How To Manage An Elderly Senior After Total Knee Replacement Surgery and Recovery at Home

"Total Knee Replacement" by krossbow is licensed under CC BY 2.0

How To Manage An Elderly Senior After Total Knee Replacement Surgery ( TKA)  and Recovery at Home

The medical world has come a long way in smoothing out the surgical process for joint replacements.

Inpatients stays, if absent of unique complications, are more swift and convenient than 20 years ago.

A medical operation that used to require several weeks of hospital care now may only require a one-day, outpatient stay.

Why Would Someone Need a Knee Replacement?

Medical conditions that would merit a total knee replacement are those that permanently wear and tear at the natural knee joint to the point where it can’t be functionally used.

In other words, if an individual can no longer or is limited in their walking due to pain or inadequate range in the knee, it may be time to consider a knee replacement.

The most common reason patients seek out knee replacements is due to the chronic effects of osteoarthritis.

Other health conditions may include additional forms of arthritis, repetitive use injuries, sports- or work-related injuries, congenital joint conditions, gout, abnormal bone growths, etc.

Some Risks of Knee Replacement Surgery in the Elderly

  • Infection
  • Blood Clots or DVT’s
  • Anesthesia
  • Damage to surrounding nerves are arteries
  • Pain and swelling around the joint area
  • Implant failure
  • Allergic Reaction to artificial knee joint components

Expectations Post-Operatively in the Hospital

After a patient has left the operating room having completed their total knee replacement, he/she will be placed in an inpatient recovery room.

Here is where the patient will be monitored and evaluated by nursing and rehabilitative (i.e. occupational and physical therapy) staff.

It may take a few hours for anesthesia to fully wear off, which means the patient will have some lack of sensation below the hips and possible negative reactions such as nausea, vomiting, or just general loss of appetite.

If the patient was hooked up to a catheter for surgery, nursing staff will wait for full sensation to come back before removing the line.

The patient shouldn’t be completely surprised if physical therapy comes in and has them walk the same day as surgery using a walker, even if it’s just a few steps in the hospital room.

Depending on the patient’s response to surgery, comorbid conditions, and prior level of function (i.e. walking versus complete immobility prior to surgery), he/she can expect to stay in the hospital anywhere between 1 to 3 days.

If a patient’s home set-up is not appropriate for safe recovery, such as impossible physical barriers (i.e. several stair cases with no elevator) or a lack of caregivers, the doctor may discuss possible transitional care or skilled nursing care before returning home.

Expectations at Home

Due to the quick healing nature of today’s total knee replacements, patients may feel like they are up for routine day-to-day tasks only a short time after their hospital stay.

It can be challenging to remember that a joint replacement is still considered a major, invasive surgery that comes with complications if post-operative precautions aren’t followed.

The main goal for patients after a total knee replacement is to NOT fall, especially if it involves landing on or contorting the operative joint. Injuring a new joint can result in additional and more complicated hospitalization hours (i.e. potential re-adjustment or redo of joint, infection, etc.).

While at home, patients can place full weight on the knee as long as they move slowly and use medical equipment recommended by their physicians and their therapists (i.e. walkers).

Patients should also avoid activities that involve lengthy walks, low squatting, or any movements that cause sharp or inflammatory pain to the operative knee.

Outpatient PT/OT

After returning home and possibly receiving home health services comes outpatient therapy services.

This involves a patient traveling to an outpatient clinic outside of their home to receive rehabilitative intervention for the post-operative knee.

Depending on the patient’s progress and past medical history, the doctor may recommend one or both types of therapy including occupational and physical.

Physical therapy’s main purpose in outpatient care is to restore full range to the knee joint and to strengthen the knee muscles for safe walking and standing balance.

Occupational therapy targets activities of daily living impacted by the joint replacement and provides ways to increase participation through restoration (i.e. exercise or strengthening) and adaptive strategies (adaptive equipment and home modifications).

Typical Home Modifications

Generally, home modifications are quite simple and inexpensive after a total knee replacement especially if the patient has little to no additional medical complications to consider and has an accessible home.

For others, a knee replacement plugs them in for the long haul concerning recovery. In which case, further home changes may be required. Usually, a patient can get by with just a walker.

Other pieces of equipment or installation may include some or all of the following: Hip kit (includes long handled supplies such as reachers and dressing sticks), toilet riser, wheelchair ramps, grab bars, shower benches, long-handled removable shower heads, non-slip mats, etc.

An occupational therapist can provide a thorough evaluation that will give a patient a better picture regarding their own unique home modifications.

Continuing Home Exercise Program and Improving Functional Mobility

HEP (Home Exercise Programs) may be assigned to the patient prior to leaving the hospital or during home health services.

This includes any therapeutic exercise that will safely strengthen the joint and increase range of motion.

Patients are strongly encouraged to carry out their HEPs regularly as set forth by their primary physicians and their therapists in order to regain mobility (i.e. walking, standing, transfers).

Avoiding HEP participation could be a major setback for patients, especially because the surgery alone severely limits mobility and not just the patient’s prior mobility history.

Do’s and Don’ts During Recovery

The Do’s and Don’ts of total knee replacement recovery really just involves the use of common sense:

Do:

  • Do get some rest, especially if movement becomes distractingly painful.
  • Do go to all of your medical follow-ups and outpatient appointments.
  • Do participate in all of your assigned HEPs.
  • Do use all recommended medical equipment for the suggested recovery time frame.
  • Do put full weight on the knee in order to restore mobility, but do so safely.

Don’t:

  • Don’t do any activity that would most likely cause you to fall (i.e. walking around without the walker, ambulating on wet or slick surfaces, squatting to the ground, etc.).
  • Don’t aggravate the surgical incision (intense scrubbing during showering)
  • Don’t NOT move during recovery.

As mentioned previously, total knee replacement recovery has grown increasingly easier over the years. However, recovery is still recovery.

Patients still need to make safe decisions in order to fully regain mobility and daily activity participation.

Author: Samuel

Samuel is a physical therapist with over 20 years medical experience. He has extensive knowledge in functional rehabilitation in the acute care hospital and in-home care settings. He has spent most of his career helping seniors transition from hospital or rehab care to living independently at home. In his free time he likes to travel and read autobiographies.

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