Knee replacement surgery for a parent. What to expect?

October 22, 2012 3:18 PM

Parent is getting knee replacement surgery. What should I expect?

My mother is getting knee replacement surgery in a few weeks and I'll be assisting around the house after she is released. The surgery will be the first of two; the other knee will be replaced early next year.

Quick background: Parent is in early sixties with severe rheumatoid arthritis, is unable to walk unassisted for more than a few minutes. She's currently largely sedentary as a result and suffers from chronic pain.

I'll be staying with her for a week or so after she is released from the hospital. After I leave, she'll have other family members assisting her. What should I expect as far as the recovery process/rehab?

posted by huskerdont to Health & Fitness (7 answers total)

If it goes anything like a recent experience I had with a family member, it will be something like this:

- She will get out of the hospital barely able to walk. They won't let her go until she can do the basics like getting to a toilet and getting into and out of bed. But she probably won't be great at it for a week post-surgery.

- There will be home health nurses visiting for a couple of weeks to take bloodwork and assess her recovery from the surgery. Dressing changes and such. You may need to assist with this. (My family member is a nurse, so I did not.)

- There will be physical therapists visiting until she is able to walk a little better to get to external physical therapy appointments.

- Pain management is key. The recovery can be very painful, especially for someone who hasn't been particularly active prior to surgery. Not only are her muscles out of shape, because of the new geometry of the knee joint, different muscles will need to be built up. Anyway, she needs to take the appropriate amount of medication to do the physical therapy and other stretching exercises adequately. But she may not want to be "drugged up" and this will effect her ability to do the work. Or on the other end of the scale, may go overboard with the drugs and not be with-it enough to be left alone.

She will likely make excellent progress in the first month- I was astonished when I would visit and my family member was walking up stairs the right way about three weeks post-surgery.

The thing to make sure of is to keep her motivated to do the exercises. After a few months, especially with another weak knee, progress gets harder to see and feel, and they may become demoralized. They will absolutely be better off than they were, and/but they will feel like that's good enough and start to give up.

It is absolutely a good thing, but it isn't fun for a couple of months.

good luck!
posted by gjc at 3:42 PM on October 22, 2012

I just went through this with my folks this month. It wasn't a fun time for any of us, but it's a good thing that you will be there. Let's see...

- Mom stayed in the hospital for two days, and she was pretty weak and woozy throughout. Getting home, we have just two stairs to get into the house, and she was able to manage it with a walker, but three of us surrounded her to make sure she didn't fall. She was fine, but I am glad we had so many.

- You mom will need to stay somewhere with no stairs.

- Before she came home, we sanitized her living area to prevent her from picking up germs/infections. She really enjoyed having her personal space tidied up and kept nice. We also set up a tray and a basket with paperwork and things she'd need close at hand.

- She was able to walk short distances in a walker day by day, but she stayed in bed most of the first week. She had oxygen service because her oxygen was low and oxygen helps heal (so easy, just plug into a wall). A physical trainer came 5x a week, a nurse 1-2x a week.

- Several times a day, we had to assemble her into The Device, which is this exercise machine which moves the leg and knee veeeeery slowly and at increasing resistances. The trainer would give her target strengths and exercises of increasing difficulty, and that was HARD.

- It's painful -- a deep, sharp pain. Mom usually refuses pain meds after surgery, but she depended quite a lot on the oxycodone. Be sure to get the fast-acting kind, because the four-hour dose lasts juuuust four hours. And the drug really affected her -- she would be alternately gleeful and grouchy. Her personality filters shifted bizarrely out of whack. I learned things I really never cared to know.

- She had to give herself shots (in the stomach) to prevent blood clots.

- Mom needed some assistance getting in and out of the shower. She had a shower stool, and we had this system of towels and bathrobes to help her maintain her privacy/dignity. Mostly, I'd just brace myself against the wall and offer her a hand and she'd pull up on her own strength.

- Once the bandages come off, the staples are amazing to behold. Thick and silver, almost like a zipper! And if she sits in the sun, they get hot!

Good luck!
posted by mochapickle at 3:51 PM on October 22, 2012

My father had his knee replaced 2 years ago, and his experience was night-and-day different than gjc's and mochapickle's family members. My dad was in and out of the hospital in 3 days, and walked pretty good (with a walker) the first day back at home. He didn't have any home health nurses or anything (but he did have my mom). Pain management was pretty simple as his pain level was not that bad. He did ice and exercises, and used one of those passive motion machines almost non-stop for the first week or so, then only at night after that. He also had to give himself shots to prevent blood clots (but this might have been related to his heart issues, I'm not sure).

My dad was in good shape before the surgery, golfing 18 holes 2-3 days a week (with a cart, but still). He was 67 at the time of the surgery, overweight, has diabetes and a heart issue, but was not (and is not) sedentary.

