it might adapt to this position, leading to a permanent bend that could affect your walking and overall mobility.
So, what's a better alternative?
To relieve soreness, consider elevating your entire leg.
You can do this by placing pillows under your whole leg from heel to thigh.
This position allows your knee to relax while at the same time promoting extension and preventing flexion contracture.
Remember, achieving
full knee extension
is the ultimate goal after a TKR.
Steering clear of resting with a pillow under your knee ensures you meet this goal.
So, next time you feel the urge to put a pillow under your knee, remember the goal: full extension and a smooth recovery.
Mistake # 2: Neglecting Knee Extension
As we have discussed, if there were a hierarchy of post-TKR recovery goals, achieving full knee extension would definitely be sitting near the top.
Now, after surgery, it's only natural for patients to focus heavily on knee flexion—the ability to bend the knee—given its role in daily activities like sitting down, climbing stairs, or hopping in and out of a car.
But equally, if not more important, is knee extension—the act of straightening the knee. Here's why.
Neglecting knee extension can have far-reaching effects on your long-term mobility.
Not achieving full extension can seriously throw off your walking pattern, leading to a compensatory or
"antalgic" gait,
a kind of limping caused by pain.
Over time, this altered gait can trigger a domino effect of other issues, such as lower back pain and hip problems, and even put undue strain on your non-operated, healthy knee.
Now, let's paint a picture here.
Suppose a person doesn't achieve full knee flexion of 130 degrees after surgery and only gets to 110 degrees.
Guess what: their daily activities will likely be largely unaffected (unless they plan to audition as a baseball catcher anytime soon!).
Their limitation in flexion probably won't even be noticeable to anyone else.
On the flip side, if the same person falls short of full knee extension by even a few degrees, their gait will be affected, and the lack of knee extension WILL be noticeable.
Achieving full knee extension allows you to walk normally and distribute your body weight evenly across the knee joint, which is crucial for avoiding new aches and pains.
So how can you keep your focus on knee extension?
It all starts with a dedicated routine.
Work with your physical therapist, and follow the recommended exercises and positions for promoting knee extension, such as
Heel props
Courtesy of HEP2GO
Prone knee hangs
Courtesy of HEP2GO
Quad sets
Courtesy of HEP2GO
Short arc quads
Courtesy of HEP2GO
Long-arc quads
Courtesy of HEP2GO
Mistake # 3: Toe-Down Walking
Let's talk about the next pitfall on the road to recovery – “toe-down walking”.
This is a common misstep after knee replacement surgery.
Toe-down walking is when you take steps with your operated leg and place the weight on your toes instead of your heel.
It might not sound like a big deal, but this seemingly minor habit can derail your recovery journey.
The first issue with toe-down walking is that it signifies an
abnormal gait
In a correct walking pattern, your heel strikes the ground first, followed by the rest of your foot.
Landing on your toes instead of your heel alters the gait and looks like an awkward limp.
Toe-down Walking - Abnormal Gait Pattern
Courtesy of HEP2GO
However, the problems run deeper.
Toe walking can lead to calf tightness and pain.
The constant strain on your calf muscles can cause them to contract and stiffen over time, causing soreness.
This discomfort can often be mistaken for symptoms of Deep Vein Thrombosis (DVT), a potentially life-threatening condition where a blood clot forms in a vein deep within your body.
By James Heilman, MD - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=9444797
Misinterpreting such pain can lead to unnecessary stress and necessitate further testing to rule out DVT.
As a physical therapist, I've encountered numerous patients who fell into the toe-walking trap after their TKR.
It's easy to get into this habit, and you should be aware of it and the problems it will cause.
Now, you might wonder why someone might start toe-walking in the first place.
Interestingly, it often circles back to an issue we've discussed above -
inadequate knee extension
If full knee extension is challenging, a person may inadvertently start toe-down walking to avoid the discomfort associated with the heel strike, which requires full knee extension.
However, this adjustment can create a vicious cycle.
Toe walking not only arises from inadequate knee extension, but it can further inhibit achieving full extension, reinforcing the abnormal gait and hindering recovery.
So, how can you prevent falling into this trap?
It comes down to mindfulness and practice.
Pay attention to your walking pattern and consciously aim for a heel-to-toe sequence. If you've been toe-walking, it may feel odd at first.
Heel Strike - Correct Gait Pattern
Courtesy of HEP2GO
But persisting with it will gradually improve your gait while reducing the possibility of calf pain and tightness.
