People decide to undergo a knee replacement surgery when they are in pain and are no longer able to take part in their everyday life activities. It is a highly effective surgery, and most people have less pain and are able to be more physically active after the surgery.

Typically, people see a gradual improvement in their pain symptoms during the first year after their knee replacement surgery. About 3 months after the surgery most people had less pain than they did before. After about a year, people state they have less pain and an overall improved quality of life.

In the video below, watch physical therapist Monica Kim discuss what to expect during the first year after a knee replacement surgery.

Read the full blog on "Is it normal to still have knee pain after a knee replacement?" here.

Read all of Monica Kim's blogs here!

The Curovate mobile physical therapy app can help you if you have had a knee replacement surgery to reduce pain in your everyday life and help get you back to the activities you love. Curovate is for at-home physical therapy exercises following a knee replacement, ACL surgery, ACL injury or hip replacement. The app includes a personalized exercise program, video guided exercises, and the ability to track your progress, all from your phone! You can download the Curovate app from the App Store or the Play Store using the links below.

If you need further customized assistance during your surgery or injury recovery check out our Virtual Physical Therapy page to book your 1-on-1 video session with a physical therapist.

Other recommended blogs

• Tips and tricks to fit rehab exercises into your daily schedule

• How to use crutches after surgery

• How to speed up recovery after total knee replacement

References

1. Bade, M. J., Kohrt, W. M., & Stevens-Lapsley, J. E. (2010). Outcomes before and after total knee arthroplasty compared to healthy adults. The Journal of orthopaedic and sports physical therapy, 40(9), 559–567. https://doi.org/10.2519/jospt.2010.3317

2. Li, C., Ng Cheong Chung, K., Ali, O., Chung, N., & Li, C. (2020). Literature review of the causes of pain following total knee replacement surgery: prosthesis, inflammation and arthrofibrosis. EFORT Open Reviews, 5(9), 534–543. https://doi.org/10.1302/2058-5241.5.200031

3. Wainwright, A. V., Kennedy, D. M., & Stratford, P. W. (2015). The Group Experience: Remodelling Outpatient Physiotherapy after Knee Replacement Surgery. Physiotherapy Canada. Physiotherapie Canada, 67(4), 350–356. https://doi.org/10.3138/ptc.2014-44

Is it safe for me to exercise if I have knee osteoarthritis or hip osteoarthritis?

Exercise is considered the most effective non-surgical treatment when it comes to managing your hip and knee osteoarthritis. Unfortunately, only about 30 percent of people with OA meet the physical activity guidelines of 150 minutes of moderate to vigorous physical activity each week. Aerobic exercises like walking can actually help to combat a lot of the comorbidities seen with people who have OA such as diabetes, high blood pressure, etc. Strength and flexibility exercises can help to improve your muscle strength, improve the stability in your joint, and increase range of motion. All of which will help you to ultimately reduce your pain. Experiencing some pain during exercise with OA is completely normal. On a scale of 1 to 10 if your pain rating goes up about two to three points during exercise that is considered completely normal. It's worthwhile to push through it because ultimately the benefits of exercise outweigh the risks.

In the video below, watch Aleesha, a physical therapist student, answer the question "Is it safe for me to exercise if I have knee osteoarthritis or hip osteoarthritis?"

Read the full blog on Is it safe for me to exercise if I have knee osteoarthritis or hip osteoarthritis? here.

Read all of Aleesha's blogs here!

Getting help from online physical therapists and our app Curovate can help you to find exercises that are specific to your needs. Curovate is a physical therapy app for ACL reconstruction, knee replacement, and hip replacement. Adding exercise to your routine as a person with osteoarthritis will ultimately help you to improve pain and return to activities that are meaningful to you!

Other Blogs Related to Osteoarthritis

• Does running cause knee osteoarthritis? Can I still run after my ACL surgery? Will running wear out my knee?
• My surgeon said I have knee osteoarthritis but I don't have pain - should I get a knee replacement?
• What is Osteoarthritis?
• What's the difference between Arthritis, Osteoarthritis and Osteoarthrosis?
• How to Become More Consistent with your Exercise Program Using Curovate
• Should I be experiencing pain when I do my rehabilitation exercises?

References

1. Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, et al. 2019 american college of rheumatology/arthritis foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Rheumatol. 2020 Feb;72(2):220–33.

2. Calders P, Van Ginckel A. Presence of comorbidities and prognosis of clinical symptoms in knee and/or hip osteoarthritis: A systematic review and meta-analysis. Semin Arthritis Rheum. 2018 Jun;47(6):805–13.

3. Juhl C, Christensen R, Roos EM, Zhang W, Lund H. Impact of exercise type and dose on pain and disability in knee osteoarthritis: A systematic review and meta-regression analysis of randomized controlled trials. Arthritis Rheum. 2013 Dec 18;

4. Messier SP, Resnik AE, Beavers DP, Mihalko SL, Miller GD, Nicklas BJ, et al. Intentional weight loss in overweight and obese patients with knee osteoarthritis: is more better? Arthritis Care Res (Hoboken). 2018 Nov;70(11):1569–75.

5. Loew L, Brosseau L, Wells GA, Tugwell P, Kenny GP, Reid R, et al. Ottawa panel evidence-based clinical practice guidelines for aerobic walking programs in the management of osteoarthritis. Arch Phys Med Rehabil. 2012 Jul;93(7):1269–85.

6. Gay C, Chabaud A, Guilley E, Coudeyre E. Educating patients about the benefits of physical activity and exercise for their hip and knee osteoarthritis. Systematic literature review. Ann Phys Rehabil Med. 2016 Jun;59(3):174–83.

“Come to Canada, we have free healthcare!” Canada is known around the world for having a publicly funded healthcare system, one that our country is quite proud of. And while the Canadian healthcare system is dynamic and based around the principles of fairness and equity, there are still many parts of critical and necessary healthcare services that are not publicly funded. So how exactly does this public funding work?

The answer is that it varies quite a bit province to province. Ontario allocates about 300 dollars for physio following a hip replacement and 250 following a knee replacement. Given an average PT session costs between $80 to $100, this covers maybe two to four sessions. British Columbia covers about 26 dollars per physio visit but only allows you a max of 10 visits a year. Manitoba has absolutely no public funding for physiotherapy. Quebec and Newfoundland don't have a funding limit but the average wait time to see a physical therapist can range between 140 to 300 days after surgery. The truth is there is not adequate funding available for physio following these surgeries and that's why Curovate was designed: to help improve access to the public so that they can receive great home care and rehab programs that will help them on their road to recovery.

In the video below, Aleesha answers the question, how much public funding is available in Canada, specifically within 5 provinces, after a hip replacement or knee replacement.

Read the full blog that discusses how much public funding is available after knee replacement or hip replacement in Canada here.

Read all 8 of Aleesha's blogs here!

The Curovate physiotherapy app was developed by a physical therapist to help address the lack of access to physical therapy after a knee replacement or hip replacement surgery. Curovate provides daily video guided strengthening exercises, the ability to measure knee range of motion, in-app chat with a physical therapist to answer your surgery and recovery questions and educational blogs and webinars. A full rehabilitation program will be provided to you and conveniently accessible through your mobile device. Check out the links below to download the app and see how it can best serve your rehabilitation needs following a hip replacement or knee replacement surgery.

If you need further customized assistance during your ACL recovery check out our Virtual Physical Therapy page to book your 1-on-1 video session with a physical therapist.

Other recommended blogs

• Why do Indigenous communities have the worst access to healthcare in Canada?
• What to expect after total hip replacement surgery
• What are the benefits of a knee replacement?

References

1. CBC/Radio Canada. (2012, July 11). 30-month wait list for physio in Labrador | CBC News. CBCnews. Retrieved October 14, 2021, from https://www.cbc.ca/news/canada/newfoundland-labrador/30-month-wait-list-for-physio-in-labrador-1.1281686

2. CBC/Radio Canada. (2005, April 26). Physiotherapy wait list swells in Labrador | CBC News. CBCnews. Retrieved October 14, 2021, from https://www.cbc.ca/news/canada/newfoundland-labrador/physiotherapy-wait-list-swells-in-labrador-1.532848

3. Deslauriers, S., Raymond, M.-H., Laliberté, M., Hudon, A., Desmeules, F., Feldman, D. E., & Perreault, K. (2019). Prioritization of referrals in outpatient physiotherapy departments in québec and implications for equity in access. Canadian Journal of Bioethics, 1(3), 49–60.

4. Health Quality Ontario. (2005). Physiotherapy rehabilitation after total knee or hip replacement: an evidence-based analysis. Ontario Health Technology Assessment Series, 5(8), 1–91.

