Knee replacement surgery – how to prepare for the surgery and regain mobility ?

Knee replacement, also known as arthroplasty, is a surgical procedure that involves replacing damaged parts of the knee joint with an artificial prosthesis. It is one of the most commonly performed orthopedic procedures, especially among older people. It is usually performed on patients suffering from osteoarthritis or after specific injuries.

The surgery provides pain relief, improves joint function, and allows for a gradual return to physical activity. Rehabilitation is necessary after the procedure.

In the vast majority of cases, knee replacement surgery is performed on patients suffering from advanced osteoarthritis. This is a chronic, progressive condition leading to damage to the articular cartilage, changes in the subchondral bone, and other joint structures (synovial membrane, ligaments, menisci). The damage caused by the disease, depending on the cause of its development, is divided into primary and secondary.

Primary osteoarthritis most often affects people over the age of 50, develops slowly, and usually affects the knee, hip, spine, hands, and feet. It is more common in women and the elderly. Genetic predisposition, obesity, microtrauma, and overload also contribute to its development.

Secondary osteoarthritis, on the other hand, is most often associated with injury. It also occurs in the course of metabolic diseases (e.g., gout), rheumatic diseases (e.g., rheumatoid arthritis), avascular necrosis, congenital defects (e.g., hip dysplasia), or after joint infections and surgeries.

In addition to advanced osteoarthritis, indications for knee replacement surgery also include:

• significant pain that interferes with the patient’s daily life,
• significant mobility problems due to stiffness and limited joint mobility,
• limb axis deformities (valgus and varus).

Before surgery, conservative treatment may be used, consisting of, for example:

• taking non-steroidal anti-inflammatory drugs to relieve pain,
• physiotherapy and physical therapy,
• the use of orthopedic equipment (e.g., orthoses, knee stabilizers),
• lifestyle modifications (e.g., weight loss to reduce joint load or replacing unsuitable physical activities (e.g., running) with other sports, such as swimming).

Surgery is the right solution when conservative treatment proves ineffective.

In the case of advanced degenerative changes affecting the entire joint, total arthroplasty is used. In this case, all joint surfaces are replaced.

The knee joint endoprosthesis is attached to the bone using bone cement, thanks to which the implant immediately becomes fully stable. Therefore, cemented arthroplasty is a good solution for older patients with poorer bone quality.

In younger people with good bone quality, an implant with a porous surface is used, into which the bone can grow naturally (osteointegration process). This solution involves a longer healing and recovery period, but is potentially more durable.

The patient will not be eligible for surgery if they have:

• active infections,
• advanced respiratory and circulatory failure,
• cancer,
• advanced osteoporosis.

The final decision on eligibility for surgical treatment rests with the surgeon, who will thoroughly assess the patient’s health. The specialist will take into account various factors, such as the potential risk of complications during the procedure itself and during subsequent recovery.

Knee replacement surgery usually takes 1 to 3 hours, and hospitalization after surgery usually lasts 3 to 7 days. The stitches are usually removed 10-14 days after the procedure. Until then, the dressings must be changed regularly. Most patients stop using crutches between 3 and 4 weeks after surgery.

Preparation for the procedure begins with a detailed orthopedic consultation, during which the doctor assesses the condition of the joint and qualifies the patient for appropriate surgical treatment. This is followed by laboratory tests, such as complete blood count and blood clotting assessment, as well as imaging tests – most often X-rays or magnetic resonance imaging.

The doctor assesses the patient’s overall health and, based on this, determines the possible risks of the procedure and rules out any contraindications. The next step is a consultation with an anesthesiologist, who selects the appropriate type of anesthesia (general or regional).

In the period preceding the operation, it is important to ensure good physical condition, especially strengthening the muscles of the lower limbs. It is also recommended to reduce body weight in case of overweight and to give up stimulants such as alcohol and cigarettes, as they can slow down the healing process and prolong the recovery period. Prehabilitation, i.e., comprehensive preparation of the patient for surgery, helps to achieve these goals.

