Recovering successfully from knee surgery

Q: I am 62 and an avid golfer. I've had arthritis in my knee for years, but recently the pain has gotten so bad that I'm having the entire knee replaced next month. How long before I'm back on the links? What can I do to make my recovery as short as possible?

A: Joint-replacement surgery replaces a joint, usually a knee or hip, with a metal or plastic one. These surgeries are usually very successful. Take Jack Nicklaus, for example. He returned to play tournament golf after his hip replacement. Of course, not every patient will enjoy a perfectly smooth recovery; patients who are faithful to physical therapy are most likely to see their full function return. The major goal is great relief from pain after the joint has healed. But that's jumping ahead. Let's take your recovery step by step.

Your rehabilitation will start right after surgery, while you are still in the hospital. Before you think about taking your first step out of the hospital bed, you will start working your new knee. Your knee will likely be placed into a CPM (continuous passive motion) machine, which gently bends and straightens it while you lie there. To get out of bed, you'll need a nurse's help at first. You'll also need crutches or a walker to get around.

Expect the in-hospital phase of your recovery to take several days. During this time, a physical therapist will show you exercises that will help get you mobile again. You'll learn how to bathe, dress and get in and out of a car without harming your implant.

Before you can go home, you need to be able to straighten your knee and bend it 90 degrees. You also need to be able to do essential tasks with little or no help. For example, you should be able to go up and down the number of stairs you have at home. Once you have those things down, or have special clearance from your doctor, you'll be discharged from the hospital. You'll still need a friend or relative to assist with meals, cleaning, bathing, shopping and fetching items you need. As you heal, you'll start taking on these tasks yourself.

Your best bet for a speedy and safe recovery is to get a physical therapist to guide your rehabilitation program and follow his or her advice! How much effort you put into your rehab is a major factor in the success of your implant. Think of yourself as an athlete training to come back from an injury. Motivation is key, so stay focused on your goal of getting back on the golf course.

Physical therapy will continue for several weeks. You'll need to do exercises designed to restore movement in the joint and strengthen your leg muscles (see illustration) a few times a day. You can do many exercises while you're sitting or lying down. In addition to formal exercises, you'll also increase your walking and daily activities. This will improve your strength and stamina, and get you closer to functioning entirely on your own.

How long you will be on crutches or use a walker depends partly on the type of implant you receive. Most people who get a cemented implant can put a little weight on it right away. They might be able to shed the crutches or walker altogether after four to six weeks. An uncemented implant isn't secure enough to bear your full weight until bone grows into it, so most surgeons recommend you put only about half your weight on your knee for the first six weeks. At that point you can begin tackling normal activities again.

After eight weeks of rehabilitation, you may be able to start golfing again. Bowling, biking, ballroom dancing and swimming are fine, too. Some sports will never be advisable with a replacement knee. The prosthesis simply won't hold up to jumping, twisting or the repeated jarring of running, soccer, basketball, volleyball or contact sports. Your doctor can tell you whether a sport is OK or not. If it is, your physical therapist can tailor your rehab program to prepare you for the safest return possible.

Full recovery takes three to six months. You can expect to have as much movement as you had before the operation. Just be sure to set realistic expectations. Your knee replacement won't enable you to do more than you could before you became disabled. And while your new knee should relieve your pain, don't count on it to lower your handicap.

The Harvard Medical School Adviser is researched and written by the faculty and staff of Harvard Medical School. Visit www.health.harvard.edu/adviser.