Hardest Day After Total Knee Surgery: A Physical Therapist’s POV

Total Knee Post Link Pic

As an orthopedic physical therapist with over four decades of dedicated service, I’ve witnessed countless patients navigate the challenging recovery journey following total knee surgery. The path to regaining strength and mobility is often marked with highs and lows, but there consistently emerges a day that tests the resolve of even the most resilient patients.

In this article, we will delve into what I’ve observed to be the hardest day after total knee surgery, the third day after surgery, explore the physiological and emotional hurdles faced, and provide strategies to assist patients through this critical phase of their rehabilitation.

As you embark on the journey toward recovery following a total knee replacement, it’s crucial to appreciate the body’s healing timeline. Achieving total recovery typically unfolds over a period that can stretch to 18 months, during which the body meticulously tends to the reparative tissue changes.

Patience is paramount as you navigate through this post-surgery phase. We must pay close attention to the surgical scar, as it serves as a visible gauge indicating the conclusion of the body’s remodeling efforts and reflecting the comprehensive rehabilitation of tissues impacted by the surgery.

For about 18 months the surgical scar will be pink. The color is indicative of the multitude of small blood vessels in the scar as the body remodels the tissue structure until it is satisfied with the final results.

THR Scar Posterior cropped Watermarked
Total Hip Surgical Scar
Notice the pinkish-red scar tissue

Upon completion of the repair process, a noticeable shift occurs; the body reabsorbs the surplus blood vessels once needed to support healing, causing the scar to transition in color until it presents a whitened hue; a testimony to the body’s intricate recuperative capabilities.

Navigating the First Days After Knee Replacement Surgery

Having observed the journey of countless individuals through the rehabilitation process following a total knee surgery, I’ve gleaned a deep understanding of the complexities involved in the initial post-operative period.

Typically, my patients are discharged within 24 hours post-procedure; a swift transition that can leave them unprepared for the demands of recovery in their own homes. Upon their arrival, many realize the necessity of certain items they lack; it’s not uncommon to find themselves without an adequate cold pack for swelling management, a toilet seat riser to ease the strain during transfers, or a properly secured environment free of potential trip hazards.

The first day post-surgery often unveils a series of unanticipated needs, transforming it into a whirlwind of activity for both the patient and their caregiver. The caregiver, especially, might find themselves immersed in a flurry of tasks, hastily modifying the home environment to accommodate the new requirements of the patient’s mobility and care.

These adjustments could include installing grab bars, securing loose rugs, and rearranging furniture to create clear paths for ambulation with walkers or crutches. Having the home prepared in advance can significantly mitigate these challenges, ensuring a smoother and safer recovery process.

It’s imperative to recognize the significance of this crucial period. The initial 24 hours at home can set the stage for the entire rehabilitation journey. An adequately equipped and prepared living space is vital for fostering optimal healing and minimizing the risk of postoperative complications.

As a seasoned orthopedic physical therapist, my advice to patients scheduled for knee replacement surgery is to plan ahead. Secure the equipment you’ll need, ensure your home is ready for your return, and understand that these preemptive steps can greatly influence the ease of your recovery and the speed of your return to daily activities and independence.

On the day of surgery, I’ve routinely assessed patients at their bedside, aware that the journey towards healing has just begun. To ensure a safe transition home, it is critical for patients to exhibit the ability to rise from bed, ambulate with the assistance of a walker or crutches, and proficiently maneuver any stairs they might encounter within their residence. The surgical team, relying on my experienced evaluation, would only authorize discharge once these competencies were confirmed.

During my tenure as Chief of Physical Therapy at a community hospital, I’ve come to understand that the initial postoperative period following a total knee replacement is pivotal.

On the day of surgery, I’ve routinely assessed patients at their bedside, aware that the journey towards healing has just begun. To ensure a safe transition home, it is critical for patients to exhibit the ability to rise from bed, ambulate with the assistance of a walker or crutches, and proficiently maneuver any stairs they might encounter within their residence.
The surgical team, relying on my experienced evaluation, would only authorize discharge once these competencies were confirmed.

The patients, still in the throes of their recovery, typically exhibit minimal swelling, reduced pain experiences, and a relatively satisfactory range of motion.
Unfortunately, this window of reduced symptoms is fleeting.
In the upcoming days, they will likely face heightened challenges as swelling increases and pain intensifies.

It’s my responsibility to prepare them for this reality by implementing personal experience and evidence-based interventions that target pain management, swelling reduction, and promoting an optimal range of motion. Being well-versed in the postoperative trajectory of knee surgery recovery allows me to offer both reassurance and realistic expectations to my patients as they embark on this transformative period of convalescence and rehabilitation.

By the third day following a total knee replacement, many of my patients have transitioned from the structured environment of the hospital to the comforts of their own home. It’s during this period that they often encounter the tough reality of the recovery process.

Typically, the third day after total knee surgery is when swelling tends to peak, which can significantly diminish range of motion and escalate pain levels.
Swelling, in my experience, is the predominant culprit behind most of the postoperative pain associated with knee surgery.