5. Hip and Knee Replacements in Canada: CJRR Annual Statistics Summary, 2019–2020 | CIHI. (n.d.). Retrieved October 14, 2021, from https://www.cihi.ca/en/hip-and-knee-replacements-in-canada-cjrr-annual-statistics-summary-2019-2020

6. Home - Canada.ca. (n.d.). Retrieved October 14, 2021, from https://www.canada.ca/en.html

7. Home - Province of British Columbia. (n.d.). Retrieved October 14, 2021, from https://www2.gov.bc.ca/gov/content/home

8. How Healthcare Works In Nova Scotia: An In-Depth Review. (n.d.). Retrieved October 14, 2021, from https://www.closingthegap.ca/how-healthcare-works-in-nova-scotia-an-in-depth-review

9. Manitoba Physiotherapy Association. (n.d.). Retrieved October 14, 2021, from https://mbphysio.org

10. Medical Care Plan Coverage - Health and Community Services. (n.d.). Retrieved October 14, 2021, from https://www.gov.nl.ca/hcs/mcp/healthplancoverage

11. Ontario Ministry of Health and Long-Term Care. (n.d.). Retrieved October 14, 2021, from https://www.health.gov.on.ca/en

12. Physiotherapy Fees | Toronto Physiotherapy. (n.d.). Retrieved October 14, 2021, from https://torontophysiotherapy.ca/fees/pricing-list

13. Sutherland, G. (2017). The market profile of physiotherapists in Canada. In Ottawa: Conference Board of Canada

14. The value of physiotherapy. (n.d.). Retrieved October 14, 2021, from https://physiotherapy.ca/sites/default/files/valuePT/cpa_valuept_jointarthroplasty-en.pdf

15. Welcome to Quinte Health Care - Exceptional care, inspired by you. (n.d.). Retrieved October 14, 2021, from https://www.qhc.on.ca

16. Wylde, V., Beswick, A., Bruce, J., Blom, A., Howells, N., & Gooberman-Hill, R. (2018). Chronic pain after total knee arthroplasty. EFORT Open Reviews, 3(8), 461–470

If you just had knee replacement surgery, you may be wondering if the symptoms you are experiencing are normal. You came to the right place for answers!

Once you're back home from your knee replacement surgery there are some things that you're going to experience that are very normal and expected from a knee replacement surgery. Some of these things include:

1. Redness, Swelling & Bruising
2. Reduced Strength & Movement
3. Clicking/Popping Noises
4. Pain and Heaviness

Watch Aleesha explain the normal symptoms after knee replacement surgery in the video below.

Read the full blog that discusses what to expect after knee replacement surgery here.

Read all 8 of Aleesha's blogs here!

The Curovate physiotherapy app is for people recovering after a knee replacement, as well as for ACL reconstruction and hip replacement. Curovate provides daily video guided strengthening exercises, the ability to measure knee range of motion, in-app chat with a physical therapist to answer your surgery and recovery questions and educational blogs and webinars. Download Curovate using the links below.

If you need further customized assistance during your ACL recovery check out our Virtual Physical Therapy page to book your 1-on-1 video session with a physical therapist.

Other Blogs Related to Knee Replacement

• Common Complications After Surgery - What to Watch Out for to Keep Yourself Healthy!
• Ice, compression, elevation and ankle pumps
• Is it normal to still have pain after a knee replacement surgery?
• Why does my knee feel weird after my total knee replacement? Why does my knee feel heavy after my total knee replacement?

References

1. Thacoor A, Sandiford NA. Cryotherapy following total knee arthroplasty: What is the evidence? J Orthop Surg (Hong Kong). 2019 Jan-Apr;27(1):2309499019832752.

2. Meier, W., Mizner, R., Marcus, R., Dibble, L., Peters, C., & Lastayo, P. C (2008). Total Knee Arthroplasty: Muscle impairments, functional limitations, and recommended rehabilitation approaches. Journal of Orthopaedic & Sports Physical Therapy, 38(5), 246–256.

3. UCONN Health Musculoskeletal Institute After Total Knee Replacement Postoperative Instructions

4.Pua YH, Poon CL, Seah FJ, Thumboo J, Clark RA, Tan MH, Chong HC, Tan JW, Chew ES, Yeo SJ. Predicting individual knee range of motion, knee pain, and walking limitation outcomes following total knee arthroplasty. Acta Orthop. 2019 Apr;90(2):179-186.

5. American Academy of Orthopedic Surgeons: Total Knee Replacement

6. Nam D, Barrack T, Nunley RM, Barrack RL. What Is the Frequency of Noise Generation in Modern Knee Arthroplasty and Is It Associated With Residual Symptoms? Clin Orthop Relat Res. 2017 Jan;475(1):83-90.

7. Bade MJ, Kohrt WM, Stevens-Lapsley JE. Outcomes before and after total knee arthroplasty compared to healthy adults. J Orthop Sports Phys Ther. 2010 Sep;40(9):559-67.

Are you deciding between a staged single knee replacement or a simultaneous double knee replacement? One of the things you may be considering is the level of pain you are expected to experience with a double knee replacement compared to a single knee replacement.

You can expect similar amounts of pain with either a double knee replacement or a single knee replacement. Pain may affect the recovery process, but don't let the fear of pain deter you from a double knee replacement. A study has shown that there is NOT a significant difference in the amount of pain that occurs with a double knee replacement compared to a single knee replacement. To get the best results from your operation, discuss with your surgeon YOUR own tolerance for pain.

In the video below, watch physiotherapist Andrew compare a double knee replacement and single knee replacement in terms of expectations for pain.

If you would like to know more about double knee replacement compared to single knee replacements, check out Part 1: should I have a double knee replacement or one at a time here and Part 2: what are the benefits and risks of a double knee replacement compared to a one knee replacement here.

Read all of Andrew's 6 blogs here!

Eager to learn more? Click here to learn more about knee replacements and many more relevant topics on the Curovate blog. Or download the Curovate physical therapy 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!

If you need further customized assistance during your ACL recovery check out our Virtual Physical Therapy page to book your 1-on-1 video session with a physical therapist.

Other Blogs Related to Joint Replacement

• Why does my knee feel weird after my total knee replacement? Why does my knee feel heavy after my total knee replacement?
• My surgeon said I have knee osteoarthritis but I don’t have pain - should I get a knee replacement?
• What is a total knee replacement?
• Is it normal to still have pain after a knee replacement surgery?
• Should I exercise before my total knee replacement?
• What is Osteoarthritis?
• How long will my knee replacement last? And is there anything I can do to make my knee replacement last longer?
• 6 Things You Need to Know After A Total Knee Replacement
• 4 Tips to Prevent Falls After Knee Replacement, Hip Replacement And ACL Surgery
• Should I be experiencing pain when I do my rehabilitation exercises?
• Ankle Pumps - Why is my medical team telling me to do these?
• How to use crutches after injury or surgery - ACL, Knee Replacement, Hip Replacement
• Physical therapy advice after knee or hip surgery to keep up with your exercises! – Part 1
• How To Use Your Walker Safely After Knee Replacement or Hip Replacement Surgery

References

1. Alghadir AH, Iqbal ZA, Anwer S, Anwar D. Comparison of simultaneous bilateral versus unilateral total knee replacement on pain levels and functional recovery. BMC Musculoskelet Disord. 2020;21(1):246. Published 2020 Apr 15. doi:10.1186/s12891-020-03269-3

2. Lindberg-Larsen M, Pitter FT, Husted H, Kehlet H, Jørgensen CC; Lundbeck Foundation Centre for Fast-Track Hip and Knee Replacement Collaborative Group. Simultaneous vs staged bilateral total knee arthroplasty: a propensity-matched case-control study from nine fast-track centres. Arch Orthop Trauma Surg. 2019;139(5):709-716. doi:10.1007/s00402-019-03157-z

3. Tsukada S, Wakui M, Hoshino A. Pain control after simultaneous bilateral total knee arthroplasty: a randomized controlled trial comparing periarticular injection and epidural analgesia. J Bone Joint Surg Am. 2015;97(5):367-373. doi:10.2106/JBJS.N.00373

4. Vulcano E, Memtsoudis S, Della Valle AG. Bilateral total knee arthroplasty guidelines: are we there yet?. J Knee Surg. 2013;26(4):273-279. doi:10.1055/s-0032-1329721

5. Clark C. 'not a haircut': Two knees, same day ... more risk? Medical News. https://www.medpagetoday.com/surgery/orthopedics/78020. Published February 14, 2019. Accessed June 2, 2022.

