9 tips for navigating knee replacement surgery - for patients and caregivers

Last fall, my husband underwent successful total knee replacement surgery at Cape Cod Hospital and, while I was somewhat prepared to take on the role of caregiver during his at-home recovery, there are a few aspects to the process that I wish I had known ahead of time.

Total Knee Replacement surgeries (TKR) are very common and getting more so. Orthopedic Surgeon Leonard F. Remia, MD, said that there are half a million done each year in America, and by 2030 there will be 650,000 annual TKRs in this country. That means an enormous number of patients taking care of themselves or their loved ones during the recovery period.

“I have developed a same-day discharge protocol, said Dr. Remia. “The majority of my patients go home the same day (His patients who are 80 and older will typically stay overnight at the hospital.).

“Many patients will have people at home, but many others live alone. Having a caregiver at home is not a prerequisite for the surgery. With our protocols and methods, the patient will be well suited to take care of themselves.”

Dr. Remia’s TKR patients have a post-recovery process at the hospital to assess their ability to walk, balance and go up and down stairs, and once they pass, they are sent home with the things they need for care, such as compression stockings, ice machines and all their prescriptions.

“Everything is provided at Cape Cod Hospital, so there is no need to make an extra trip to the pharmacy,” he said. His team also liaises with home health agencies, which most insurance covers, who will provide nurses and physical therapists for follow-up home visits. “In some circumstances, those agencies will even do a home safety check ahead of time, pre-surgery, to assess what might help for patient mobility such as moving furniture or putting away throw rugs.”

Suggested Tips

Even with these preparations and provisions, there can still be challenges ahead in the weeks and even months after TKR. My husband was a trooper and followed all the care protocols, treatment recommendations, and the physical therapist’s suggested exercise plan, but he still experienced a significant amount of inflammation and discomfort. It took both of us working together to make his recovery a successful one.

So, if you find yourself one of the thousands of spouses, roommates, friends, or family members about to care for a TKR patient, here are my suggestions on how best to navigate their at-home recovery.

1. First and foremost, remember that every BODY is different - what you may have heard from someone else’s recovery might not apply. Understand - and help the patient understand - there are as many paths to recovery as there are people.
2. Ask questions of your surgical team and take notes before and after the surgery. There is so much information to absorb!
3. Create systems that work for you for keeping track of medications and nurse and physical therapy (PT) appointments.
4. Turn to the professionals - surgery team, nurses, PTs - they are helpful and knowledgeable, and they can make themselves available to answer questions and calm concerns.
5. Get the house ready. Plan for as stress-free a setup at the house as possible. Some things to consider: Where will the patient be most comfortable sleeping? How easily can they get to the bathroom? Can they elevate their leg when needed? For my husband, I set up the couch in the family room with comfy blankets, extra pillows for elevating his leg, and some nice things (hand cream, a small house plant, bottled water, a TV remote with fresh batteries) to make the first few days extra relaxing and easy.
6. Be prepared with additional gear. As Dr. Remia said, CCH sent us home with a walker, compression stockings, and a nifty ice-cold water distribution machine that you fill with ice or frozen water bottles, plug in and wrap the connected packs around the knee and leg. It was great for helping with his swelling. But I needed to get additional ice packs ready, buy my husband a cane for when he graduated from the walker and pick up some extra compression stockings and grip-bottomed socks.
7. Be patient with your patient - and yourself. There will be pain, and possibly a lot of it - so everyone in the house might get a bit frustrated. That is normal - so go easy and keep smiling. There might be weeks of swelling and discomfort, and each person’s level of pain will be different. Dr. Remia’s system of pain management is mainly narcotic-free. “We use a multi-faceted modality, with nerve blocks and less addictive medications, and try to stay away from oxycontin and other opiates, which can be addicting and have secondary problems associated with them,” he said.
8. Try your best to create an easier schedule for the following week or two. If you can take some time off work do it or, if not, plan ahead for delegating and prioritizing tasks. And ask for a bit of help from a relative or neighbor so that you can get out of the house on occasion.
9. Look to the future - the surgery was done for a reason, and now your loved one is on their way to more mobility - that might mean more walks together, fun outdoor activities, sports, and travel.

“It is about quality of life,” said Dr. Remia. “Sometimes, pre-surgery, the patient’s knee pain is so great that they cannot do the things they love - walk their dog, exercise, sometimes they can’t even sleep. For 95 percent of patients, there is significant pain relief, and it can be life-changing surgery.”

There is a lot to look forward to with your loved one post-recovery, so keep your eye on the prize of better health, stability, and flexibility!