What Total Knee Replacement Surgery is Like

I'm now 7 days post-total knee replacement, and have a new right knee!  And while everyone from doctors to nurses to physical therapists insists that it is different for everyone, and I'm sure that it is, I didn't find much to read prior to surgery that really described what it was like, so here is my attempt:

Choosing a Surgeon

My surgery was performed at Rutland Regional Medical Center (RRMC) in Vermont.  We live in Vermont, and although I grew up in Boston and have had many surgeries in the world-renowned hospitals there, I heeded my father's advice on where to have the surgery performed and how to choose a surgeon.  My Dad is a former President of the American College of Surgeons, a retired chief of surgery from Boston's Chidren's Hospital, and is currently a founding member of OR Dx + Rx Solutions for Surgical Safety, an independent group of renowned surgeons, anesthesiologists and nurses who spend time at hospitals reviewing their perioperative teams, suites and processes.  So I trust his advice! What he recommended was:

- having the surgery done close to home if possible, because the surgeon who performed the operation always knows the joint/issues/etc. better than anyone just reading a report or films;

- choosing a surgeon who does joint replacements all the time, and who understands your goals for the surgery and works with people who have similar goals (in other words, as an active 50 year old who lives a stone's throw from skiing and whose family skis almost every day all winter, skiing was key to me, and having a surgeon who works with active people and skiers was important); and

- choosing a hospital with a good track record for infection and success rates.

I also talked to my physical therapists, and they were very helpful in saying that they saw patients who had had joint replacements done by my doctor at the hospital I was going to, and they recommended him based on the results they had seen. 

Preparing for Surgery

This will likely all be covered really well in the materials you receive from the hospital. If it isn't, I'd worry about having surgery at that hospital.  I met with my surgeon and a pre-surgery coordinator about 3 months before my surgery date. I was given a packet of info, and while they usually have you attend a class, because of COVID, mine was via video.  While prehab is important for some people, my surgeon basically said to do what I could tolerate pain-wise, which honestly wasn't that much.  I walked the dog every day, did a gentle strength class twice a week, and that was pretty much it.  But what was really important was the week before surgery.  About three weeks pre-op, I had a check up with my primary care doctor, and went to the hospital for pre-op blood work, and a staph test.  Mine came back positive (as do about 30% of people's, but it still grossed me out!) and I had to use prescription ointment up my nose for 5 nights and mornings before surgery.  I also had to take sterile showers, sleep on clean sheets and use clean towels - showers for five nights and then the morning of surgery, scrubbing my entire body with the sterile soaped sponges they sent me. 

Infection is a big risk with joint replacement.  The nurses called me repeatedly to check in to make sure everything was going okay, and the pharmacy called so they would have everything ready for me post-op.  They also had a home-visit nurse/physical therapist contact me - she has been coming each day since I have been home. 

Take the time to do the showers right - but make sure you rinse every bit of the sterile soap off of you!  I forgot (apparently) the back of my shoulder one night and the next morning woke with a burning red patch of skin!

While there was a chance my surgery would be outpatient, I packed as if it wouldn't be, and brought really loose stretchy shorts and a comfy tee shirt to go home in. 

Surgery Day

Really, I'll talk about post-op, because pre-op is pretty standard - you check in, get weighed, change into a gown, get some sterile stuff up your nose, they start an IV.  They did a nerve block for my knee and I'll admit that didn't feel great going in.  They also had a hard time getting my spinal started which was a little freaky not to mention uncomfortable.  But honestly I don't remember anything after that as I was out!

I came to in recovery and had no feeling or ability to move below the waist.  Such an odd feeling! The nurse was great and was there all the time checking on me.  As the feeling started to come back and I was able to wiggle my toes and move a bit, the pain also started: intense and fiery sciatic nerve pain.  I would say this was about 3 hours after surgery.  They moved me to the room I would stay in overnight, and as I got there, the pain intensified.  It got to the point where I was crying and just almost couldn't stand it - like a blow torch was burning the back of my leg down to my foot.  They got me morphine which helped immensely.  

One odd thing is that I've had a lot of orthopedic surgeries, and have always really wanted to just sleep afterward.  But I didn't sleep after this surgery until night time, even with the morphine. 

My surgery was at 8 a.m. and around 2 or 3 p.m. the OT (occupational therapy) team came to help me learn to move, stand up, walk with my walker, dress etc.  It didn't really go as planned - I needed to go to the bathroom, and I fainted on the way.  Luckily there were three OT/nurses with me, and they got me safely back to bed, with a cool towel on my forehead. So much for going home day 1!

So then it was really about being comfortable.  My nurses were amazing - checking on me every half hour, bringing me warm blankets, ginger ale, fresh ice for my knee, and pain meds on a schedule. I did do some simple exercises in bed off and on, and got up quite a few times on the walker.

Day 2

The night wasn't as bad as I thought it would be.  On Day 2, I could definitely feel when the knee nerve block wore off! The doctor visited me in the morning, and then OT and PT came back - they helped me get dressed, use a shoe horn and other gadgets to get shoes and socks on, and I went to the PT room in a wheelchair.  There, I got up and walked on my walker, did stairs with crutches, and a few other things.  

Pain was still not bad - I was having antiinflammatory via IV, Tylenol and oxy. 

The ride home - 1.5 hours on a windy mountain road - was not bad at all!  I had been dreading it.  Having the nurse time my meds so well really helped. 

I was drinking a ton of water this entire time, which made me feel better I think, and I was up for eating normally. I did do a big green smoothie in the morning, and I recommend thinking about foods and drinks that will get things moving while you are on all the pain meds.

Getting up to my room wasn't too bad - but I will say that the car ride and the trip up the stairs was exhausting! I also definitely didn't feel great that night, and almost wished I could have stayed one more night in the hospital. 

My husband and sons have been super helpful - checking in to replace ice, keeping the dog from jumping up on the bed (my biggest fear is he will land on my leg!), etc.  They brought up a big 5 gallon thermos full of ice water, and I've consistently refilled my water bottle from that.  THey also replace the ice packs on my knee often, and I ice a lot. I keep a packet of graham crackers nearby - if I haven't eaten in a while and it's time for pain meds, I have one first.

My friends did a meal train and it has been a LIFE SAVER.  It's a lot to take care of someone after surgery, and not having to shop and cook has been great for my husband (who also has a broken hand!). 

Day 3

The visiting nurse/PT came the next morning, and she has been amazing.  I have done the exercises multiple times a day, and I thought I'd have to work through pain, but really she has me do them up to the point of pain.   

The pain has been weird and not what I expected. I thought the knee itself would hurt all the time.  Instead, I have been stiff and sore in my hips, quad, hamstring and calf on that leg. Yes, the knee is a little sore, and doesn't feel great doing certain things like bending a lot or straightening a lot for a long period, but overall, the ache in my quad and hip has been the worst part. 

My lower back also gets sore if I lie on my back for a long time, so moving around helps. 

Days 4-7

Walking is getting easier and steadier, and I have reduced oxy to night only - my visiting nurse said not to cut down on meds at night, and to try to stay on the schedule with the Tylenol all the time. I'm scared of the oxy - of liking it and wanting to take it - so I just take it at night when the pain is really bothersome.

Yesterday (Day 6) I was able to bend my knee to 90+ degrees, and got on my stationary bike with my PT.  I didn't do a full revolution but did back and forth, controlling the wheel with my good leg, and it went fine.  Walking a little better too, and practicing walking "normally" albeit with my walker. 

I'm not back to work (I work from home as a writer) but hope to be by next week.  

Right now I'm dreading getting the staples out...but after that I feel like it's home free and all about PT and recovery!