6. Cao G, Chen G, Yang X, et al. Obesity does not increase blood loss or incidence of immediate postoperative complications during simultaneous total knee arthroplasty: A multicenter study. Knee. 2020;27(3):963-969. doi:10.1016/j.knee.2020.01.012

Total knee replacements can be very effective in improving function and decreasing pain for people with osteoarthritis. Due to advancements in knee replacements they now last on average 5-10 years longer than they used to.^[3] People are also getting knee replacements earlier in life. But how early is too early?

In the video below, Zacharie answers the question "Am I too young to get a knee replacement?" and gives a number of points to consider when determining when to have your knee replaced.

Read the full blog to learn more about "Am I too young to get a knee replacement?" here

Read all 8 of Zacharie's blogs here!

The Curovate app has rehab protocols for total knee replacement that help with strengthening and get you back to normal. Download our Curovate physical therapy app from the links below. Curovate provides daily video guided strengthening exercises, the ability to measure knee range of motion, in-app chat with a physical therapist to answer your surgery and recovery questions and educational blogs and webinars.

If you need further customized assistance during your knee replacement recovery check out our Virtual Physical Therapy page to book your 1-on-1 video session with a physical therapist.

Other Blogs Related to Joint Replacement

• How long will my knee replacement last? And is there anything I can do to make my knee replacement last longer?
• Should I put off my total knee replacement surgery? Am I waiting too long for my knee replacement? What are my other options?
• Should I exercise before my total knee replacement?
• Why does my knee feel weird after my total knee replacement? Why does my knee feel heavy after my total knee replacement?
• How is my body weight related to the success or failure of my knee replacement or hip replacement? Do I need to lose weight before my hip replacement or knee replacement?
• My surgeon said I have knee osteoarthritis but I don’t have pain - should I get a knee replacement?
• What is a total knee replacement?
• Is it normal to still have pain after a knee replacement surgery?
• What is Osteoarthritis?
• 6 Things You Need to Know After A Total Knee Replacement
• Should I be experiencing pain when I do my rehabilitation exercises?
• Ankle Pumps - Why is my medical team telling me to do these?
• Can I exercise before my ACL surgery - the importance of prehabilitation

References

1. Bayliss, L. E., Culliford, D., Monk, A. P., Glyn-Jones, S., Prieto-Alhambra, D., Judge, A., ... & Price, A. J. (2017). The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study. The Lancet, 389(10077), 1424-1430.

2. Britton-Jones, C. A. (2017). Prehabilitation. British Journal of Hospital Medicine, 78(12), 729-729.

3. Bone, M. and J. T. (2020, September 2). How long does a hip or knee replacement last? Cleveland Clinic.

4. Deere, K., Whitehouse, M. R., Kunutsor, S. K., Sayers, A., Price, A. J., Mason, J., & Blom, A. W. (2021). How long do revised and multiply revised knee replacements last? A retrospective observational study of the National Joint Registry. The Lancet Rheumatology, 3(6), e438-e446.

5. Kennedy, L. G., Newman, J. H., Ackroyd, C. E., & Dieppe, P. A. (2003). When should we do knee replacements?. The Knee, 10(2), 161-166.

6. Julin, J., Jämsen, E., Puolakka, T., Konttinen, Y. T., & Moilanen, T. (2010). Younger age increases the risk of early prosthesis failure following primary total knee replacement for osteoarthritis: a follow-up study of 32,019 total knee replacements in the Finnish Arthroplasty Register. Acta orthopaedica, 81(4), 413-419.

Have you ever suffered injury or gone through surgery and your doctor or physiotherapist has advised you to apply ice to the affected area?

Why do they do that? The two main benefits of ice after injury or surgery are:

1. Pain Management: The cooling effect of ice acts as a numbing agent that reduces pain in the area and ice basically acts as an alternative to pain-killer medications for many people.
2. The other benefit is that when you apply ice along with a little bit of pressure you can help reduce swelling and inflammation in that area.

In the video below, watch Dimitri answer the questions "Why should I use ice after my injury or surgery?" and "Why does my physical therapist tell me to use ice?"

Read the full blog on how does ice contribute to my recovery and should I use it here.

Read all 3 of Dimitri's blogs here!

Remember, icing is generally safe but it’s always safest to consult your healthcare professional for advice before icing your recently-operated or injured area. And remember if you have had surgery and are using ice, keep your knee or hip clean and dry while applying ice for pain relief.

You can find more information about recovery from hip replacement, knee replacement, as well as ACL tears and surgery from our Curovate App! Curovate is an app for physical therapy. Within the Curovate app, there are personalized rehabilitation plans which include video-guided exercises and precise scheduling of when to perform these exercises at your stage of recovery. Proper rehabilitation, which is accomplished with diligent exercise and pain management, is key to ensuring your body can recover at (near) 100% of its ability before sustaining the injury. Click the links below to download the Curovate physical therapy app, available for iOS and Android devices!

If you need further customized assistance during your recovery check out our Virtual Physical Therapy page to book your 1-on-1 video session with a physical therapist.

Other Related Blogs

• Am I too young to get a knee replacement?
• I injured my ACL what should I do?
• After I wake up from ACL surgery, what should I expect?
• Ice, compression, elevation and ankle pumps
• Physical therapy advice after knee or hip surgery to keep up with your exercises! – Part 1

References

1. Pan, L., Hou, D., Liang, W., Fei, J., & Hong, Z. (2015). Comparison the effects of pressurized salt ice packs with water ice packs on patients following total knee arthroplasty. International journal of clinical and experimental medicine, 8(10), 18179–18184.

2. Adie S, Kwan A, Naylor JM, Harris IA, Mittal R. Cryotherapy following total knee replacement. Cochrane Database Syst Rev. 2012;9

3. Macedo LB, Josue AM, Maia PH, Camara AE, Brasileiro JS. Effect of burst TENS and conventional TENS combined with cryotherapy on pressure pain threshold: randomised, controlled, clinical trial. Physiotherapy. 2015;101:155–160.

4. Block J. Cold and compression in the management of musculoskeletal injuries and orthopedic operative procedures: A narrative review. Open Access J Sports Med. 2010;1:105–113.

5. Fang L, Hung CH, Wu SL, Fang SH, Stocker J. The effects of cryotherapy in relieving postarthroscopy pain. J Clin Nurs. 2012;21:636–643.

6. Algafly AA, George KP. The effect of cryotherapy on nerve conduction velocity, pain threshold, and pain tolerance. Br J Sports Med 2007;41(6):365-369; discussion 369.

7. Herrera E, Sandoval MC, Camargo DM, Salvini TF. Motor and sensory nerve conduction are affected differently by ice pack, ice massage, and cold water immersion. Phys Ther 2010;90(4):581-591.

8. Clarke, H. A., Manoo, V., Pearsall, E. A., Goel, A., Feinberg, A., Weinrib, A., Chiu, J. C., Shah, B., Ladak, S. S., Ward, S., Srikandarajah, S., Brar, S. S., & McLeod, R. S. (2020). Consensus statement for the prescription of pain medication at discharge after elective adult surgery. Canadian Journal of Pain, 4(1), 67–85.

9. Mayo Foundation for Medical Education and Research. (2020, December 1). Edema. Mayo Clinic. Retrieved October 11, 2021, from https://www.mayoclinic.org/diseases-conditions/edema/symptoms-causes/syc-20366493.

10. GW;, S.-S. (2006, April 7). Analysis of inflammation. Annual review of biomedical engineering. Retrieved November 1, 2021

11. Weber, K. (n.d.). The technical benefits of icing - inverse med. The Technical Benefits of Icing. Retrieved November 1, 2021

If you have been diagnosed with osteoarthritis in the hip or knee, you have likely been told by your doctor you may need a joint replacement now or in the future. You may have either already seen a surgeon about getting a joint replacement or already had a joint replacement. It is possible that at some point during the process the topic of your body weight may have come up. Maybe your family doctor suggested weight loss to help you manage your osteoarthritis. Or maybe the surgeon asked that you lose some weight before surgery. This may leave you wondering, “what does my weight have to do with my osteoarthritis and joint replacement?” This is a great question, and the truth is that your body weight has a lot to do with your hip and knee joint health!

The body mass index (BMI) is a way of estimating body fat by dividing a person’s body mass in kilograms by their height in metres squared. BMI is not a perfect measure but research shows that it does a good job of predicting body fat and a number of health risks.^[10] The question is, do you need to lower your BMI before hip replacement or knee replacement surgery?

