Common Questions and Answers

Scar mobilization can help decrease tethering of the skin to the underlying tissues. Once the wound has healed nicely (usually 4 weeks after surgery) you can start manipulating the scar. Place your thumb or palm on the incision and with increasing force rub in circles moving your way down the scar to break up the scar tissue.

Scar mobilization can help increase knee flexion as well.

The evidence on when to drive after a joint replacement is conflicting and the most common theme is that you need to be relatively pain free and able to move you leg quickly from the gas to the brake to be safe.

A good guideline for most people is that you can gradually return to driving when you are off narcotic medications AND using minimal assistance of walking devices. For most of my patients after a total knee replacement this will be somewhere between 2 to 6 weeks post op.

Please use common sense and be safe. If you are unsure or feel unsafe please wait to check with myself, another health care provider or SGI!

The first goal after surgery is to get full knee extension. To allow your muscles to relax when you stand for prolonged periods, you need to lock out your knee in extension (and to do this you need to have full extension of the knee). To assess for full knee extension after a surgery, it is best to sit on a flat hard surface with your entire leg straight (hip to heel) and your patella (kneecap) and toes pointing straight up. If you have full knee extension, you won't be able to slide your hand under your knee. If you can slide your hand under your knee, then you still have work to do...!! Follow the physios instructions on getting full knee extension back.

The second goal after surgery is to get full knee flexion. You will need at least 100 degrees before you see me at six weeks but I would eventually like you to get over 130 degrees (unless for some revision knee replacement surgeries I have told you otherwise). This will come with time and effort!

The third and most important step is strengthening. Strengthening after a knee replacement means not only getting the leg muscles stronger but also getting your core muscles stronger. The muscles that are the most important and are also often forgotten after a knee surgery are the glut and hamstring muscles. Please talk to your therapist or see my section on muscle strengthening for more guidance.

Sometimes when you start working on strengthening, you over-do it and start to lose range of motion. If this is the case, you will need to back off of strengthening for a bit, work again on getting a good range of motion and after this has returned, re-focus on getting your strength back!! In this case, maybe a different approach to strengthening than the previous attempt (and make sure you focus on the gluts and hamstrings).

Numbness around the incision is quite common after a knee replacement (from cutting the skin nerves passing through the incision). the numbness is almost always on the outside of the knee. It can take up to a year for it to go away and even then, some people are left with some residual numbness.

Tenderness around the knee is usually from tendonitis and inflammation. This will sometimes worsen a few months after the knee replacement and will usually resolve when your knee strength improves. Anti-inflammatories (including medications and creams) can be helpful in the short term. Often, the people that have the most pain are those that cannot take NSAIDs (ie celebrex/advil etc).

If you are in significant pain or discomfort please let my office know.

Yes, you are allowed to kneel on your knee after a knee replacement. For some people the scar is tender and if this is the case you may want a pad to kneel on. To kneel easily you need to have good flexion and people with >130 degrees of flexion will usually find kneeling easiest!

Unfortunately, some people never end up kneeling comfortably and if this is the case for you, you need to listen to your body and respond accordingly.

I usually don't put restrictions on travel post-op. All I ask is that you attend your regular follow-up. Travelling may increase your risks slightly as discussed below.

If you have prolonged immobility (ie sitting in a plane or vehicle for hours) this can increase your risk of blood clot. We give 2 weeks of blood thinners post op but if you are travelling and still have symptoms/swelling after coming off blood thinners then you can take ASA daily a few days before and after travelling if this is safe for you to do (and if you are worried discuss this with a health care provider).

Please note ... if you leave the province or country you may not have the appropriate health coverage or they may not cover you for pre-existing conditions. To be safe, make sure you check with your travel insurance provider!

Clicking in the knee is very common and can have many causes. When the metal and plastic contact eachother it can create a click and this is normal for most knee replacements. Clicking can also come from scar tissue and as your muscles get stronger, your knee will track better and this clicking should go away. Sometimes clicking comes from the patella (kneecap). Most often the clicking from your kneecap does not cause any issues.

If clicking is associated with signifigant pain or instability you should contact my office.

If you have an infection not associated with your joint replacement, you should have this treated early with antibiotics (especially if it is associated with fevers and chills).

If you are worried about an infection in or around your joint replacement PLEASE do not start antibiotics without contacting my office.

If you are having an invasive procedure or routine teeth cleaning within 4 to 6 months of your joint replacement it would be ideal to delay if possible. If you cannot delay then you should have prophylactic antibiotics (and these can be prescribed by your doctor/dentist or myself).

If you are having routine dental work AFTER 6 months it is currently the recommendation of the Canadian Dental College and the Canadian Medical Association that prophylactic antibiotics are not routinely needed.

Initially most people will start with a walker. You may transition to a cane when you are stable enough that you will not fall and hurt yourself.

As your stability and strength increases over time you can stop using the cane. If you notice that during an activity you are starting to limp you should either stop the activity or use the cane for the remainder of the activity. Limping means your muscles are not strong enough yet! If you limp too much it can cause pinching in your hip or knee OR trochanteric bursitis (lateral hip pain). Too much activity will not wreck your knee replacement but it can be quite uncomfortable and it can also increase inflammation which can limit knee range of motion.

Heat can be good for rehab especially if you are feeling stiff (ie. in the morning).

Ice, cooling pads or even cooling machines (such as ColdTherapy or Game Ready) can be helpful to decrease inflammation. This may be useful after activities or excercise.

Compression can be used to decrease swelling in the foot and leg. Tensor bandages, compression stockings or compression machines (such as Game Ready) can decrease swelling and improve circulation. Swelling in the leg can last for months after a joint replacement.

Massaging the leg (yourself or by a professional) can help with swelling as well. The better blood flow you have in the leg, the better you will heal!

Cold therapy (ie cryocuff) or similar machines will circulate iced water over the area of concern. These machines are available many places in the city however if you are having difficulty locating a place to rent or purchase you can call Mike at SOSMC (https://www.sportsmedcenter.ca/contact).

Benifit companies will often cover a portion of these costs.

Return to work is quite variable after a joint replacement. It depends on your ability to function and the type of job you are returning to. For you to be successful you must be able to have time to perform physio/rehab.

If you are returning to a sedentary job, you can often return to work when you are mobilizing safely and have your pain under control (sometime in the first six weeks). For a light duty job, the return to work is often after two to three months and for a moderate duty job, it can be up to four to six months until you can return safely.

The best way to return to work is to have your physiotherapist develop a return to work plan when they think you are ready. If you need to have this reviewed by me please send a copy to my office.