Depending on how active you are, you may worry that your knee aches and pains mean someday you’ll need to replace this important joint. Research shows that running and cycling can help protect you from osteoarthritis (the primary cause of knee replacement), but there’s still a chance that at some point you may need to undergo surgery to address chronic knee pain. In fact, each year, more than 600,000 adults in the U.S. have knee-replacement surgery and by the year 2030, it is estimated that 3.48 million total knee replacements will be performed annually.
Thanks to significant medical advancements over the years, this routine surgery no longer has to sideline athletes for months. But that doesn’t mean that you shouldn’t approach it with some caution.
Knee-replacement surgery no longer has to sideline runners for months.
There are two types of knee replacements: partial and total. “A partial replacement targets specific parts of the knee joint—the ones containing damaged bone and cartilage. With total knee-replacement surgery, the entire knee cartilage surface is removed and replaced with implants made from artificial materials,” said Gregory Colbath, M.D, a fellowship-trained sports-medicine orthopedic surgeon with Spartanburg Regional Healthcare System in South Carolina.
Which one you need will be up to your physician, but either way, understanding the recovery process can help improve your outcome. Runner’s World spoke to Dr. Colbath about key recovery factors to keep in mind before you undergo knee-replacement surgery—so you can be back up and moving around as quickly as possible.
Identify Your Right-After-Surgery Needs
Thanks to today’s less invasive procedures, more patients either stay in the hospital for one night or are discharged the same day, according to the American Academy of Orthopaedic Surgeons. This means having a support system at home during your initial postoperative days is paramount.
“Patients should ask their doctor: ‘What type of support setup can you help me with?’ ‘Will nurses be coming to the house?’ ‘What assistive aids will I need?’ ‘Do you think I will need any extra support?’” Dr. Colbath said. As you gradually regain mobility, you’ll be able to handle more and more independent tasks, but until then, plan to have someone assist in your recovery.
Ace Your Recovery and Manage Discomfort
“The post-op recovery process has changed dramatically over the last 30 years,” said Dr. Colbath. Patients have gone from staying in the hospital for up to a week to being sent home the same day. This is with the help of surgery protocols that focus on what is referred to as Enhanced Recovery After Surgery (ERAS). “We started to look at rapid recovery and realized that mobility and getting patients up and moving was a better treatment. There is less opportunity to develop blood clots or post-operative complications with this program. Our expectation now is that a patient can get moving as soon as they are out of the recovery area.”
Still, knee replacement is a surgery, so there will be discomfort involved. Pain medications can be useful, but America’s opioid epidemic has proven the risks involved with over-reliance on addictive pain relievers. Not to mention, opioids are often accompanied by side effects that can make recovery more difficult, such as nausea, constipation, mental fog, and drowsiness. Luckily, effective non-opioid pain management options exist and are available for many common surgeries—like a knee replacement—and have helped doctors like Dr. Colbath drive rapid recovery after surgery. “Every hospital and surgical center is a little different, but it’s important to ask, ‘What type of opioid-sparing strategies do you use post-operatively?’” he said.
“We’re not solely relying on opioids—there are other measures, such as nonsteroidal anti-inflammatories, long-acting numbing medications, ice, and early mobilization.”
Many hospitals practice multimodal pain control, in which there’s less reliance placed on a single type of pain medication. “We’re not solely relying on opioids—there are other measures, such as nonsteroidal anti-inflammatories, long-acting numbing medications, ice, and early mobilization,” said Dr. Colbath. For instance, newer long-acting non-opioid medications such as EXPAREL® (bupivacaine liposome injectable suspension) are gaining in popularity. “These medications allow patients to get through that initial ‘storm of surgery,’ which is experienced in the first few days after surgery when the body’s pain response is highest.” EXPAREL, a local anesthetic, is administered during surgery and works by releasing numbing medication over several days. This way, it produces long-lasting pain relief as compared to traditional short-acting agents, explained Dr. Colbath. It is administerd directly into the surgical site, so it doesn’t have an impact on the entire body like opioid-based medications.