Day three may indeed be the most challenging because the powerful hospital-grade medications have worn off. These opioids and analgesics, known for their efficacy, are no longer masking the discomfort. Furthermore, patients commonly struggle with the home pain control medication regimen due to foggy recollections of post-op instructions, initially explained while still under the influence of hospital drugs. This scenario can lead to inadequate pain management at home.

Another factor contributing to increased discomfort is the potential misapplication of cold therapy. Correctly utilizing cold therapy for inflammation is key, but the standard advice of a mere fifteen minutes may not be optimal. In my professional judgment, this approach can paradoxically aggravate swelling in the knee, intensifying the pain.

Read my article:
Ice After Total Knee Replacement: A PT’s Complete Guide

During my initial home visit, usually on the second or third day post-surgery, a common refrain from patients is their surprise at the sharp contrast in their well-being: “I was much better when I was in the hospital; I don’t know what happened.” This sentiment underscores the need for a comprehensive and well-communicated pain and swelling management strategy following discharge.

Managing Pain in the Critical Days After Knee Replacement Surgery

Postoperative pain management is a cornerstone of recovery following total knee surgery, and over the course of my forty-year tenure as an orthopedic physical therapist, I’ve refined several strategies to assist my patients.

Initially, my patients are prescribed two sets of pain medications: a baseline, time-contingent option for persistent discomfort, and a stronger, pain-contingent medication reserved for “break-through” pain.
In my professional experience, this latter option is crucial when a patient’s pain intensifies to a 7 out of 10 or higher.

My advice for those experiencing more severe discomfort is to keep the affected limb elevated. I cannot stress enough that new knee recipients should not sit with their foot on the floor for more than 20 minutes a couple of times a day at most. Instead, it’s beneficial to rest in a recliner or to put your leg up on an ottoman or sofa to foster better circulation and reduce inflammation.

Sitting in a dependent position with the foot on the floor can cause fluid accumulation in the foot, resulting in a stasis ulcer.
This is one of my patients who refused to sit with her leg elevated and even slept in the upright chair with her foot on the floor.

121213 Stasis blister dorsum of foot 3 cropped watermarked
This patient just refused to elevate her leg after surgery!

Another key strategy to control knee pain is cold therapy, which is incredibly effective in reducing swelling. I instruct patients to apply cold therapy for no less than forty minutes at a stretch.

Most of my patients have been instructed by a medical professional to apply cold packs to the knee for 15 minutes, then take it off for 20-30 minutes.
In my opinion, this is exactly the WRONG advice!
This technique will most likely add to the swelling of the knee.
To better understand this concept, read my article:
Ice After Total Knee Replacement: A PT’s Complete Guide

Removing the cold pack before this time can inadvertently contribute to increased swelling, so it’s essential to maintain this cool compression for the full duration. With these measures, along with consistent physical therapy, my patients can often navigate the most challenging days of post-knee surgery with greater ease and less discomfort.

With over four decades of expertise in orthopedic rehabilitation,my primary aim is to meticulously tailor a rehabilitation program that systematically enhances the range of motion, powers muscle recruitment, and fortifies the ability to walk with confidence. Concurrently, I work on augmenting balance, a critical element in mitigating the risk of falling, thus ensuring a safe return to daily activities.

The complexity of physical therapy after a knee replacement surgery lies in balancing the intensity of the exercises within the patient’s tolerance levels while still maintaining a pace that fosters tangible progress. For those who are more apprehensive, it’s crucial to gently yet firmly encourage their participation in exercises that may initially seem daunting. I find that with just the right nudge, even timid patients can significantly increase their rehab milestones.

Most patients benefit from structured guidance, where I introduce them to the appropriate rehabilitation protocol, and then make necessary adjustments based on their response.

Those patients with a ‘Type A’ personality present a unique challenge. In these cases, I find myself applying the brakes to their enthusiasm, ensuring they don’t jeopardize their recovery by pushing too hard. Indeed, ‘more is better’ is a fallacy; in the realm of knee surgery recovery, it’s the measured approach that yields the best results.

They need continual reminders to ‘stay in the lane, for overexertion can lead to setbacks. A single misstep from these patients could ignite a flare-up of symptoms that would undoubtedly cost us nearly a week to temper before we can resume their progressive regimen.

Ultimately, as a physical therapist, I have seen that personalized physical therapy is instrumental in optimizing rehabilitation success after a total knee surgery. It requires a nuanced understanding of each individual’s recovery curve and a commitment to the art and science of healing that defines my profession.

As an orthopedic physical therapist, I’ve observed the recovery process for countless patients after knee replacement surgery. In my experience, ensuring your home is primed for recovery can significantly impact your comfort and speed of recuperation after surgery.

Contrary to what one might expect, the toughest days typically aren’t during your stay in the hospital but often occur when you return home.
Hence, preparing your home for the recovery process after total knee surgery is a cornerstone of postoperative care.