1. If your BMI is between 30-40 you may be more likely to develop osteoarthritis or need a hip or knee replacement. A higher weight will also make you more likely to develop these conditions at a younger age.
2. If your BMI is between 30-40 you likely do not have to lose weight before surgery as outcomes and risks are similar to lower BMI individuals.
3. A BMI above 40 increases the risk of complications and infection increases and may require weight loss to increase safety for a hip or knee replacement.

Watch Zacharie answer the question "Do I need to lose weight before my hip or knee replacement?" in the video below.

Read the full blog that discusses weight loss before knee or hip replacement

Read all 8 of Zacharie's blogs here!

Regardless of your BMI, if you get a hip replacement or knee replacement Curovate can help you. The Curovate mobile app has rehabilitation protocols for both hip replacement and knee replacement surgeries, to help you have the best possible outcome. Curovate also provides daily video guided strengthening exercises, the ability to measure range of motion, in-app chat with a physical therapist to answer your surgery and recovery questions, and educational blogs and webinars.

If you need further customized assistance during your ACL recovery check out our Virtual Physical Therapy page to book your 1-on-1 video session with a physical therapist.

Other Blogs Related to Joint Replacement

• Why does my knee feel weird after my total knee replacement? Why does my knee feel heavy after my total knee replacement?
• My surgeon said I have knee osteoarthritis but I don’t have pain - should I get a knee replacement?
• What is a total knee replacement?
• Is it normal to still have pain after a knee replacement surgery?
• Should I exercise before my total knee replacement?
• What is Osteoarthritis?
• How long will my knee replacement last? And is there anything I can do to make my knee replacement last longer?
• 6 Things You Need to Know After A Total Knee Replacement
• 4 Tips to Prevent Falls After Knee Replacement, Hip Replacement And ACL Surgery
• Should I be experiencing pain when I do my rehabilitation exercises?
• Ankle Pumps - Why is my medical team telling me to do these?
• How to use crutches after injury or surgery - ACL, Knee Replacement, Hip Replacement
• Physical therapy advice after knee or hip surgery to keep up with your exercises! – Part 1
• How To Use Your Walker Safely After Knee Replacement or Hip Replacement Surgery

References

1. Abdulla, I., Mahdavi, S., Khong, H., Gill, R., Powell, J., Johnston, K. D., & Sharma, R. (2020). Does body mass index affect the rate of adverse outcomes in total hip and knee arthroplasty? A retrospective review of a total joint replacement database. Canadian Journal of Surgery, 63(2), E142.

2. Gandhi, R., Wasserstein, D., Razak, F., Davey, J. R., & Mahomed, N. N. (2010). BMI independently predicts younger age at hip and knee replacement. Obesity, 18(12), 2362-2366.

3. Guo, H., Xu, C., & Chen, J. (2020). Risk factors for periprosthetic joint infection after primary artificial hip and knee joint replacements. The Journal of Infection in Developing Countries, 14(06), 565-571.

4. Horan, F. (2006). Obesity and joint replacement. The Journal of Bone and Joint Surgery. British Volume, 88-B(10), 1269–1271.

5. Kulkarni, A., Jameson, S. S., James, P., Woodcock, S., Muller, S., & Reed, M. R. (2011). Does bariatric surgery prior to lower limb joint replacement reduce complications?. The Surgeon, 9(1), 18-21.

6. Li, W., Ayers, D. C., Lewis, C. G., Bowen, T. R., Allison, J. J., & Franklin, P. D. (2017). Functional gain and pain relief after total joint replacement according to obesity status. The Journal of bone and joint surgery. American volume, 99(14), 1183.

7. Liljensøe, A., Laursen, J. O., Bliddal, H., Søballe, K., & Mechlenburg, I. (2021). Weight loss intervention before total knee replacement: a 12-month randomized controlled trial. Scandinavian Journal of Surgery, 110(1), 3-12.

8. Liu, B., Balkwill, A., Banks, E., Cooper, C., Green, J., & Beral, V. (2007). Relationship of height, weight and body mass index to the risk of hip and knee replacements in middle-aged women. Rheumatology, 46(5), 861-867.

9. Roth, K. C., & Bessems, G. J. (2006). Sorry, but you will have to lose weight before receiving your knee replacement. Pain, 124, 126-33.

10. Stevens-Lapsley, J. E., Petterson, S. C., Mizner, R. L., & Snyder-Mackler, L. (2010). Impact of body mass index on functional performance after total knee arthroplasty. The Journal of arthroplasty, 25(7), 1104-1109.

11. Wendelboe, A. M., Hegmann, K. T., Biggs, J. J., Cox, C. M., Portmann, A. J., Gildea, J. H., ... & Lyon, J. L. (2003). Relationships between body mass indices and surgical replacements of knee and hip joints. American journal of preventive medicine, 25(4), 290-295.

Are you recovering from a total knee replacement and wondering what exercises you can do to help with your recovery? This video will go over the early phase of recovery, and explaining what functional recovery is and how to achieve functional recovery.

During the early stages of recovery following a knee replacement, it is important to have a rehabilitation plan focused on achieving functional recovery as soon as possible.^[1] Functional recovery is the process of regaining or improving your ability to do everyday activities such as sitting, standing and walking after a knee replacement.^[1]

Following a knee replacement, the two most important outcomes that define functional ability are range of motion and quadriceps muscle strength because both are necessary for everyday activities.^[2][3] For example, a minimum range of 110° of knee flexion is needed to do most daily activities such as walking, climbing stairs, descending stairs and getting up from a chair.^[4] Additionally, the quadriceps are the muscles at the front of your thigh and are involved in activities like getting up from a seated position.^[3] Despite the importance of range of motion and the quadriceps for daily activities, it is common for people who have had a knee replacement to experience limited range of motion in the knee^[2] and to experience a loss of muscle strength in the quadriceps.^[3] Thus, following a knee replacement, exercises aimed at improving range of motion and quadriceps muscle strength are essential in the early phase of recovery.

Exercises that focus on knee flexion, knee extension, quadriceps muscle strengthening and functionality are recommended during the first 6 weeks after surgery. Six safe and effective exercises that you can do daily to help you achieve functional recovery include assisted knee flexion with a towel, double leg bridges, active knee extension over a roll, seated leg extension, straight leg raise and supported squats. For a more detailed description of these 6 exercises, click on this link. Please consult with your healthcare provider to ensure that these exercises are safe for you.

The Curovate Physical Therapy App has detailed videos and descriptions of these 6 essential exercises as well as many other important exercises for your recovery. Click on one of the download links below to start your knee replacement recovery today! Curovate is an evidenced-based app with guided physical therapy plans, daily guided video exercises, ways to measure and monitor your progress, and measure your knee range of motion! Download the Curovate App by clicking on the links below.

If you need further customized assistance during your knee replacement recovery check out our Virtual Physical Therapy page to book your 1-on-1 video session with a physical therapist.

Blogs related to Knee Replacement

• How can I relieve/manage my pain after my total knee replacement?
• Can I run after a knee replacement?
• How do I shower and go to the washroom after a knee replacement?
• When can I return to work after a knee replacement?
• Are ice cubes just as good as ice machines for managing pain after my knee replacement?

References

1. Lisi C, Caspani P, Bruggi M, et al. Early rehabilitation after elective total knee arthroplasty. Acta Biomed. 2017;88(4S):56-61. Published 2017 Oct 18. doi:10.23750/abm.v88i4-S.5154

2.Sancheti KH, Sancheti PK, Shyam AK, Joshi R, Patil K, Jain A. Factors affecting range of motion in total knee arthroplasty using high flexion prosthesis: A prospective study. Indian J Orthop. 2013;47(1):50-56. doi:10.4103/0019-5413.106901

3.Meier W, Mizner R, Marcus R, Dibble L, Peters C, Lastayo PC. Total Knee Arthroplasty: Muscle impairments, functional limitations, and recommended rehabilitation approaches. Journal of Orthopaedic & Sports Physical Therapy. 2008;38(5):246-256. doi:10.2519/jospt.2008.2715

4. Rowe PJ, Myles CM, Walker C, Nutton R. Knee joint kinematics in gait and other functional activities measured using flexible electrogoniometry: how much knee motion is sufficient for normal daily life?. Gait Posture. 2000;12(2):143-155. doi:10.1016/s0966-6362(00)00060-6

We hope this physical therapy advice will help you keep up with your daily exercises following a knee or hip surgery. There are a few reasons why people have a hard time keeping up with their daily rehab programs:

1. Pain: After any kind of surgery, you will feel pain in the affected area and you will likely feel pain during the first couple of months of the rehab process. What you need to remember is that the pain is temporary and exercises helps to reduce pain over time. The functional gains and the long-term benefit for outweighs the pain that you are feeling at the moment.
2. Fear: After any kind of surgery, people have a natural fear that they might re-injure themselves during the rehab process but it's important to remember that the likelihood of re-injuring yourself during the rehab is very low if the program is both effective and done consistently.

