Hip & Knee Replacement Recovery FAQs: Orthopaedic Surgeon Video Answers
After hip and knee replacement surgery comes a lengthy recovery. This recovery will be filled with ups and downs and triumphs and failures—all of which will spark a host of questions. Although everyone’s recovery is different, there are frequently asked questions that we hear time and time again.
We asked patients (like you) for their most pressing questions in joint replacement recovery. Two leading orthopedic surgeons: Dr. Trevor North, MD from Cleveland Clinic Michigan and Dr. John Tiberi of Kerlan Jobe in the Los Angeles area took time to answer each question.
Watch the “Ask a Surgeon” video answers to your FAQ about hip and knee replacement recovery.
DISCLAIMER: The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for informational purposes only.”
11 FAQ About Knee and Hip Replacement Recovery
1. Knee Manipulation Under Anesthesia: When is a MUA Recommended?
Knee manipulation under anesthesia is a procedure after a knee replacement to correct stiffness. Stiffness after knee replacement surgery is common, although a manipulation is not usually required. Manipulation under anesthesia addresses range of motion (extension and flexion) issues.
A manipulation under anesthesia (MUA) is not something that is considered until after the 6 week mark of recovery. If pain and stiffness are preventing the patient from recovering and returning to healthy, normal function than a MUA may be required. In the procedure scar tissue is broken up. Although this operation will set back recovery, it may be necessary for long-term gains.
2. Trouble Sleeping After Joint Replacement Surgery?
Trouble sleeping after joint replacement surgery? This is a common complaint for those recovering from surgery. Not being able to sleep is more than just frustrating. It can interfere with your mental and physical recovery. Another point of concern is finding comfortable sleeping positions that are safe. Sleeping on your surgical side after surgery can go against the hip or knee precautions your surgeon laid out.
For instance, after hip replacement surgery lying on your surgical side can cause complications. Laying on your incision can cause fluid to collect. It’s better to avoid this until past the 6 week mark. More loosely, your body should let you know when certain sleeping positions are comfortable or not. Simply, if it hurts or isn’t comfortable, don’t lay like that.
When trying to fall asleep and stay asleep, it’s important to put in extra effort to better your odds of resting well. This includes things like taking your medication on time, removing electronics from the bedroom, and engaging in relaxing reading or writing etc. It’s important to avoid napping too much during the day, and to try and do as much physical activity as your body permits.
3. IT Band Knee Pain After Surgery: How Common is It?
IT band knee pain (sometimes referred to as “iliotibial band” pain) is felt on the outside of your knee. After a total or partial knee replacement (TKR or PKR), IT band pain is reported by patients. However, only about 5% of patients report IT band issues or pain to their physicians.
Generally, IT band pain is something that corrects itself. It is caused because with arthritis, the bone and cartilage is affected and degrades. This causes the muscles and tendons around the knee joint to tighten up to support the bone loss. Once the knee is replaced, the ligaments return to a more natural state (before arthritis). This means that the ligaments in the knee are quite stretched.
Physical therapy with a focus on IT band stretches will address the issue. Deep tissue massage and ultrasound can speed up the healing process and reduce pain as well.
4. Postoperative Stiffness & Swelling After Joint Replacement
Postoperative stiffness and swelling after a knee replacement is very common. It’s normal, but it can become unmanageable if not worked at in the weeks after surgery. It may be surprising to hear but, stiffness and swelling are not always related. When it comes to stiffness, targeted exercise and stretching is the best way to improve it. This is especially true for knee replacements. Physical therapy or range of motion exercise are crucial to getting over stiffness.
For swelling, you can reduce the effects by elevating your surgical side above your heart. Wearing compression stockings and following a strict icing routine also helps. The biggest thing when getting over swelling is to simply wait it out. You must stay on top of icing and elevating, but time is always required. For some patients, swelling lasts a very long time. Although being swollen is normal, if you notice something odd or are concerned, always talk to your doctor.
5. Driving After a Knee Replacement: When is it Safe?
When is it safe to drive after a knee replacement? Each doctor will have their own opinion. There is no proven date that one can or cannot drive at. This is because each individual is different and each surgery is different. For example, someone who had a hip replacement with a certain approach may take longer to drive than someone who had a partial left knee replacement.