Remember, the goal is to restore normalcy in your daily activities, starting with your walking pattern.
Mistake # 4: Not Doing Enough Ankle Pumps
As we continue our exploration of common mistakes after knee replacement surgery, we now shift our focus from the knee to the ankle.
"Ankle pumps" is a simple exercise where you repeatedly flex and extend your foot at the ankle, like pressing down and letting off an imaginary pedal.
Courtesy of HEP2GO
This movement might seem inconsequential, but it is a critical part of your recovery journey.
Here's the deal: after the surgery, especially a procedure like a knee replacement where mobility is initially limited, the risk of developing a Deep Vein Thrombosis (DVT) increases.
A DVT is a blood clot that forms in a deep vein, often in your lower leg or thigh.
It can lead to serious health complications if the clot breaks off and travels to your lungs, causing a pulmonary embolism.
Deep vein thrombosis (DVT) is a potentially life-threatening condition that occurs when a blood clot forms in a vein that is located deep inside your body, often in the lower leg or thigh.
You must be aware of the signs and symptoms, as prompt diagnosis and treatment can significantly decrease the risk of serious complications, such as pulmonary embolism.
Here are the common signs and symptoms of DVT in the lower leg:
Swelling and warmth in the affected leg, sometimes including the foot and ankle
Calf pain or cramping, especially when flexing the ankle upward
Red or discolored skin on the leg
Leg fatigue or heaviness
However, it's essential to note that not everyone with DVT experiences symptoms.
Some people have no noticeable symptoms at all, which can make the condition difficult to catch.
If you or someone else experiences these symptoms, seek medical attention immediately, particularly if accompanied by
shortness of breath
chest pain
light-headedness
which could indicate a pulmonary embolism – a life-threatening complication of DVT where a piece of the clot breaks off and travels to the lungs.
Remember: This list of symptoms is not exhaustive and is for informational purposes.
Always consult with a healthcare provider for medical advice.
Regularly doing ankle pumps can help mitigate this risk.
These exercises encourage blood flow in the lower legs, which can prevent clot formation.
Remember we discussed above how calf pain from toe walking can be mistaken for a DVT?
Well, doing ankle pumps can help avoid this scary scenario.
Yet, many patients overlook or neglect these simple exercises, potentially due to their seeming lack of relation to the knee.
But make no mistake: failing to incorporate enough ankle pumps into your daily routine can have serious consequences.
As a side note, some surgeons require their patients to wear
compression stockings after knee replacement surgery
which can also help reduce the risk of DVT.
If your surgeon recommends this, absolutely adhere to their advice.
Remember, the surgeon's protocol supersedes anything else, so following it is paramount.
So, how can you avoid this common pitfall?
Incorporate ankle pumps into your daily routine.
You can do them virtually anywhere: sitting in your chair, lying in bed, or even during a commercial break on TV.
Ankle Pumps Exercise with Correct Leg Elevation
Aim for a set of 10 to 20 repetitions every hour to keep the blood flowing in your lower legs.
Mistake # 5: Not Walking Enough
We're moving to our next common mistake following knee replacement surgery: not walking enough.
It might sound counterintuitive – after all, your knee just had major surgery.
Shouldn't you rest it?
While rest is indeed essential, it's only part of the recovery equation.
Walking is vital in your post-surgery rehabilitation, and here's why.
Walking engages your muscles, promotes blood flow, and helps regain the correct gait mechanics.
It’s a
weight-bearing exercise
that improves bone strength and encourages joint flexibility.
However, it's common for patients to hesitate to walk after surgery.
They may fear pain or think they're causing harm to the new knee.
But unless your surgeon or physical therapist has told you otherwise, you should be up and walking as soon as possible.
But what about walking aids, you might ask?
Assistive devices like walkers or canes provide extra support, improve balance, and allow you to increase weight-bearing on the operated leg gradually.
Using an assistive device isn't a sign of weakness; it ensures safety and reduces post-operative soreness by taking some weight off the operated leg.
And there's no strict timeframe for transitioning from a walker to a cane or ditching these aids altogether.
This transition largely depends on individual recovery progress and comfort levels.
Some people might quickly progress from a walker to a cane, while others might skip the cane and go straight from the walker to unassisted walking.
But here's the catch: it's not just about walking; it's about walking correctly.
We discussed earlier how you can develop bad habits like "toe-walking" and how these habits can cause complications.
Using an assistive device can help you practice the correct gait pattern.