Check out the video below, where Dimitri answers the question "How can I keep up with all of my exercises after ACL injury or surgery?" and provides advice and tips for exercise.

For more information about physical therapy advice check out the 4 part Curovate blogs, starting with part 1, on how to keep up with your injury and surgery daily exercises here.

Read all 3 of Dimitri's blogs here!

The Curovate app has rehab protocols for ACL injury. Download our Curovate physical therapy app from the links below. Curovate is an app for at-home physical therapy exercises following a knee replacement, ACL surgery, ACL injury or hip replacement. Curovate also provides daily video guided strengthening exercises, the ability to measure knee range of motion, in-app chat with a physical therapist to answer your surgery and recovery questions, and educational blogs and webinars.

If you need further customized assistance during your ACL recovery check out our Virtual Physical Therapy page to book your 1-on-1 video session with a physical therapist.

Other recommended blogs

• How do I stay consistent with my physical therapy exercises after surgery or injury? Part 2
• How do I stay consistent with my physical therapy exercises after surgery or injury? Part 3
• How do I stay consistent with my physical therapy exercises after surgery or injury? Part 4

References

1: Chan, D. K., Lonsdale, C., Ho, P. Y., Yung, P. S., & Chan, K. M. (2009). Patient motivation and adherence to postsurgery rehabilitation exercise recommendations: the influence of physiotherapists' autonomy-supportive behaviors. Archives of physical medicine and rehabilitation, 90(12), 1977-1982.

2: Gignac, M. A., Cao, X., Ramanathan, S., White, L. M., Hurtig, M., Kunz, M., & Marks, P. H. (2015). Perceived personal importance of exercise and fears of re-injury: a longitudinal study of psychological factors related to activity after anterior cruciate ligament reconstruction. BMC sports science, medicine and rehabilitation, 7(1), 4.

3: Pizzari, T., McBurney, H., Taylor, N. F., & Feller, J. A. (2002). Adherence to anterior cruciate ligament rehabilitation: a qualitative analysis. Journal of Sport Rehabilitation, 11(2), 90-102.

4: Barber-Westin, S. D., Noyes, F. R., & Andrews, M. (1997). A rigorous comparison between the sexes of results and complications after anterior cruciate ligament reconstruction. The American journal of sports medicine, 25(4), 514-526.

5: Jack, K., McLean, S. M., Moffett, J. K., & Gardiner, E. (2010). Barriers to treatment adherence in physiotherapy outpatient clinics: a systematic review. Manual therapy, 15(3), 220-228.

6: Naugle, K. M., Fillingim, R. B., & Riley, J. L. (2012). A meta-analytic review of the hypoalgesic effects of exercise. The Journal of pain, 13(12), 1139-1150.

Image by koldunov from Canva Pro

Do you want to learn the 6 most important exercises after a knee replacement? This blog will go over the early phase of recovery following a total knee replacement, explaining what functional recovery is, what is important for functional recovery, and identifying essential exercises that you can do every day to help you recover.

What is functional recovery and how is it measured?

Following a total knee replacement, full recovery involves a rehabilitation plan focused on achieving functional recovery as soon as possible.^[1] Functional recovery is the process of regaining or improving your ability to do everyday activities such as sitting, standing and walking after a knee replacement.^[1] In the context of a knee replacement, functional recovery refers to restoring mobility, strength, flexibility, and overall function of the knee.^[1] To gather an accurate understanding of where you are in your functional recovery process, your healthcare provider may use patient-reportd outcome measures, performance-based measures, and physical impairment measures to evaluate your physical function.^[2]

Patient-reported measures are usually in the form of questionnaires and are completed by you, the patient.^[4] These measures provide useful information about your perceptions of physical function.^[4] An example of a patient-reported outcome measure is the knee injury and osteoarthritis outcome score otherwise known as the KOOS. The KOOS is designed specifically for people with various knee conditions and assesses pain, symptoms, activities of daily life function, sport and recreation function and knee-related quality of life through a series of questions.^[5] Click on this link to learn more about patient-reported measures and the KOOS and click this link to learn how to interpret your KOOS scores.

In contrast, performance-based measures are conducted by healthcare providers who focus on directly observing and evaluating a patient's physical abilities through a series of functional tasks.^[4] An example of performance-based measures of activity is the six minute walk test in which people are timed to see how far they can walk on a level surface in six minutes.^[2] In general, performance-based tasks are used by healthcare providers to assess various aspects of physical function, strength, flexibility, and mobility.^[4]

Physical impairment measures are assessments used by healthcare providers to quantify specific impairments, such as muscle weakness or limited range of motion.^[2] By using these measures, healthcare providers are able to identify underlying impairments that may be contributing to functional limitations.^[2] An example of a physical impairment measure is assessing knee range of motion or quadriceps strength. For example, if you are having difficulty with the six minute walk test, physical impairment measures can identify if it may be due to limited range of motion in your knee or quadriceps muscle weakness among other things.

Through using patient-reported, performance-based and physical impairment measures, your healthcare provider can gain a better understanding of how you are doing after your total knee replacement. In having this understanding, they can then create a tailored rehabilitation plan to help you achieve your functional goals.

Why is it important to achieve functional recovery?

Following a total knee replacement, range of motion is the most important outcome that defines functional ability.^[6] In the case of a knee replacement, range of motion refers to how much you are able to flex (bend) or extend (straighten) your knee. Surgeons typically use knee flexion range of motion as a measure to determine the success of a total knee replacement surgery.^[7] Range of motion is important for functional recovery because a minimum range of 110° of knee flexion is needed to do most daily activities such as walking, climbing stairs, descending stairs and getting up from a chair.^[3] Despite the importance of range of motion for daily activities, it is common for people who have had a knee replacement to experience pain and stiffness in their knee after surgery. As such, exercises aimed at improving range of motion are essential in the early phase of recovery.

Another important outcome for functional ability is quadriceps muscle strength. The quadriceps are the muscles at the front of your thigh and they function to straighten your knee from a bent position. The quadriceps are the muscles that help you stand up from a seated position. After a knee replacement, it is common for people to experience loss of muscle strength in the quadriceps. The loss of muscle strength in the quadriceps is due to a lack of use and poor communication of nerves from the brain to the muscle resulting in overall weaker muscle contractions and reduced strength.^[8] Although loss of hamstring strength has also been reported after a knee replacement, there is an emphasis on addressing quadriceps muscle weakness due to the quadricep’s key role in functional activities such as walking and climbing stairs.^[8] Thus, following a knee replacement, rehabilitative exercises are needed to address the loss of quadriceps muscle strength in order to achieve functional recovery.

What are the most important exercises I should do every day to maximize my recovery?

After a knee replacement, the goal is to improve knee range of motion, improve quadriceps muscle strength and promote independence in daily functional activities. Given these goals, knee flexion, knee extension, quadriceps muscle strengthening and functional exercises are recommended during the first 6 weeks after surgery.

Knee flexion exercises are particularly important during the early phase of recovery. In one study, it was determined that achieving a cut off range of 105^o of knee flexion within the first month of recovery led to the likelihood of achieving 120° of knee flexion by 12 months.^[9] In other words, if knee flexion range of motion is improved in the early stages of recovery, this can translate to improved long-term outcomes.^[9]

Given the emphasis on achieving range of motion and improving quadriceps muscle strength after a knee replacement, knee extension range of motion exercises and the straight leg raise are effective exercises. Both exercises involve quadriceps muscle activation and both exercises involve keeping the knee straight which works to improve knee extension range of motion.^[10]

The squat is an important motion required in many daily activities such as bending down to the floor or getting in and out of a car, on or off the toilet or a chair. Managing to do a controlled squat also requires balance, knee flexion and extension as well as adequate strength of the quadriceps and hip extensor muscles.^[11] Given the importance of improving knee range of motion, improving muscle strength and promoting independence in daily functional activities, the squat is a great exercise to do in the early phases of recovery with support.

Below is a list and description of 6 safe and effective exercises that you can do daily to aid in your recovery journey. Please keep in mind that everyone may recover at a different pace so your ability to do these exercises may take a bit longer but most people are able to do the following within the first 6 weeks after knee replacement. Please consult with your healthcare provider to ensure that these exercises are safe for you.