Your doctor may still recommend some opioid-based medications, but the amounts can be drastically reduced with the help of non-opioid medications, like EXPAREL. “Instead of taking 60 pain pills, you may only have to take four or five as the local anesthetic wears off. We emphasize taking “minimum quantity necessary” to get past the initial post-operative pain. Many of our patients report they were opioid free for their total joint replacement experience,” Dr. Colbath said. Most discomfort will start to subside after one week, he added, as inflammation starts to dissipate.
What Post-op Could Look Like
A variety of factors (your age, weight, pain tolerance, fitness) can influence your recovery from knee-replacement surgery. But as an athlete, you’ve already got an edge since you know what it’s like to set a goal and work toward it. “It’s a gradual progression. You wouldn’t just wake up and try to run a marathon. You work your way up to that and do your training. That’s our focus in the post-operative phase,” Dr. Colbath said. This is also where long-acting, non-opioid pain control options like EXPAREL can prove helpful. Well-managed pain and minimal side effects from medications like opioids can mean a quicker and easier rehab experience. Here’s a general outline of what you can expect as you recover from knee-replacement surgery.
Day one: Today, the average knee replacement takes less than a couple of hours. Don’t expect to be fully immobilized for long—a physical therapist may prescribe you gentle exercises to improve your range of motion.
Day two: Patients are typically at home and often begin rehab within a day after surgery. This can include things like transferring to a chair, getting in and out of bed, and walking with a walker or crutches. You’ll continue to do exercises to increase your range of motion and movement, which helps reduce scar tissue.
One week post-surgery: Eventually you’ll advance to walking short distances with an assistive device and will continue to focus on regaining knee range of motion . You’ll also likely start working on performing everyday tasks and rebuilding strength and flexibility.
Three weeks post-surgery: You’ll be able to walk or stand for 10 minutes or more, and you may not need any assistive devices.
Four to six weeks post-surgery: By this point, you’ll be able to walk longer distances and return to work if your job is not highly active. You’ll continue to do physical therapy to increase your range of motion.
Seven to 11 weeks post-surgery: You may be cleared to do low-impact exercises like swimming, walking, and cycling, as well as continuing to rebuild strength and increase range of motion.
12 weeks post-surgery (and beyond): By now, you’ll ideally have reached a full range of motion and stability in your new knee. Some patients will be given the all-clear to start a gentle exercise program, but be sure to consult with your doctor and physical therapist about which goals are appropriate for you.
Disclaimer: Every patient scenario is unique and your doctor can outline which procedure is best indicated for your condition and stage of disease.
Indication
EXPAREL® (bupivacaine liposome injectable suspension) is indicated for single-dose infiltration in patients aged 6 years and older to produce postsurgical local analgesia and in adults as an interscalene brachial plexus nerve block to produce postsurgical regional analgesia. Safety and efficacy have not been established in other nerve blocks.
Important Safety Information
EXPAREL should not be used in obstetrical paracervical block anesthesia.
In studies in adults where EXPAREL was injected into a wound, the most common side effects were nausea, constipation, and vomiting.
In studies in adults where EXPAREL was injected near a nerve, the most common side effects were nausea, fever, and constipation.
In the study where EXPAREL was given to children, the most common side effects were nausea, vomiting, constipation, low blood pressure, low number of red blood cells, muscle twitching, blurred vision, itching, and rapid heartbeat.
EXPAREL can cause a temporary loss of feeling and/or loss of muscle movement. How much and how long the loss of feeling and/or muscle movement depends on where and how much of EXPAREL was injected and may last for up to 5 days.
EXPAREL is not recommended to be used in patients younger than 6 years old for injection into the wound, for patients younger than 18 years old for injection near a nerve, and/or in pregnant women.
Tell your health care provider if you or your child has liver disease, since this may affect how the active ingredient (bupivacaine) in EXPAREL is eliminated from the body.
EXPAREL should not be injected into the spine, joints, or veins.
The active ingredient in EXPAREL can affect the nervous system and the cardiovascular system; may cause an allergic reaction; may cause damage if injected into the joints; and can cause a rare blood disorder.
FOR MORE INFORMATION, PLEASE VISIT www.EXPAREL.com or CALL 1-855-793-9727. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
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