Firstly, consider the layout of your living space. Movement post-surgery can be taxing, and clear pathways free of clutter are essential. Arranging furniture to create a conducive environment for maneuvering with crutches or a walker will ease your ability to navigate after knee replacement surgery.

Maintenance scaled
Showering can be particularly difficult after total knee surgery.

Read our article:
Showering After a Total Knee Replacement: An OT’s Recommendations

When it comes to bathing after total knee surgery, safety is paramount. Install grab bars and a stable shower chair to prevent falls on slippery surfaces

Similarly, a raised toilet seat with arms can protect your new knee and provide substantial support after surgery.

Moreover, you’ll want to establish a comfortable ‘recovery zone’ equipped with necessities within arm’s reach, which could include medication, ice packs, water, and entertainment.

Cross legs at ankles

Read my article:
Can I Sit In A Recliner After Knee Replacement? A PT’s Advice

Fostering a healing environment isn’t restricted to the indoors. Consider access to your home post-surgery, ensuring ramps or handrails are in place if necessary. Steps can be a significant obstacle after total knee replacement, so planning for these eventualities ahead of time can reduce strain and risk of injury.

Moreover, assembling a support system is equally important to modifying physical surroundings. Having someone assist you, especially during the initial period after total knee replacement surgery, can cloister the fear of tackling daily tasks alone. Whether it’s help with cooking or a reminder for your physical therapy exercises, the presence of a dedicated caregiver or family member can be a substantial boon to your recovery process.

Effective preparation of your home after knee replacement surgery is instrumental in ensuring an ease of recovery. This preemptive approach to home setup may not only avert unnecessary pain or injury but can also foster a swifter, more comfortable healing journey total knee replacement patients. By anticipating your needs and modifying your environment accordingly, you set the stage for a smoother transition back to everyday life.

Tips To Speed Up Recovery After Knee Replacement Surgery

First and foremost, adhering to a consistent recovery regimen is pivotal. Starting from the day of surgery, it’s essential to maintain a delicate balance between rest and rehabilitation. Early movement, albeit cautious, aids in promoting circulation to the knee joint, which can speed up recovery. By the time you’re overcoming the hurdles of the hardest days post-surgery, the benefits of these efforts become evident.

In the days after surgery, the use of supportive products to aid in mobility should not be understated. Quality walking aids, comfortable footwear, and cold therapy machines (Amazon link) can all contribute to a more manageable recovery process.

These products, along with prescribed exercises, help stabilize and strengthen the replaced knee, allowing for a return to function. Complementing this, managing pain is paramount after surgery, as it directly influences your ability to participate in necessary physical therapy.

Effective pain control not only aids in comfort but ensures you can engage in exercises designed to restore the knee’s range of motion and strength.

Your home should be a sanctuary for healing after knee replacement. Preparing it in advance, by removing hazards and ensuring the items you need are within reach, allows for a secure environment to recuperate in.

Lastly, keep in mind that recovery is not just physical. Support from family, therapists, and other healthcare providers forms a network that encourages progress and aids in overcoming the toughest days after surgery. With these tips to speed up recovery, each day can lead to significant improvements in regaining the full function of your knee replacement and a return to an active lifestyle.

Embarking on the journey towards restoration of mobility after knee surgery, particularly after total knee replacement, can be full of challenges and milestones. The recovery process after knee replacement surgery is unique to each individual, yet there are common experiences in terms of pain and healing that most patients can expect.

Post-surgical pain after knee replacement is often noted as the most significant hurdle by patients. This discomfort is typically most pronounced in the days immediately following the surgery.

When considering what to expect after knee surgery, the first day often involves managing immediate postoperative pain and beginning the healing process.

As we progress through the initial days after knee replacement surgery, it’s not uncommon to find the third day to bring about peak levels of pain and discomfort, presenting a difficulty that’s far greater than the challenge of climbing stairs. Despite being part of the expected healing timeline, it can be quite daunting, and this period demands a robust pain management strategy.

Read my article:
A PT’s Total Knee Pain Expectations: (Day 1 through Day 30)

The involvement of a physical therapist early on is crucial for an effective recovery process. Rehabilitation exercises introduced after surgery are designed to aid in healing and to facilitate a gradual return to activities. During the critical days after total knee replacement, one must adhere to the prescribed movement regimens and use medication as directed to mitigate pain.

Preparing your home for ease of recovery can greatly contribute to a smoother transition post-surgery. Considering spaces like the bathroom, kitchen, and especially the bedroom, where one may face challenges due to pain that makes it difficult to climb stairs; such forethought by the patient and family can prove invaluable.

Overall, having clear expectations for the recovery process can empower patients to navigate the complex days after knee replacement surgery, and to approach the healing journey with confidence and understanding.

Read my other articles about Total Knee Replacement

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Dr. Robert Donaldson

Dr. Donaldson is dually licensed; physical therapy in 1975 and doctor of chiropractic in 1995. He held credentials of Orthopedic Clinical Specialist in physical therapy for 20 years, QME in California, and taught at USC. He owns and operates an orthopedic physical therapy practice. See "About Me" page.

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