What can you expect as you recover from joint replacement surgery? Listen to this podcast by Dr. Derek Amanatullah of Stanford University for some answers to FAQs on the matter!
Interviewer
Hi Dr. Amanatullah! How are you?
Dr. Amanatullah:
Hi thanks for having me again.
Interviewer:
Absolutely I imagine every patient you see is different but for a generally healthy person what would you say is a quote unquote “normal recovery time” after a joint replacement?
Dr. Amanatullah:
Yeah I definitely agree every patients a little bit different but I would say for the average patient, most people follow a pretty standard recovery. And then also, patients expectations differ and that really get changed based on who they met with, who their family members are, who they may have had surgery there unions about surgery.
But in general, the first two weeks really are the slowest, but we get the most gains. So people experience some pain, they may need some medications, sometimes narcotic pain medications, but we try to minimize those best as best as possible. And then you should experience improvements day by day for the first two weeks or so.
After that recover starts to slow down, meaning that we start to recover a week by week. The incision is basically healed, and we’re starting to slowly progress and get more motion and more activity. That can come with kind of a waxing and waning recovery, meaning the more I push it, the more it might hurt. But yet the more I rest, the more stiff it might get because I’m not using it. So the patient is kind of of their best therapist here as they begin to improve week by week out to about six weeks to three months.
At about six weeks to three months, most patients will tell you that about 70 to 80 percent better, but they still have some issues with maybe the terminal range of motion, maybe a little bit of swelling, maybe an occasional pain here ir there with high level activity, or some fatigue with long distance ambulation.
That slowly goes away over the course of the next nine months, month by month, to the point that bad about one year most patients are fully recovered from their surgery.
So in general we talk about needing some help in the beginning, or at least someone to check on you, kind of feeling independent ready to go back to work sometime between four weeks and three months depending upon how active your work is, and then really not being fully recovered from any type of surgery on a major joint out to a full year.
Interviewer:
Wow! Okay so the signs of the patient are fully recovered you don’t expect to them until full 12 months afterward.
Dr. Derek Amanatullah:
So you’ll see lots of signs of recovery. My goals are pretty simple.
My goals would be that the wound is healed and I can remove the sutures if there are sutures at two weeks.After that that’s the first check up. I check the patients at six weeks.
Six weeks, will want to say good functionally recovery basically getting ready to remove a gate aid or go down in the type of gate aid. We want to see range of motion in the knee to over ninety degrees, and that the leg completely straight.
But how people recover and how much activity they need for recovery is all really different, so it follows the general guidelines. At three months, I definitely want to see the patients almost fully recovered at 70, 80, maybe even 90, some people even 100 percent.
But there’s no formal thing we look at other than how the patients feel how their motion is, and how strong they are.
But again, an 80 year old male who is not extremely active might need different amounts of recovery to get to fully active, and a forty five year old female in yoga who has really high expectations. Everybody is a little bit different in what they get and that’s why we will give you this kind of average trajectory for the average patient, some faster some slower.
I would say you can tell people are on this course even at their two week and six week visit. People continue along this trajectory pretty reliably.
Interviewer:
You mentioned the gait aid a couple of times. Talk to me a little bit about the importance of the gate aid in terms of how that impacts recovery time.
Dr. Derek Amanatullah:
So I don’t believe that the gate itself actually makes people recover. So the recovery is mostly from the surgery and then that time for the bone to grow in the implants or for them to get reconditioned from the deconditioning of the original arthritis.
For me the gate aid is really there so that patients don’t fall and that they don’t limp.
So if a patient’s walking with a limp, then I think they need a cane or a Walker. If the patient feels unstable after a certain amount of distance or fatigued or isn’t going farther and pushing themselves, they may want a gait aid to catch themselves. I think the major goal of the gate aid is to prevent falls, but it doesn’t change the overall trajectory of recovery. So if a patient wanted to walk without a gate aid, as long as they didn’t fall, I don’t think they’re placing themselves at high risk.
That said of a patient wanted to run after surgery or go skiing or do something like that, I think that’d be ill advised because the implant hasn’t grown into the bone.
In that particular scenario you could imagine putting someone on the gate would slow them down. But in general I don’t think that the gate aid’s controlling their recovery; it’s controlling their comfort with their recovery.
Interviewer:
Sure. What are some of the problems that could arise if the patient develops a limp?
Dr. Derek Amanatullah:
So a limp I think in general is probably more disconcerting to the patient than it is to myself, assuming there’s no structural damage associated with it. It looks awkward and people don’t feel like they’re fully recovered if they have a limp.
In general limps are related to several causes. One can be a learned limp, and the reason you get a learned limp would be if you had hip surgery and you have hip pain, we protect that side. That’s very normal recovery process and in the process of protecting that the patient basically learns to limp to protect and keep pain away from that side. That can take some therapy to get rid of, but using a cane as long as there’s a limp can help reduce that possibility.
I don’t think there’s anything formally dangerous about a limp even if it’s from the other causes not just weakness. It’s just quite unsightly and patients don’t like it very much.
Interviewer:
For sure. In addition to some of the other things you’ve mentioned, what else can either severely elongate or reduce on how long recovery takes?
Dr. Derek Amanatullah:
So people talk about prehabilitation. I’m I’m not a huge fan of prehabilitation. I think that most patients when they received a cut, it’s an injury from the cut that drives their recovery a lot more than how strong they were ahead of time.
That said, a patient’s condition ahead of time is really important. Say, if a patient’s wheelchair-bound, it’s going to take a long time to walk because of the deep conditioning from being in a wheelchair. That said, if a patient is up and ambulatory and participating in yoga or sport, their recovery is probably a little bit faster.
But I don’t really believe you can take a person in a wheelchair and rehab them all the way to the person who’s doing high level sports, so that’s why I don’t think we see a huge difference with prehabilitation or rehabilitation before surgery.
The other thing that can change recovery is medical problems. So the more medical problems, the more issues we could have with surgery that could complicate surgery.
So in general healthy active patients will go the fastest, while debilitated patients and patients with multiple medical issues can take the longest and may need to go into a rehabilitation center, in order to get strong enough and condition enough even to do general activities of daily living.
Interviewer:
That’s it! Thank you so much for your time today.
Dr. Derek Amanatullah:
Thank you.