How can you avoid the mistake of not walking enough?
It's all about balance.
Listen to your body and give it time to rest when needed, but also push yourself to get up and move regularly.
You can easily incorporate walking into your daily routine – a short stroll around the house, walking to your mailbox, or even moving around while cooking.
Every step counts.
Remember, as with many aspects of recovery, consistency is the key.
The more consistent you are with your walking routine, the smoother your recovery journey will be.
Mistake # 6: Not Using Ice Therapy Enough
Next on our list of common errors is a simple but often overlooked aspect of post-surgery recovery: not using ice therapy enough.
Ice therapy, or cryotherapy as it is sometimes known, is a crucial part of the recovery process after a knee replacement.
Applying cold to the area around your new knee helps reduce swelling and inflammation, two common side effects of surgery.
Moreover, ice therapy can also help manage pain, reducing the need for heavy reliance on pain medications.
Despite its benefits, some patients underuse this effective, non-invasive treatment method.
They may forget, feel it's a hassle, or underestimate its effectiveness.
Yet, this simple act can contribute greatly to a smoother recovery.
Depending on your surgeon's advice and the resources available, there are various ways to apply ice therapy.
Some surgeons provide their patients with an "ice machine," a device that circulates cold water through an attachment placed on the knee.
Others might receive ice pack covers and ice packs, which are also effective.
But what if you don't have access to these items?
Something as simple as a Ziploc bag filled with crushed ice or even a bag of frozen peas wrapped in a towel can do the trick.
The key to effective ice therapy is consistency and proper usage.
Aim to apply ice to your knee for 15-20 minutes every 2-3 hours, or as your healthcare professional advises.
Be sure not to apply the ice directly to your skin, as this can cause ice burns – always use a thin cloth or towel as a barrier.
Mistake # 7: Not Drinking Enough Water
We've arrived at the final, yet critical, mistake on our list: not drinking enough water after knee replacement surgery.
Hydration is fundamental for our overall health and even more so when our body is healing.
Let's start with the basics: water makes up around 60% of our body and plays a vital role in countless bodily functions.
It aids in nutrient absorption, digestion, temperature regulation, and much more.
When you're not adequately hydrated, these essential processes can be compromised, which is the last thing you want during your recovery.
A particularly relevant function of water post-surgery is its role in maintaining
regular bowel movements
Many patients are prescribed
opioid pain medications
that can often lead to constipation.
Staying well-hydrated helps prevent this common and uncomfortable side effect, aiding in the normal function of the digestive system.
Moreover, the importance of water extends beyond these general benefits when it comes to post-surgery recovery.
You see, following surgery, particularly when anesthesia and pain medications are involved, your body might accumulate toxins.
This can occur due to the metabolization of the drugs and the natural inflammation process following the procedure.
Water acts as a natural detoxifier
It aids in flushing these toxins out of your system, making it easier for your body to recover.
Without sufficient hydration, these toxins could prolong your recovery period and potentially contribute to feelings of fatigue or malaise.
Despite its importance, some patients don't drink enough water post-surgery.
They may forget, not feel thirsty, or underestimate the power of hydration.
But skimping on water can delay your recovery and make you feel worse.
So, how can you avoid this mistake?
It's simple: make a conscious effort to drink water regularly throughout the day.
Aim for at least eight glasses of water a day.
You may need more if your doctor recommends it or if you're particularly active.
Final Thoughts on Rehabilitation After Total Knee Replacement
Knee replacement surgery can be a life-changing event, paving the way for an active, pain-free lifestyle that may have seemed out of reach.
By avoiding the seven common yet costly mistakes we discussed in this article, you're setting yourself up for a smoother, more efficient recovery.
Always remember: it's the small actions and consistent habits that often have the most significant impact on your recovery.
Listen to your body
Follow the directions of your healthcare professional
Remain committed to the process
You've taken a tremendous step towards improving your quality of life by opting for knee replacement surgery.
Now, make sure your recovery aligns with your goals:
Regaining mobility
Reducing pain
Returning to the activities you love
While every recovery journey is unique, these guidelines can serve as a roadmap to help you avoid common pitfalls.
Staying dedicated and patient and following the correct practices will ensure you'll be back on your feet and enjoying your renewed mobility before you know it.
Related Articles
Cracking the Code of Knee Pain: Understanding the Root Causes and Relief Solutions Part 1
Cracking the Code of Knee Pain. Part 2: Relief Solutions
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