There are two definite criteria for determining if you can safely drive. For one, you cannot drive if you’re taking narcotic pain medication. It’s illegal and dangerous to drive under the influence of narcotics. Secondly, you have to be ready to slam on the breaks. If your reaction is delayed, then you shouldn’t be driving. Ultimately, you should ask your doctor about when you are free to operate a vehicle.
6. How Soon After Surgery Can You Massage Scar Tissue?
How soon after a replacement can you massage the incision scar tissue? First of all, scarring is mostly genetic and there isn’t much you can do to influence how much scarring you will have. Even your surgeon cannot take credit for a good-looking scar! The location on your body, incision size, and your genetics play a factor in what your scar will look like. However, if you want to put on topical creams, minerals or medication on your incision, you should wait at least a month.
The same goes for massaging your scar. If you massage too soon, you could disrupt the healing tissue. One month into recovery you won’t be fully healed. Soft tissue healing takes 3 months or more. Be gentle when massaging and monitor any pain, discomfort or reaction.
Read all about scars after hip and knee replacement surgery. Learn what to expect and what you can do to minimize your scar.
7. Avascular Necrosis of the Hip: How Common is it?
Avascular necrosis of the hip is not uncommon. In other words, avascular necrosis of the hip or femoral head is not rare. Avascular necrosis is when the bone undergoes cell death because there has been a lack of bloodflow. There is not a definitive answer or reason for why this happens but it is triggered by surgery.
Contributing factors that show an increased risk of avascular necrosis are the use of oral steroids taken for a medical reason. A history of alcohol abuse can also contribute. Finally, there has been a link to the avascular necrosis of the hip/ femoral head with blood clotting disorders, viruses like HIV, and medications used to treat HIV.
8. Drop Foot After Joint Replacement: Is it Permanent?
Drop foot after joint replacement is rare but can happen after hip or knee replacement surgery. It happens in only about 1% of joint replacement cases. It can be permanent but is usually treatable. Drop foot is when a patient cannot bring their toes and foot up towards the direction of their head.
What are drop foot causes? Drop foot is a nerve injury. This could mean a traumatic injury which is very rare but is most likely a stretched nerve. A stretch injury is sometimes just a normal correction of the patient’s deformity. There are cases where it is temporary but it can also be permanent. If it is permanent, braces or surgery can help fix the problem.
9. Dislocation Risk After Hip Replacement: Bending Over?
Is bending over a dislocation risk after hip replacement surgery? In other words, can bending over at the waist cause a dislocation or the hip to come out of socket. Bending over at the waist is a risk, which really depends on the surgical approach.
Surgeries that are done through a posterior approach (from the back) have a higher risk of dislocating from the back. Anterior hip replacements (done from the front) have a higher risk of dislocating from the front. Bending over at the waist could place you at risk for a posterior dislocation. During the first 3 months after surgery, the risk of a dislocation is the highest. After 3 months, your risk goes down and it’s safer to bend over and perform “normal” movements. Be very careful when bending over or moving past the 90 degree bend as this increases the possibility of dislocation (which almost always required a revision/ surgery).
10. Knee Joint Clicking After Replacement
Knee joint clicking, popping, or clunking can be very uncomfortable. However, it’s very normal after surgery. After all, these prosthesis parts are made of plastic and metal. They are not natural. As scar tissue forms around the knee, the clicking sounds (sometimes called the “patellar clunk” or “kneecap clunk”) should lessen or go away. This can take some time.
If popping or clicking as you walk continues more than 12 weeks after surgery, let your surgeon know. Before the 12 week mark, your thigh muscle and quadricep function have not fully returned. It takes 12 weeks for your muscles to fully strengthen and this is when the annoying “clunking” should go away. If the knee popping or knee clicking continues, talk to your doctor. They will have some non-surgical things that you can do.
11. Pain After a Joint Replacement: What’s Normal?
What kind of pain is normal after a joint replacement? How long should you be in pain after a knee replacement? How much pain is normal after a hip replacement?
Pain management after a replacement has improved drastically. Multimodal pain management (which means several different types of medications are used to treat pain) is commonplace. This pain management technique limits the amount of narcotic pain medication that a patient needs. Narcotics are addictive and have a laundry list of side effects.
The day of surgery your pain should be better controlled. A few days later, you could experience more pain as the anesthesia has worn off. You may notice a spike in pain a couple weeks into recovery as physical therapy becomes more aggressive and you are likely on a lower dose of pain medication. As you heal, you should be in less pain. If pain has not gone away or is worsening, speak to your doctor.
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