Well done on reaching the 3 month post op mark for your Total Knee Replacement! The 3 month mark is a fantastic opportunity for us to assess how things are going. We generally find that TKR’s heal slightly slower than a total hip replacement, so if you have had a THR previously, don’t be surprised if you aren’t quite as advanced at this stage. In general, we expect most of our patients to fall into that range of 70-80% through the full recovery by 3 months post op. The final recovery part takes the next 3-6 months, so that by 6-9 months from your surgery, you should be doing all the things you want to do, with minimal restrictions. By now, however, you should be better than before surgery and able to see that you are improving all the time.
This is the time to reflect on the things that you couldn’t do before the surgery and those that you can do now. You should feel much better than before the surgery, your walking should be improved, and you should sleeping and performing normal activities without much difficulties. She people find that stairs (especially going down stairs) is still evolving, especially if you have found stairs difficult prior to surgery. This required dedication to strengthening up your quadriceps muscle.
The main thing is that your range of motion should be improving and by now, I would expect you to be finding minimal limitations from normal daily activities. The optimal flexion range that we should be achieving now is 110-120 degrees (0 degrees is considered as your leg straight or flat, with 120 degrees measured from your thigh bone (femur) to your shin bone (tibia). If you had a very restricted range prior to the surgery, then you may find you’re not quite at this level, however you would have received your range of motion in a video after your surgery from me, which is what we mechanically can achieve before any scar tissue fully heals.
There are still 2 symptoms that many people have at the 3 month mark after their total knee replacement:
- Start up stiffness: This means that depending on how long you sit for, you might find that the first few steps are stiff. This is NORMAL and almost everyone has an element of this at this stage (The same for after a total hip replacement). The first few steps after being in a seated position for a long time will be a bit stiff, and you should be able to walk through it, after which it should disappear and feel a lot better after – your walking stride and capabilities would then be far better than before surgery. Depending on how long you limped for prior to your surgery, or how long you were limited by your hip – this will dictate how long after surgery you will still maintain some of this abnormal gait. Going up and down stairs, getting in and out of a car should all be much easier now.
- Some discomfort: most people will still find that there are some limits with how long you can stay on your feet, or walk for, and this will show by some discomfort at night time. There may also be a sensation of some swelling around the muscles in the afternoon/evenings, and even some slight heat. This is normal, and will disappear over time. There may still be some heat around your knee, which is also normal at this point.
The main thing, is that you are noticing that things are continuing to improve, from a mobility and functional level. I would anticipate that by now, things are all improving each week.
The Xrays that you have had will show the implant position. The main thing that I am looking for here, is that there is evidence that there has been no movement of the implant – we do an initial Xray at the time of surgery to confirm its position in relation to your 3D scan but that Xray is not as well aligned as the one that we do around the 3 month mark. I can send a copy of your recent Xrays to your email if you wish.
Below I’ve added some FAQ’s for this timeframe.
Finally – many of my patients request that this appointment is done in as convenient a way as possible, and I have had many requests to have this 3 month final appointment done as a phone call. All of you would have my personal mobile number at this stage, so you know how to SMS me if you have any concerns about things. Which is why I would like to offer the following options to you. If you wish to pop in for your 3 month review in person, then you do not need to do anything at all. Just come in at your scheduled time and I will see you then. Alternatively, please reply to the email that I sent to you to advise if you would prefer:
A: A phone call in place of a physical review. I will call you, and send you a copy of your Xrays to your email.
B: No phone call – you will contact me as required. I can still send you the Xray for your records. I will then cancel your 3 month review appointment on our system, but you know you can contact me anytime via SMS as you need to, or call you back if you wish to discuss more than SMS can handle!
I hope this helps with things. Often patients are so recovered at this point that this visit is not required. If the above sounds like you, then you might be able to cancel this 3 month review in the ways described above. Just let us know prior to your appointment so we know beforehand.
Thankyou again for your trust in our surgery and outcomes. I hope you have found the quality of life improvements to be fantastic!
Dr Chien-Wen Liew
Do I still need to do physiotherapy?
In general, no. I do not recommend physiotherapy if you feel that you are functionally excellent. In general, most of the gym/physio treatments at this stage should not be isolated to your knee, but should be general in nature, rather than just for your hip. If you are using a physio for general health/fitness, than this is fine. Go ahead, but you should not need continued physiotherapy for your knee replacement from now. Strengthening your quadriceps and hamstrings will benefit you the most, but you can do them for both legs, and not just the operated one (or two).
Do I need any more Xrays of my knee?
This recent Xray should be your last one, and unless you find that your symptoms change, or anything feels unusual in the future, further Xrays are usually not required. We would normally recommend that routine Xrays in the future are not necessary – if anything feels unusual down the track, contact us or your GP and we can organise another Xray for you. Routine Xrays are certain intervals (ie 10 years) are not required.
What activities can I do or not do now?
Like I mentioned prior to the surgery, you can pretty much do any activities that you wish, with the exception of long distance road running, or jumping from things. A knee replacement is not designed to handle the forces of high impact. You can walk and ride and swim as far as you like, but jumping off things, and running are not recommended. You can return to sports like tennis, table tennis, etc without issues, and of course, if you need to run across the road, please go for it – it can handle this.
I notice a click sometimes in my knee
This is normal – some people have more laxity laterally than others. This is a normal variation – the lateral side of your knee will be where the clicking comes from and is due to a difference in the laxity of the medial (inner) from lateral (outer) compartments. This is normal, and is why your implant can pivot, and twist, rather than just acting like a simple hinge. The clicking, if not painful, is not dangerous to the implant longevity or its function.
There is a small numb patch to the side of my knee.
You would normally have a curved lateral incision around the outside of your knee. The nerves run from the medial (inner) aspect to the outer aspect of your knee, and any cut down your knee will result in a small numb region. This is fine, and expected. Because we do a curved lateral incision, this numb patch will be small. The lateral incision allows you to start kneeling on things, like the bed, couch, grass and carpet. You will still find it somewhat uncomfortable kneeling on very hard surfaces like concrete etc, but you can do it if you can – you won’t damage the implant in any way!