I flew out to help my mom with his recovery, but basically wasn't needed. I think your mom's doctor will be able to guide you about what to expect given your mom's health status.
posted by OrangeDisk at 3:57 PM on October 22, 2012 [1 favorite]

Just Nthing stuff already here, but I had a hip replacement 5 years ago (accident) and saw people with knee replacements in the physical therapy place.

- blood clot meds are a Big Deal. A friend of mine's mother died after a hip replacement because of a blood clot. I think it was entirely preventable had they been on top of the prescribed clot meds.

- therapy can be very painful, but do NOT let her cut corners on it. Physical therapy is paramount after a joint replacement. I thought the people with knees were going through more initial pain than I was (hips are actually easier than knees as far as therapy goes). The therapist will manipulate the leg trying to get full range of motion. She may feel they are trying to kill her. But if she will get through it, replacement knees apparently feel great compared to arthritic ones - most patients are eager to get the second knee replaced, assuming that is needed.
posted by randomkeystrike at 5:02 PM on October 22, 2012

My husband had this earlier this year, and I had heard all sorts of horror stories about how difficult the recovery is. Nothing like that happened to us! He is now free from pain and very active!

Details of the procedure will be different because we are in the UK. But he has made a great recovery - if you are feeling nervous about this sort of surgery I would say we have found it very very worth while.

My husband is a stubborn bloke who insisted on not slowing down through all the agony of a crumbling knee - the surgery has had a better outcome than I could have hoped for. Your mother has to be conscientious about doing her exercises. It took about three months for my husband to visibly gain muscle on the wasted leg and start being as active as he had been previously. He is 63, overweight, has severe arthritis, and had a hip replacement four years ago, which we were told is easier to recover from. But the knee replacement has been marvellous. He will never have the full range of movement back, but he is much improved.

By the fourth day he was refusing any form of help. So I think you should try to boost your mother's confidence as much as you can. She may not be a stubborn awkward person like my husband and may appreciate a bit of help and consideration but I would say don't overdo it: sometimes doing things for people is not as helpful as letting them get on with it.
posted by glasseyes at 5:10 PM on October 22, 2012

I went through this with my Dad in June.

- nthing the exercises. He did not have a passive resistance machine, but did have several types of exercises he needed to do every day. These are key to recovery.

- Pain: he was in a lot of pain. Pain makes people do weird things and act in weird ways. My Dad was pretty low key. My Mom, when she got her hip done last December, was an absolute bitch for the first week, which is completely uncharacteristic for her. She's apologized a million times and I know she wasn't in her right mind, but it was a hard couple weeks.

- Incontinence. Sometimes the pain meds/after effects of anesthesia will cause incontinence (usually just of the urinary type). In addition, mobility will be hindered, so the time from full bladder -> brain signal to go -> get to the restroom might be compromised. There are pads you can put under a sheet that will soak up urine, preventing you from needing to change the mattress pad and/or do more significant cleanup of the mattress. For the patient's comfort, I'd suggest placing a pad or two under the sheets before they get home, just in case. It's not a fun thing to do or conversation to have, but it's better than needing to do a complete bed overhaul in the middle of the night due to an accident.

- Frustration. My dad was initially in worse pain after the surgery than before. For both of my parents, the first few weeks had times of them wondering if it was worth it. The answer was yes. I ended up developing a mantra of, "You know it would have gotten worse with time if left untended, but you can only go up from here!" Remind them of the larger rewards ... the ability to get around without pain IS out there, but it will take time.

- Sleep. Get good sleep and nutrition. Make ahead meals are great. Keep cut up fruits and veggies on hand, as you'll need to be able to eat in short bursts if it's a rough recovery.

- Grab bars are a godsend in the bathroom. Your parent may resist (mine had huge issues having them put in, because it's "for old people"). Put them in anyways.
posted by RogueTech at 8:19 AM on October 23, 2012

My mom had both of her knees replaced a few years ago. She stayed in the hospital for at least a week, maybe longer, but that wasn't surprising since she had both knees done at once.

She was in a lot of pain afterwards, and for quite some time -- once she was home, she had a visiting nurse coming in to check on her and such, which was helpful.

One thing that we weren't expecting was how depressed she was for a while after the surgery -- for a month or so, she was very tearful and unhappy, wishing she hadn't had the surgery, etc. It makes sense in hindsight, of course -- healing after surgery takes a lot out of you, plus the pain and being largely immobile, not being able to really get comfortable, etc. So, that's something to think about -- I wish I had thought of it beforehand, so I could have tried to plan ways to brighten up Mom's recuperation time.
posted by sarcasticah at 3:53 PM on October 23, 2012