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A common question people have about total knee replacements is how long before they’re able to walk again. In fact, a study on people who underwent total knee replacements showed that the most important activity to return to was walking.[1] This could be walking without pain, walking greater distances, improving the quality of their walk or returning to walking in social activities.[1] So, whether you’re a person who enjoys a slow paced stroll through the park or someone who must walk throughout the day to make ends meet, this blog will provide crucial information on what to expect after your knee replacement and how you may optimize the results of your surgery to get back onto your feet faster and stronger.

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When can I start walking?

The simplest answer is that you may begin to walk right after your surgery! But, the walking you do immediately after your surgery is going to look a little bit different than how you walked before your surgery. The guidelines provided by most surgeons and hospitals will recommend getting you onto your feet and to put weight through the operated foot as soon as possible [2]. Putting weight onto the freshly replaced knee and walking will allow for the structures within the knee to heal, as movement brings in blood and nutrients to the area. How much you are able to do may depend on the amount of pain, swelling, and lingering effects from the pain medication. This is why right after surgery and likely till the third day, you will be using some sort of walker, cane, or crutch depending on your ability to hold up your own weight. [2][3] Don’t worry your health care provider will teach you how to use your walking aid before you leave the hospital. From the third day to the fourth week, your physical therapist will help you recover your ability to walk by increasing the amount of time spent walking, decreasing the reliance on an assistive device (ie. crutch, cane, etc), and correcting any mistakes that are made within your walking pattern[2]. Finally, between the fourth week and the eighth week, it is expected that you will be walking normally without a walking aid.[2] Here is a breakdown of the walking recovery timeline:

1st day following surgery to 3rd day: short walks with an assistive device (eg. a walker); from the bed to a chair, or to the washroom.[2]

3rd day to 4 weeks: progressively increasing walking distance while using a walking aid that provides less support. Meaning you will transition from a walker to a crutch to a cane. Some people are able to go straight from a walker to a cane.[2]

4-8 weeks: Walking independently with no assistive device.[2][4]

click here for a more detailed recovery timeline.

If you’re nervous or afraid about this timeline, rest assured that walking within 24 hours of the procedure is safe. From a study of over 2,600 people who began to walk within 24 hours of their total knee replacement, the researchers recorded only 21 falls, 12 injuries and 6 sutures that reopened.[5] Early walking has also been found to reduce the length of stay at the hospital, decrease the amount of pain after surgery, and increase how much you’re able to move the knee immediately after the operation.[5] People who began to walk early were also more satisfied with the outcomes from the procedure and were able to return to their daily lives faster.[5]

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When should I expect to be walking like I did before?

The issue in answering this question is that the walking goals people want to achieve are going to differ from person to person. But with the help of some studies we can at least get an understanding of when most people are regaining a functional amount of walking endurance. First, a study on over 4000 people, with an average age of 68 years most of whom were women, showed that at 6 months 1 in 10 were unable to walk for 15 minutes.[6] This seems unnerving at first, but if we assume the reverse is also true then that means the large majority, or 9 in 10, are able to walk for 15 minutes or more at 6 months![6] The authors of this study found that a younger age, the use of a smaller or no walking aid before their surgery, lower depression levels prior to surgery, and the absence of pain in the opposite knee were correlated with better walking abilities after the operation.[6] It is important to note that this study did have limitations, for instance it disregarded the previous health status of the people who were part of the study.[6] In other words, the people who were not in great health and could not walk 15 minutes before their surgery, may also be the same people who reported the inability to walk 15 minutes after their surgery.[6]Now lets say that your goals are related to the distance you're able to walk. Another study on 41 people with total knee replacements showed that most people were able to walk 1 kilometer or more at 8 weeks, and at 3 months they were satisfied with their ability to walk this distance.[1] Once again this study is not perfect and should be taken with a grain of salt primarily due to the small amount of data. Nevertheless, these two studies tell us that there is a large range of time where most peoples’ walking ability is returning to a normal level. Do not feel discouraged if the distance or time you are able to walk is different then what has been discussed as your path to recovery will differ.

What can I do to prepare myself to recover my ability to walk as fast as possible?