Prehabilitation activities prior to knee replacement surgery are conducted by experienced physical therapists. They focus on the patient’s overall condition and do not aim solely at strengthening the muscles of their legs. The best results, in the form of better tolerance of the procedure and faster recovery afterwards, are achieved by activities that have a positive effect on the entire body. These include light physical activity, carefully selected to improve circulation, therapeutic treatments, strengthening the immune system, ensuring adequate sleep, stress reduction, and a proper diet. Centers such as NAMI Medical Resort and Clinic offer comprehensive assistance, taking care of every aspect of preparation for surgery – from the body to the mind. Thanks to this, the patient has a better chance of a faster recovery and better treatment results.

During the preoperative visit, the physiotherapist will assess the patient’s current functional status, select the appropriate therapy method – manual, kinesitherapy, or physical therapy – and develop an individual exercise plan.

Physiotherapy started before surgery will improve the patient’s fitness, strengthen muscle strength, and help alleviate pain. These are important effects, not only because they increase the comfort of everyday functioning. Working with a physiotherapist is a prehabilitation activity that:

• helps prepare the body for a better transition through the procedure itself,
• reduces the risk of possible complications,
• contributes to a faster return to fitness after surgery.

After the procedure, the patient has difficulty moving and can only do so with the help of crutches or a walker. It takes time and conscientious rehabilitation to regain fitness. Therefore, before returning from the hospital, it is a good idea to remove all items from the home that could cause tripping, such as cables or low furniture. The bathroom is a particularly important room. Non-slip mats or special handles and handrails to facilitate daily hygiene are useful here.

The rehabilitation process can also be aided by renting a CPM splint, a rehabilitation device that allows gentle joint flexion within a precisely controlled range. The CPM splint relieves the patient and its use helps prevent stiffness, tissue adhesions, and swelling, and supports healing, regeneration, and proper circulation. The device is not essential for home rehabilitation, but it certainly supports the return to fitness.

Rehabilitation begins in the first hours after surgery, while the patient is still in the hospital. In this initial phase, the patient performs exercises designed to prevent joint immobilization and improve circulation. They are accompanied by physiotherapists, who also teach them how to use crutches correctly, move around on flat ground and stairs, and use the toilet. This is essential instruction in order to be able to return to independent functioning in their own home and begin further rehabilitation at home or on an outpatient basis.

Later, rehabilitation activities focus on gradually improving muscle strength and increasing joint mobility. To this end, patients mainly perform strengthening and stretching exercises recommended by their physical therapist. At the same time, it is important to maintain cardiovascular fitness, for example through exercises on stationary bikes, elliptical trainers, or treadmills. Full rehabilitation usually takes 4 to 6 months, although elderly patients may take up to 9 months to recover.

During rehabilitation, it is worth focusing on improving the condition of the entire body. A nutritious diet, therapeutic treatments, breathing exercises, and other techniques to reduce potential stress will also help in the recovery process. At NAMI Medical Resort and Clinic, we provide care from an interdisciplinary team. After surgery, patients can not only work with an experienced physical therapist, but also comprehensively support their process of returning to full strength. Even before the procedure, it is worth choosing a place where we can comprehensively prepare for it and then rehabilitate, already fully aware of who we will be working with and how.

Returning to physical activity after knee replacement surgery is possible, but high-intensity and contact sports should be avoided, as these can lead to implant wear and the need for reoperation. There are studies indicating that returning to demanding disciplines (e.g., skiing, horse riding, or running) is easier the more fit the patient was before the surgery and the more advanced they were in a given sport.

At NAMI, we believe that comprehensive rehabilitation under the supervision of experienced specialists is the foundation for a return to full fitness. Our team of orthopedic physiotherapists are experts who support patients at every stage of treatment, tailoring the therapy plan to their individual needs. We offer a comprehensive orthopedic program that includes diagnostics, manual therapy, physical therapy, and rehabilitation exercises. Our facilities also allow us to take care of the patient’s properly composed diet and mental condition. Don’t wait and get professional support before and after your surgery.

NAMI Medical Resort and Clinic exclusively offers medical programs.

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