1. Assisted knee flexion with a towel

• While lying on the ground, wrap the bottom of your ankle with a towel or bed sheet so that you are holding both ends of the towel as indicated in the photo above. Slowly bend your surgical knee as far as possible by sliding your heel towards your butt and pulling the towel up towards your chest.
• Complete 2 sets of 25 reps

2. Double leg bridges

• While lying on your back with both knees bent, push your feet down into the floor and lift your butt off the floor until your hips are straight as indicated in the photo above and then slowly lower it back down
• Complete 3 sets of 10 reps

3. Active knee extension over a roll

• While sitting on the floor, place a rolled up towel under your ankle and try to straighten your surgical knee as best as you can. Think about pressing the back of your knee into the floor. Click on this link for more information on how to complete your rehabilitation exercises with home equipment.
• Complete 2 sets of 25 reps

4. Seated leg extension

• Started in a seated position with both legs touching the ground. Begin by contracting your quadriceps muscles to straighten the surgical knee. Straighten the knee as far as you can ad then return your leg to the starting position.
• Complete 3 sets of 10 reps

5. Straight leg raise

• While lying on your back, keep one knee bent and keep the surgical leg straight. With the leg that is straight, or your surgical leg, contract your quadriceps muscles and lift your whole leg up from the floor. Lift your leg as high as you can without your knee bending.
• Complete 3 sets of 15 reps

6. Supported squats

• With a table in front of you, place your hands on the table and use it as support. Slowly lower your body down so that your knee bends to about 60^o as indicated in the photo above. Remember to stick your butt out as you lower your body. Then, push up to straighten your knees and repeat.
• Complete 3 sets of 12 reps

Conclusion

After a knee replacement, starting functional recovery as soon as possible can help to strengthen and mobilize your operated knee faster, allowing you to continue to live your life independently. Through using a combination of patient-reported outcome measures, performance-based measures, and physical impairment measures, your healthcare provider can gain insights into your progress and help tailor treatment plans to your needs. During the early phase of recovery, there is a focus on improving knee range of motion and quadriceps muscle strength, since both are limited following surgery and both are crucial for daily activities. Exercises focusing on knee flexion, knee extension, quadriceps strengthening, and functional movements like squats are essential during the early phases of recovery. In this blog we discuss 6 specific exercises that are critical for your early recovery after a knee replacement. While there are many other exercises and other activities that are necessary for knee replacement recovery, the 6 exercises mentioned in this blog are the most important during the early phases of recovery.

These 6 critical exercises and all of your daily exericses can be found in the Curovate Physical Therapy App. Simply use one of the download links below to start your knee repalcement recovery today! Curovate is an evidenced-based app with guided physical therapy plans, daily guided video exercises, ways to measure and monitor your progress, and measure your knee range of motion! Download the Curovate App by clicking on the links below.

If you need further customized assistance during your knee replacement recovery check out our Virtual Physical Therapy page to book your 1-on-1 video session with a physical therapist.

Blogs related to Knee Replacement

• 6 Things You Need to Know After Total Knee Replacement
• Exercises You Can Do After Total Knee Replacement
• TKR Implant Loosening
• Become More Consistent With Your Exercise Program Using Curovate
• How Do I Stay Consistent with my Physical Therapy Exercises After Surgery or Injury? Part 1
• Exercise Before Knee Replacement

References

1. Lisi C, Caspani P, Bruggi M, et al. Early rehabilitation after elective total knee arthroplasty. Acta Biomed. 2017;88(4S):56-61. Published 2017 Oct 18. doi:10.23750/abm.v88i4-S.5154

2. Mizner RL, Petterson SC, Clements KE, Zeni JA Jr, Irrgang JJ, Snyder-Mackler L. Measuring functional improvement after total knee arthroplasty requires both performance-based and patient-report assessments: a longitudinal analysis of outcomes. J Arthroplasty. 2011;26(5):728-737. doi:10.1016/j.arth.2010.06.004

3. Rowe PJ, Myles CM, Walker C, Nutton R. Knee joint kinematics in gait and other functional activities measured using flexible electrogoniometry: how much knee motion is sufficient for normal daily life?. Gait Posture. 2000;12(2):143-155. doi:10.1016/s0966-6362(00)00060-6

4. Bolink SAAN, Grimm B, Heyligers IC. Patient-reported outcome measures versus inertial performance-based outcome measures: A prospective study in patients undergoing primary total knee arthroplasty. The Knee. 2015;22(6):618-623. doi:10.1016/j.knee.2015.04.002

5. Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee injury and osteoarthritis outcome score (koos)—development of a self-administered outcome measure. Journal of Orthopaedic & Sports Physical Therapy. 1998;28(2):88-96. doi:10.2519/jospt.1998.28.2.88

6.Sancheti KH, Sancheti PK, Shyam AK, Joshi R, Patil K, Jain A. Factors affecting range of motion in total knee arthroplasty using high flexion prosthesis: A prospective study. Indian J Orthop. 2013;47(1):50-56. doi:10.4103/0019-5413.106901

7.Han AS, Nairn L, Harmer AR, et al. Early rehabilitation after total knee replacement surgery: A multicenter, noninferiority, randomized clinical trial comparing a home exercise program with usual outpatient care. Arthritis Care & Research. 2015;67(2):196-202. doi:10.1002/acr.22457

8.Meier W, Mizner R, Marcus R, Dibble L, Peters C, Lastayo PC. Total Knee Arthroplasty: Muscle impairments, functional limitations, and recommended rehabilitation approaches. Journal of Orthopaedic & Sports Physical Therapy. 2008;38(5):246-256. doi:10.2519/jospt.2008.2715

9.Oka T, Wada O, Asai T, Maruno H, Mizuno K. Importance of knee flexion range of motion during the acute phase after total Knee Arthroplasty. Physical Therapy Research. 2020;23(2):143-148. doi:10.1298/ptr.e9996

10.Suh J, Liow MH, Pua YH, et al. Early postoperative straight leg raise is associated with shorter length of stay after unilateral total knee arthroplasty. Journal of Orthopaedic Surgery. 2021;29(1):230949902110022. doi:10.1177/23094990211002294

11.Rossi MD, Eberle T, Roche M, et al.. Use of a Squatting Movement as a Clinical Marker of Function After Total Knee Arthroplasty. American Journal of Physical Medicine & Rehabilitation. 2013; 92 (1): 53-60. doi: 10.1097/PHM.0b013e318269d8d0.

Are you recovering from a total knee replacement and wondering what cold therapy devices you should purchase or if you need to purchase any devices at all to help manage your pain? This video will explain the effects of ice machines and compare it to effects of ice cubes on managing pain following a knee replacement.

After a total knee replacement, your doctor may recommend using ice to help alleviate pain and swelling .^[1] You may be wondering why ice and how does it help with pain? Following a knee replacement surgery, pain is experienced because the nerve endings in your knee send pain signals to your brain.^[2] If these signals do not reach the brain, the sensation of pain may be absent or lessened.^[2] As such, ice is able to alleviate pain because it reduces the internal temperature of the knee and slows down the speed at which the pain signals travel from the knee to the brain.^[3] Check out this blog to learn more about what you can do to manage pain after knee replacement surgery.

Now that we have an understanding of how pain is experienced, you may be wondering what types of ice devices are available and if they are better than using regular ice cubes or you may be wondering what an ice machine even is.

Ice machines are computer assisted devices that generally work by circulating cold water through a pad or wrap which is then applied to the affected body part.^[4] Although ice machines allow for precise temperature control, continuous application, and compression which can help minimize swelling, a drawback is that they are expensive, and are less portable.^[5]

In contrast, ice cubes alone can provide the same pain relieving benefits and they are accessible, cost-free and easy to use.^[1] In a review of existing studies comparing the effects of ice machines and ice bags, the results show no significant difference in pain reduction between the two methods.^[5]

Thus, if you are contemplating whether or not to buy an ice machine, based on what we know, I would recommend opting for ice cubes. They are equally effective in managing pain after knee replacement surgery, while also being easily accessible, cost-free, and convenient to use. Ice cubes provide the same pain-relieving benefits as ice machines, without the expense or inconvenience of purchasing and using a specialized device.

To learn more about cold therapy, and the effects of ice machines, and ice cubes, check out my blog on the curovate website!

If you have had a knee injury or surgery try our app Curovate for your daily recovery. Curovate provides video-guided daily exercises, progress tracking, and the ability to measure your knee and hip range of motion all within the app!

If you need further customized assistance during your surgery or injury recovery check out our Virtual Physical Therapy page to book your 1-on-1 video session with a physical therapist.

Other recommended blogs

• How can I relieve pain after my total knee replacement

• What are normal symptoms after a knee replacement surgery?

• Knee replacement recovery movements that are safe and what to avoid

• Is it normal to still have pain after a knee replacement surgery?

