Total knee replacement surgery is a major surgery performed only after various other methods of conservative treatment have failed. During the surgery cuts are made in several areas, starting with a long longitudinal incision down the front of the knee at the top of the patella (kneecap), extending down to the tibial tubercle. A cut is then made deep into the capsule to reach the knee joint.
At this point, the knee is entirely exposed. Smaller cuts are made to eliminate cartilage in the bone and to correct deformities before trial hardware is fit inside the knee and test for range of motion. When the right fit is made, the permanent pieces are moved into place and sealed there with bone cement. Knee replacement rehab exercises will begin immediately.
On the day of the surgery, the leg with the new knee will be placed in a CPM, or continuous passive motion machine, that will gently start range of motion therapy for 4-6 hours. This will be repeated each day the patient remains hospitalized, usually three. Physical therapy will begin the next day and happen twice daily, with knee replacement rehab exercises including motion exercises, stretching and strengthening, and beginning to walk with the aid of a walker. The patient usually goes home on the 3rd day post-surgery, although depending on their recovery, they could go for a short 5-12 day stay at a rehab facility.
At a skilled nursing facility, if this is where the patient is moved to before home, knee replacement rehab exercises will continue twice a day, with general nursing care provided around the clock, including any dressing changes, administration of pain meds and other medicines, and any assistance the patient may still require. If the patient has gone home, they will have a home health nurse who will visit them 3 to 4 times a week to do the same things that the patient in the rehab facility would be doing, including physical therapy that may, at first, be painful, but ease with each successive week.
At about week 6 to 12 post-operative, most patients will be able to move on to knee replacement rehab exercises that include focusing more on rebuilding strength in the knee. Pain should be decreasing just about weekly at this point and the patient should be able to start coming off the more intense pain medications to using a NSAID or Tylenol. Around weeks 12 to 16, the patient should be resuming most of the normal activities with only the occasional swelling and tenderness and after six months, patients should definitely be feeling like a new person, with full healing taking about one year, give or take a few weeks depending on rehab tolerance.