I was recently scrolling Instagram, as you do, and I came upon a really interesting statistic about knee replacements. I went further to confirm – cause you never know what you find on social media – this statistic through the Journal of Bone and Joints Surgery and it is an accurate statistic.
I was drawn to this article because many Americans get their knee replaced. In this research, the question was, “What percentage of people who get their knee replaced are dissatisfied with the outcome of their knee replacement?” So the journal that did this study found that 18.6% of people were dissatisfied with their knee replacement.
I would say that number is kind of high because a knee replacement is an elective surgery most of the time. Sometimes you have a rheumatoid arthritis or another autoimmune disease that requires a joint replacement because the joint is literally no longer functional. But for the most parts, knee surgeries are elective. You don’t have to have them done so I thought that percentage was fairly high.
Most Significant Predictor For Dissatisfaction
So upon looking further at the study to just learn a little bit more about it is the most significant predictor or dissatisfaction is pain. If they were still having pain after their knee replacement or during the process of healing with their knee replacement, they were dissatisfied with the outcome.
I find this interesting for many reasons so I wanted to take you through a little bit of my thought process. Before we get into more of this dissatisfaction on knee replacement, let’s set the stage on what knee replacement is.
What Is Knee Replacement?
Your knee is comprised of your femur, your thigh bone, your tibia -which is your shin bone- and then your knee cap, or your patella. Essentially what happens in a knee replacement, is they place in metal parts on the top of your tibia and the bottom of your femur, and they sometimes shave down the back of the patella and put a metal piece there as well. So that’s basically what a knee replacement entails. Obviously anytime you are changing, going inside the joints and changing the joints, it’s changing the mechanics of what is going on. And many times after a knee replacement, you won’t see somebody have full range of motion, meaning the majority of people can almost bring their heel all the way to their buttocks when they are lying on their back. Now if you have extra hamstring or calf tissue, you’re not going to get all the way there, but that’s generally what you’re looking for with full range of motion with bending your knee.
And with straightening your knee, with a knee replacement, unless something’s really messed up, the knee should be completely straight. That’s actually probably more important than the knee bending itself.
But, again, when you go in and do a surgery, you’re changing the mechanics of things so the knee bends and straightens a little bit differently than it might have before.
In My Experience: When Is There Success In Satisfaction, Mobility And Strength
So in my experience with treating patients with knee replacements, I see the most success and satisfaction – and the study concurs with this – from people that have the expectation that the recovery process isn’t necessarily going to be an easy thing. This wasn’t in the study but this is personally in my experience, that those that had about a physical therapy which involves exercise and strengthening up, and maybe even had some medication management whether that be in pill form or with an injection, tended to have better outcomes after surgery as well. Not just only in satisfaction but in strength and in movement ability.
I think this is for several reasons. First, the stronger that you are when you’re going into surgery, just the better it’s going to be for you when you come out of surgery. You’re not going to be having to make as many gains. What tends to happen before surgery because somebody is in so much pain or their struggling with certain activities like functional activities like getting up and down the stairs, or just walking, you start to lose strength, and so, upon losing that strength, you’re not moving quite as much. Then when you’re coming out of surgery, your resiliency to that surgery is going to be less and it’s going to take way more significant gains, to gain the strength back to support the knee replacement.
I see that doing exercise and physical therapy prior to getting a surgery done, well it’s not going to fix the person a hundred percent, obviously, that’s why their choosing to get surgery, it’s giving them a good foundation for when they come out of surgery. And with that foundation there, it’s a little easier to build upon so that recovery can be a little faster.
I find that if recovery is slow, people get really frustrated and it’s hard to see the light at the end of the tunnel and they might not be quite as compliant with their exercises because it’s frustrating. Like if you’re not feeling good, you don’t really want to keep doing those things especially if you have not seen any kind of results at all.
The other nice thing about doing physical therapy prior to doing surgery – because I’m not against doing surgery I think sometimes that’s the best course of action – is that a physical therapist understands what to expect after surgery and sometimes surgeons don’t really have the time, or to start really thinking about it, you don’t fully educate the patient on what to expect after surgery. So they might just be like, “Yeah you will be up and moving right after surgery,” which is not incorrect but many people after a total knee replacement particularly depending on their functional level prior to surgery, they might need a walker, they might need a cane, they might need crutches to support them. If the person is not expecting that after surgery, it can be alarming and upsetting to lose maybe some functional ability that you had prior to surgery because you do go backwards a little bit with surgery before you start moving forward.
The other thing that happens with surgery is you have a weight increase of inflammation which again is normal. You want inflammation to help heal the area but with inflammation, comes pain. So if you’re not expecting any pain post-surgery, it may sound funny for some people who wouldn’t expect pain after surgery, but I have worked with patients before that were literally not expecting to have any pain after surgery. And so with not having that expectation, again it can be quite alarming to all of a sudden wake up from a surgery and be like, “What? I’m not a hundred percent? This is wild.”
So that’s why having physical therapy prior to surgery can really be helpful because as a physical therapist, I can help prepare my patients mentally for what it’s going to take after surgery to get back or even go further than they were prior to all these pain in their knee joint.
Nerve Block: What Is It And Is It Helpful During Surgery?
The other thing that happens, sometimes after a surgery, I think that they’re backing off doing this as much with knee replacements, it depends on what kind of surgeon you’re seeing, but they’ll do a thing called a nerve block, which is essentially to help mitigate pain and decrease pain. Though the nerve block can lead to some decreased strength in your quadriceps, that muscle in the front of your thigh. If you don’t have good strength in that area, it’s not really supporting the knee joint very well. So, again, this is something that could lead to decreased functionality, and increased pain and can really really be frustrating for the patient.
Importance Of Understanding What To Expect After Surgery
So it’s really important prior to a surgery that you fully understand what to expect afterwards. It does not mean that it’s always the case that you’re going to have decreased strength after surgery, it doesn’t mean that you’re going to have exorbitant amount of pain after surgery, but it’s good to know what to expect that that could be the case, so then you’re not alarmed. When people are alarmed about their pain, pain actually becomes worse and then again leads to worse outcomes after surgery.
Getting Physical Therapy Before Surgery
So that’s why I think it’s really great to do conservative treatments before surgery even if surgery is definitely the option that that’s going to happen. Sometimes it can take weeks before you get into surgery so it might be beneficial to do like four weeks of physical therapy and exercises prior to the surgery.
Now, again, the big thing is that insurance can sometimes really be limiting on the amount of physical therapy that you can access. This is the reason that I’m an out of network provider because I want to be able to treat patients through the whole process and really help them be prepared for whatever is to come next.
Conclusion
So just to reiterate on knee replacements, and this really goes towards any surgery in general, I would suggest physical therapy first, a good set of exercises to help with strengthening and get you prepared prior to surgery. Doing any medications or injections, again to possibly avoid surgery, sometimes if we can get out of that pain cycle with medication or injection, we can completely avoid surgery. Then, if these things are really not working, that’s when we want to look into surgery. And then before you go in for a surgical procedure, making sure you really understand what is to be expected post-surgery will really help with feeling more satisfied with the surgery itself and also help to decrease your pain level and increase your functionality in the long term.
So I hope this helped to give you some insight on that kind of scary statistic that 18.6% of people were dissatisfied with their outcomes from a total knee replacement and it gave you some insights on how to prepare yourself for a surgery if you ever need one in the future.