References

1. White PF. The changing role of non-opioid analgesic techniques in the management of postoperative pain. Anesthesia and Analgesia. 2005;101(5S). doi:10.1213/01.ane.0000177099.28914.a7

2. Institute of Medicine (US) Committee on Pain, Disability, and Chronic Illness Behavior; Osterweis M, Kleinman A, Mechanic D, editors. Pain and Disability: Clinical, Behavioral, and Public Policy Perspectives. Washington (DC): National Academies Press (US); 1987. 7, The Anatomy and Physiology of Pain. Available from: https://www.ncbi.nlm.nih.gov/books/NBK219252/

4. Martin SS, Spindler KP, Tarter JW, Detwiler KB. Does cryotherapy affect intraarticular temperature after knee arthroscopy? Clinical Orthopaedics and Related Research. 2002;400:184-189. doi:10.1097/00003086-200207000-00023

4.Coviello M, Abate A, Ippolito F, et al. Continuous cold flow device following total knee arthroplasty: Myths and reality. Medicina. 2022;58(11):1537. doi:10.3390/medicina58111537

5. Markert SE. The use of cryotherapy after a total knee replacement. Orthopaedic Nursing. 2011;30(1):29-36. doi:10.1097/nor.0b013e318205749a

Image by LPETTET from Canva

Do you know the difference between a partial knee replacement, unicompartmental knee replacement, and a total knee replacement? If you are unsure as to what these terms all mean, rest assured that you are not alone. I have dedicated this blog to help you understand the various types of knee replacements. More specifically, this blog will discuss what will happen in these operations, how they compare to each other, and which surgery is ideal for you.

Partial? Total? What do these words mean?

Beginning with the most common, a total knee replacement is what it sounds like. A total knee replacement is a surgery to replace the top part of the shin bone, the lower end of the thigh bone, and part or all of the kneecap. Together these 3 bones or parts form the knee joint, hence the term total knee replacement. If you would like to learn more about total knee replacements read this blog. The two remaining terms, partial and unicompartmental knee replacement, describe the same procedure.^[1] To understand this procedure, we can think of the knee joint by dividing it into 3 compartments: the inner side of the knee, the outside of the knee, and the kneecap.^[1] With a partial or unicompartmental replacement, typically only one portion of the knee is replaced. This could be any one of the 3 compartments mentioned previously, but most often it is the inner side of the knee also called the medial compartment.

Partial and total knee replacements have the same goal, which is to take out the part of the knee causing pain and stiffness, then replace them with artificial parts.^[1] Both procedures require general anesthesia, meaning you will be put to sleep before the operation. After the operation, the recovery process is almost identical and may only differ in terms of timeline.^[1] Check out this blog to learn more about the general recovery process after a knee replacement, and click here to learn more about walking after a knee replacement.

Which procedure is better?

With all surgical procedures, there is a possibility of complications such as an infection or a blood clot. The same risks and complications associated with a total knee replacement are also a potential risk with partial knee replacement. Read more about the common complications after a knee repalcement and what you can do to avoid them by clicking here. However, there is research that shows partial knee replacement has equal or better results than a total knee replacement. From a study of 1000 cases of partial knee replacements, 96% of the implants were still viable and functioning 5 years after the initial surgery.^[5] From the 29 people that did require another surgery at 5 years, the most common cause for revision was osteoarthritis developing in the outer part of the same knee.^[5] Furthermore, in a study of over 100,000 people with knee replacements there was a significantly lower rate of complication for the people who had undergone a partial knee replacement.^[6] The 25,334 people with a partial knee replacement benefitted from a reduced length of stay at the hospital, lower rates of complications such as blood clots, heart attacks, and strokes.^[6] People with a partial knee replacement also feel more satisfied and content with their new joint in comparison to those with a total knee replacement.^[7] In a small study of 130 people with knee replacements, the 65 people with a partial knee replacement reported that their joint felt more natural and that they were more satisfied with the results of the procedure.^[7] How is this all possible? There are a few reasons, first partial knee replacements are thought to be less invasive as the procedure is typically done with a smaller cut to the knee.^[1] Second, partial knee replacements are often done with a younger and more active population leading to better self reported outcomes from their surgeries.^[1][6]

Where partial knee replacements often come up short is the longevity or how long the knee lasts until another surgery is needed. The previous study of 100,000 people with knee replacements also found that people with partial knee replacements were 2.1 times more likely to need another surgery for the same knee down the road.^[6] Total knee replacements are also more popular with surgeons as they are less technically complex, and an extremely effective (if not the only solution) to end stage osteoarthritis that is causing significant pain and hindering daily life activities.^[1][2][4][6] The widespread popularity of total knee replacement is a strength of the procedure. The popularity of total knee replacements makes finding a surgeon who is competent and willing to perform the procedure much easier.^[1][2]

So should I get a total or partial knee replacement?

The answer to this question depends on what sort of issues exist within your knee and the current health of the knee in question. A partial knee replacement is suggested for a person with osteoarthritis or damage affecting the front and inner portion of their knee joint. The medical terminology used to describe this condition is known as Antero-medial osteoarthritis.^[2] But, simply having this condition does not guarantee that you will have the choice to undergo a partial knee replacement. The following criteria would not allow a person to receive a partial knee replacement: people with an active infection, inflammatory disease such as diabetes or rheumatoid arthritis, and history of surgical procedures on the tibia or shin bone, weakness or damage to the ligaments within the knee joint.^[2] This last point is particularly important as anyone who wants a partial knee replacement must have normal and functional ligaments within their knee joint to qualify. In other words, people who have had an ACL replacement surgery may not be able to opt for a partial knee replacement.^[2]

Something else to consider before choosing your procedure is the surgeon who will be doing the operation. It is estimated that only 10% of the surgeons in the world offer partial knee replacements.^[2] Thus, it is crucial that you know how competent and comfortable your surgeon is with any knee replacement procedure as it will affect the outcomes of your surgery. From a study of over 450,000 people with a knee replacement, it was found that a surgeon who does not perform many knee replacements, especially partial knee replacements, has 4 times the revision rate.^[3] A higher revision rate means that the chances of you needing another surgery down the line is greater. The question then is how familiar with partial knee replacements should your surgeon be? A study of 41,000 knee replacements showed that surgeons that perform partial knee replacements 20% of the time will have acceptable revision or failure rates, and surgeons that perform partial knee replacements 50% of the time will have the best results.^[4] The takeaway here is that how much experience and how often your surgeon does this surgery will dictate the need for another surgery.^[2][4]

Conclusion

The goal of this blog was to inform people who are facing a decision between a total and partial knee replacement. We have covered differences between the two procedures, the benefits and issues, and which procedure may be best for certain people. Some practical advice, consult your surgeon and healthcare team on the current condition of your knee to determine your eligibility and also assess the competence of your surgeon in regards to partial knee replacements. Also please understand that both operations are safe and effective ways of addressing osteoarthritis of the knee that results in pain and limitations, this blog is not meant to deter you from having either procedure but to inform your choice and optimize your results.

Want to learn more about the different kinds of knee replacements? Check out the Curovate blog for easily understandable information, practical advice, and much more! Regardless of what procedure you choose, getting back onto your feet as soon as possible is important to everyone. Try the Curovate physical therapy app to get you back to doing the things you love! Curovate is 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!

If you need further customized assistance during your ACL recovery check out our Virtual Physical Therapy page to book your 1-on-1 video session with a physical therapist.

Blogs related to knee replacement

• 6 Things You Need to Know After A Total Knee Replacement
• What is a total knee replacement?
• Should I put off my total knee replacement surgery? What are my other options?
• What Kind of Exercises and Sports Can I Do After A Total Knee Replacement?
• How Long Will My Knee Replacement Last and Is There Anything I Can Do To Make My Knee Replacement Last Longer?

References

1.Knee replacement surgery. Versus Arthritis. https://www.versusarthritis.org/about-arthritis/treatments/surgery/knee-replacement-surgery/. Accessed June 20, 2022.

2. Campi S, Tibrewal S, Cuthbert R, Tibrewal SB. Unicompartmental knee replacement - Current perspectives. J Clin Orthop Trauma. 2018;9(1):17-23. doi:10.1016/j.jcot.2017.11.013

3. Liddle AD, Pandit H, Judge A, Murray DW. Effect of surgical caseload on revisionrate following total and unicompartmental knee replacement. J Bone Joint Surg Am. 2016;98(1):1–8.