Research has shown that what you do before the operation will affect the recovery process after the surgery, in other words what you put in is what you get out. One of the best ways to optimize the recovery process is with exercise before you go for your operation.[7] A study on 50 people around the age of 60 with total knee replacements showed that high intensity strength training before the operation led to improved ability to walk, take the stairs, sit up and down, improved knee flexibility and strength, and decreased how much pain they felt.[7] All these benefits led to a decreased length of stay at the hospital and a less costly hospital bill overall. [7][8] High intensity exercises in this case meant resistance training for the lower body such as leg extensions, leg curls, hip adduction (bringing your thighs together).[7] Along with preoperative exercise your surgeon and potentially other members of your healthcare team should be providing you with information and material on how to manage the pain, the dressing and wound, and what to expect after the operation.[3]

Some surgeons use a device known as a continuous passive motion machine or CPM, this device will move your knee by itself in hopes of regaining flexibility within the knee. Unfortunately, there is a lack of evidence to support the use of this device; studies show that this device does not significantly improve the flexibility within an operated knee.[3] You may find yourself waking up after the surgery with this device attached to your knee already, but keep in mind that you should not rely on this device to regain function within your knee. Although the machine is not harmful, the best way to get back on your feet is to do just that, and follow the rehabilitation protocol provided to you by your physical therapist.[7]

Another crucial consideration that should be discussed with your surgeon and healthcare team before you go for your operation is how you are feeling psychologically. The previous study of 4000 people showed that poor psychological health or depression was an important predictor of pain and walking limitations 6 months after a knee replacement.[6] Although a discussion on your mental health before a knee surgery seems out of place, having this talk will give your healthcare team the opportunity to provide you with the resources to prepare you for the challenges ahead.[3][6]

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Conclusion

This blog was meant to address the question of when you should expect to walk again after a total knee replacement. We discussed a rough timeline for the recovery of walking and the factors that affect how quickly you may regain the ability to walk. To recap, you may begin to walk or put weight onto the operated leg immediately after your surgery, and within a matter of weeks you will likely be walking independently. The time in which you regain your previous ability to walk is a little more ambiguous and dependent on many factors, some that have been discussed in this blog above and some that have not been covered in this blog. More important than these timelines is the fact that actively trying to walk and following the rehabilitation plan set out by you and your healthcare team is the best way to return to normal walking.

In need of a convienent and effective way to guide your recovery? Try the Curovate app, an evidence based app that will provide you with a physical therapy plan, guided video exercises, and more to assist you along your journey to recovery! Download Curovate today by clicking the links below!

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References

1. Barker KL, Hannink E, Pemberton S, Jenkins C. Knee Arthroplasty Patients Predicted Versus Actual Recovery: What Are Their Expectations About Time of Recovery After Surgery and How Long Before They Can Do the Tasks They Want to Do?. Arch Phys Med Rehabil. 2018;99(11):2230-2237. doi:10.1016/j.apmr.2018.03.022

2. Total Knee arthroplasty (TKA) Post-Op Rehabilitation Protocol - University Orthopedics, Inc. Adult Reconstruction Division. (2022, June 6). Retrieved from https://universityorthopedics.com/assets/knee/PT-knee-protocol.pdf

3. Jette DU, Hunter SJ, Burkett L, et al. Physical Therapist Management of Total Knee Arthroplasty. Phys Ther. 2020;100(9):1603-1631. doi:10.1093/ptj/pzaa099

4. TKA Rehab Protocols - South Shore Health. (2019, October 29). Retrieved from https://www.southshoreorthopedics.com/resources/rehab-protocols/#1482259836425-d87f413f-e73c

5. Lei YT, Xie JW, Huang Q, Huang W, Pei FX. Benefits of early ambulation within 24 h after total knee arthroplasty: a multicenter retrospective cohort study in China. Mil Med Res. 2021;8(1):17. Published 2021 Mar 5. doi:10.1186/s40779-021-00310-x

6. Pua YH, Poon CL, Seah FJ, et al. Predicting individual knee range of motion, knee pain, and walking limitation outcomes following total knee arthroplasty. Acta Orthop. 2019;90(2):179-186. doi:10.1080/17453674.2018.1560647

7. Calatayud J, Casaña J, Ezzatvar Y, Jakobsen MD, Sundstrup E, Andersen LL. High-intensity preoperative training improves physical and functional recovery in the early post-operative periods after total knee arthroplasty: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc. 2017;25(9):2864-2872. doi:10.1007/s00167-016-3985-5

8. Guerra ML, Singh PJ, Taylor NF. Early mobilization of patients who have had a hip or knee joint replacement reduces length of stay in hospital: a systematic review. Clin Rehabil. 2015;29(9):844–854. doi: 10.1177/0269215514558641.