“Enough about you, let’s talk about knee”
Taking Charge of Your Knee Recovery
When all is said and done it is your knee. Which means that nobody cares about it as much as you do… after all you’re the one who is going to rely on that knee for the years to come. This means that, to some degree, you have to take charge of your knee recovery, and take an active role in everything that happens once you are out of that operating room and taking your first steps with your new knee. You are the coach and you have to lead the many members of your own “team knee.”
As any good coach knows it is a big responsibility to lead a team. It takes careful player selection, coordination of many resources, dedication to excellence and a lot of plain old hard work to win the game. You have to build a team of strong players who get along, respect each other, and are willing to work together toward a common goal. And as the coach, your team will be looking to you for guidance.
The Orthopedic Surgeon
We usually expect our doctors to take on a leadership role when it comes to so many of our ailments. After all they are the ones with the medical degrees. You pick your orthopedic surgeon because of his (or her) reputation, bedside manner, education, and success rate. Your surgeon is in charge of what happens in his surgical home-court (the surgery room) and also recommends a course of action for after surgery.
He also offers his specific approach to knee surgery, and carefully selects those who will be in the operating room working as a closely-knit unit on your knee. This is where the orthopedic surgeon’s training and schooling really shines. I think many surgeons are most comfortable in the operating room practicing their craft. There is artistry and a great degree of highly specialized skill on display in a total knee replacement operation. If you want to see a great (if slightly grisly) example of this skill click here.
After the surgery is done (45-60 minutes for most knees) much of your surgeon’s job is actually done. You will have access to your surgeon on a number of other occasions, and he will provide guidance on your recovery plan. He will be more involved if there are challenges or complications to your recovery. However, he has played his primary role in your knee replacement and others will step in as team captains going forward.
The Physician’s Assistant (PA)
When you select an orthopedic surgeon, you are ‘hitching your wagon’ to his full staff. The Physician’s Assistant will be play an important role in what happens as you move through the weeks post-surgery. After all that great work in the operating room is done, there you are facing the rehab players who will help you win the ultimate game of getting you to full mobility.
Orthopedic PAs
Orthopedic physician assistants help with many of the less-complex job duties so a surgeon can focus on tasks requiring his more specialized skills. They conduct examinations of new patients, write treatment plans, perform and interpret diagnostic tests and conduct outpatient procedures such as closing up a wound. They also help the surgeon conduct hospital rounds.
While PA’s cannot perform major surgeries, they do assist during surgery by getting equipment ready, explaining the surgical procedure to the patient, administering local anesthesia, performing duties during surgery such as closing a wound or keeping the area clean, and looking after the equipment. They are also responsible for educating patients about their conditions and any follow-up they might need, adjusting medications or dosages and referring cases to the surgeon or another physician when needed.
Physical Therapist/Physical Therapist Assistant
You will work with a Physical Therapist and/or Physical Therapist Assistant at some point in your recovery. It may be in your home during the first few weeks after surgery. It may also be in an outpatient clinic. Your PT will play a very important role in your recovery. In many ways your outcome and happiness with your knee replacement is dependent on your recovery plan and team.
A good PT, one that you like and who understands your goals, fears, and limitations is worth his or her weight in gold. I have heard it countless times from so many patients, ‘a good surgeon is crucial, but rehab is the other half of a successful knee surgery.’
At X10 Therapy we have a recovery staff skilled in physical therapy and strength training. We call them Knee Recovery Coaches. Some are PTA’s and some have other highly developed skills that they put to use on behalf of our patients. Of course we have this huge advantage in that we have the X10 Knee Machine. It is the cornerstone of our brand of recovery. To learn more about The X10, click here.
Taking Charge of Your Knee Recovery: Some Next Steps
Pick Good Players
If you are reading this prior to knee replacement surgery you have a great opportunity to do this in just the right way. Some thoughts here:
Review your surgeon’s record of success.
- Find out his (or her) approach in surgery and how invasive will the surgery be.
- Understand your surgeon’s knee hardware preference and techniques.
- Interview your therapy team (both Home Care and Outpatient) and find out if they have worked together before.
- And do not just accept your hospital’s services before you explore all options. YOU are in charge of directing your therapy after surgery… YOU get to pick the team.
Be Active, Not Passive (Coach Your Team!)
Ask the hard questions. Make sure you fully understand the answers you get back. Write down answers to questions, don’t be afraid to ask your team to define any words or ideas you don’t understand. Being in charge of your knee means knowing what, how, and why you are doing things.
Set Expectations
You need at least 115º degrees range of motion to be active on a bike, to play golf, garden, live a normal, active life. Extension is important for normal walking (having a steady gait), but make your team also focus on your flexion as you will need to bend your leg backwards with ease to walk up and down stairs.
Keep Your Own Records in a Fresh New Notebook
Begin to track your range of motion numbers as they improve starting immediately after surgery and continue until you achieve your goal. Physical therapists use a device called a goniometer to track this. Document your abilities with your new knee. When were you able to stand on your own, leave the wheelchair behind, the walker, the cane. When could you walk stairs on your own? And as time goes on, how much weight can you lift with you good leg? Your “new” leg? A common measurement of time for a knee replacement patient is D.P.S. (days post surgery).
Finally be sure to keep an eye on what pain meds you are taking each day and how they make you feel. If they seem too strong the doctor can prescribe something lighter which will allow you to be more active in your everyday life.
Share Information
Make sure your surgeon’s office knows how you are progressing. You can call them whenever you have hit a milestone, even before your scheduled two or three week meeting. Tell your therapists what your knee was like before surgery. Be descriptive about pain levels during recovery, and try to be consistent in your assessment of your pain. Keep your partner and family informed on your progress. Be ready to bring all this information to your outpatient team once you are mobile enough to travel to your therapy after you have left home to travel to your therapy.
Play the Long Game
Keep at it, even after your team has moved on to the next “knee coach”. If you can beat scar tissue over the first 2 to 4 weeks after surgery you will really be on your way to success.
It may not be in everyone’s nature to “take charge” of a team. Be gentle but firm. So often patients who are not motivated, not informed, not committed to rehabilitation suffer the consequences. After a certain point you will lose some of your options. After about twelve weeks surgeons no longer like to perform a manipulation (MUA, Manipulation Under Anesthesia).
The only other option is breaking through scar tissue the hard way – if possible – which is really painful. Past that – you are looking at either living with more limited use of your knee or another invasive procedure like an arthroscopy or even a completely new replacement surgery called a revision.
You, Taking Charge of Your Knee Recovery
So, ok coach, get ready to lead your team to victory. You will be glad you did because in the end, you will be the winner.
I welcome your comments below.
The X10 Meta-Blog
We call it a “Meta-Blog” because we step back and give you a broad perspective on all aspects of knee health, surgery and recovery.
In this one-of-a-kind blog we gather together great thinkers, doers, writers related to Knee Surgery, Recovery, Preparation, Care, Success and Failure. Meet physical therapists, coaches, surgeons, patients, and as many smart people as we can gather to create useful articles for you. Whether you have a surgery upcoming, in the rear-view mirror, or just want to take care of your knees to avoid surgery, you should find some value here.
I like the advice you gave about taking over your knee rehabilitation by keeping your own records and setting your own expectations. The doctors are obviously going to do a good job but if you take the initiative to try and get better as soon as possible you will see faster results. Thanks for giving this great advice to people who are in knee rehabilitation.