4.Liddle AD, Pandit H, Judge A, Murray DW. Optimal usage of unicompartmental knee arthroplasty: a study of 41,986 cases from the National Joint Registry for England and Wales. Bone Joint J. 2015;97-B(11):1506-1511. doi:10.1302/0301-620X.97B11.35551

5. Pandit H, Jenkins C, Gill HS, Barker K, Dodd CA, Murray DW. Minimally invasive Oxford phase 3 unicompartmental knee replacement: results of 1000 cases. Bone Joint Surg Br. 2011;93(2):198–204.

6. Liddle AD, Judge A, Pandit H, Murray DW. Adverse outcomes after total and unicompartmental knee replacement in 101,330 matched patients: a study of data from the National Joint Registry for England and Wales [published correction appears in Lancet. 2015 Feb 28;385(9970):774]. Lancet. 2014;384(9952):1437-1445. doi:10.1016/S0140-6736(14)60419-0

7. Zuiderbaan HA, van der List JP, Khamaisy S, et al. Unicompartmental knee arthroplasty versus total knee arthroplasty: Which type of artificial joint do patients forget?. Knee Surg Sports Traumatol Arthrosc. 2017;25(3):681-686. doi:10.1007/s00167-015-3868-1

This blog is going to help you answer the question of whether or not you need a total knee replacement. The information provided will be divided into two sections. The first section will be dedicated to discussing the signs and symptoms a surgeon would like to see before they offer the option of a total knee replacement. The second section will explain what you would see in your own knee that is suggestive of needing a knee replacement.

What signs would make a surgeon suggest a total knee replacement

A survey asked all the registered orthopedic surgeons within the province of Ontario, Canada about which characteristics would make them more likely to suggest a knee replacement.^[1] Although there wasn’t a perfect consensus among the 234 surgeons, there were certain features that the majority agreed would make them suggest a total knee replacement:^[1]

• Pain that is resistant to medication (173 of the surgeons agreed)
• X-ray imaging that shows moderate to severe knee osteoarthritis (154 of the surgeons agreed)
• Pain that continues throughout the night (149 of the surgeons agreed)
• Pain that prevents the person from standing on that leg (144 of the surgeons agreed)
• The person is unable to walk without pain (140 of the surgeons agreed)
• An age of 80 years old (73 of the surgeons agreed)

The surgeons were also given 3 different hypothetical cases and asked to pick the one that they believe is the best fit for a total knee replacement.^[1] The case that was chosen by the majority described a 70 year old woman with knock knees (knees that tilt inward towards each other) and osteoarthritis that affected the entire knee joint.^[1] If the details of this case or the features above sound familiar to your situation then chances are a total knee replacement could be an option for you. However, simply having knee osteoarthritis on your X-ray without knee pain is usually not an indication for a knee repalcement as you can read in this blog.

Another study consulted 20 different healthcare professionals who have experience with total knee replacements and found 3 different variables or factors that affected a surgeon's decision in suggesting a total knee replacement.^[2] The first factor was the severity of damage within the knee.^[2] Damage within the knee is assessed in 3 ways: the intensity of pain, the degree of disability, or some form of imaging.^[2] The second factor is how the person presents as a whole, for instance the surgeon will consider how quality of life would change with a surgery, the individual’s mental health, and the person’s motivation.^[2] People who are more motivated to get back to work, in good mental health and obtain an improved quality of life from the procedure will most likely be selected. To read more about how to overcome mental block during surgery and injury recovery check out this blog. In certain countries, the socioeconomic status of the person and their insurance coverage is also a factor the surgeon considers before offering a total knee replacement.^[2] The final variable is the environment as access to surgical procedures of any kind is based on the availability of a hospital and a surgeon. For instance, rural areas struggle with long waitlists and poor access to elective surgeries such as a knee replacement.^[2] This is an important consideration because even if you have all the signs and symptoms that point towards a knee replacement, you may not be able to get the operation in a timely manner because of your geographic location.^[2]

The Ontario criteria is a tool used by some surgeons to determine the appropriateness of a total knee replacement and where on the waiting list someone should be placed.^[3] This tool calculates appropriateness based on how functional an individual is and the type and level of pain they are experiencing.^[3] This tool is unique because it clearly defines each one of the factors, for instance functional ability is separated into 4 different classes with class 1 being normal and 4 being a person with severe osteoarthritis and is bedridden or immobile.^[3][4] The tool is meant to help the surgeon in their decision by categorizing the person into groups that would benefit the most or the least from a knee replacement.^[4] The full breakdown of the tool is outside the scope of this blog, but know that this tool may be used to assess your need for a knee surgery.

As you can see there is not a universal sign or method that can be used to determine who is the best fit for a total knee replacement or when in their life they should get the operation.^[4][5] Overall, you can expect your healthcare team to assess your need for a total knee replacement by looking at your pain levels and how the issue is affecting your everyday life and considering the healthcare resources that are available in your geographic location.

Image by rolleflex_graphy726, from Unsplash

How would I know if I need a total knee replacement?

The most noticeable sign or symptom is severe and persistent pain within your knee. This pain may be causing you to lose sleep and it could get worse with use. ^[5] People with an osteoarthritic knee often describe the knee as feeling extremely stiff, aching with movement, looking swollen and puffy, and that the knee will buckle at any moment.^[5] The second indication is that your knee is causing severe disability. This may look different from person to person, it could be that you’re unable to walk the distances that is normal for you, do the physical activities and sports that you enjoy, or you’re missing work because of knee pain or disability. ^[5] Finally, if pain medication or other treatments are no longer effective, total knee replacement will likely be suggested to you by your healthcare practitioner.^[5] To be quaint, if you can’t sleep, can’t walk, and can’t work then you know you need a knee replacement.^[4][5]

Conclusion

As it was mentioned above, there is still a lack of agreement among surgeons on what signs or indications definitively point towards a knee replacement. Most studies have found that a combination of severe pain and loss of ability to participate in activities of daily living will be key indicators for the surgeon. This is not to say that someone who does not exhibit these exact issues will be prohibited from undergoing a total knee replacement or that someone who does show these signs must absolutely have their knee replaced. Fortunately, in the current era of informed and shared decision making, the person with the knee pain has a lot of control over what to do next. However, your socioeconomic status, or how much money you make, can be a limiting factor in your ability to access a knee replacement in many parts of the world where this procedure is paid for by the person who needs it. Also if you live in a rural part of the world you may have limited access to this procedure. Previously younger people were prevented from having a knee replacement as it was suggested that their knee repalcement would not last long enough.^[3][4] But now younger people with a strong desire to go back to work or have family obligations that require a functional knee may opt for an early surgery and their surgeon must respect and support that decision.^[3][4]

Having a total knee replacement is no easy task and optimizing the recovery process after a total knee replacement surgery is crucial to getting back to a normal life. To help get you on track with your recovery the Curovate App is an essential resource! An evidence-based app that provides you with personalized physical therapy recovery plans for knee osteoarthritis, before a knee repalcement and after a knee replacement, daily guided video exercises, ways to measure your knee range of motion and monitor your recovery progress! Download the Curovate App from the Google Play store or the Apple App store by clicking on the links below.

If you need further customized assistance to help you decide if you need a knee replacement check out our Virtual Physical Therapy page to book your 1-on-1 video session with a physical therapist.

Related blogs

• Should I put off my total knee replacement? What are my other options?
• Am I too young to get a knee replacement?
• What is a total knee replacement?
• What kind of exercises and sports can I do after a total knee replacement?
• My surgeon said I have knee osteoarthritis but I don't have pain, should I get a knee replacement?

References

1. Wright JG, Coyte P, Hawker G, Bombardier C, Cooke D, Heck D, Dittus R, Freund D. Variation in orthopedic surgeons' perceptions of the indications for and outcomes of knee replacement. CMAJ. 1995 Mar 1;152(5):687-97. PMID: 7882231; PMCID: PMC1337616.

2.Dieppe P, Basler HD, Chard J, et al. Knee replacement surgery for osteoarthritis: effectiveness, practice variations, indications and possible determinants of utilization. Rheumatology (Oxford). 1999;38(1):73-83. doi:10.1093/rheumatology/38.1.73

3. Naylor CD, Williams JI. Primary hip and knee replacement surgery: Ontario criteria for case selection and surgical priority. Qual Health Care. 1996;5(1):20-30. doi:10.1136/qshc.5.1.20

4. Dieppe P, Lim K, Lohmander S. Who should have knee joint replacement surgery for osteoarthritis?. Int J Rheum Dis. 2011;14(2):175-180. doi:10.1111/j.1756-185X.2011.01611.x

5. Price AJ, Alvand A, Troelsen A, et al. Knee replacement. Lancet. 2018;392(10158):1672-1682. doi:10.1016/S0140-6736(18)32344-4