Knee Replacement Recovery: Get Ready for the 3 'Powerful P' Experiences

Closeup of total knee replacement patient exercising using 'doughnut' on wooden board.
Closeup of total knee replacement patient exercising using 'doughnut' on wooden board.

The evening after knee replacement surgery, I was startled to see the size of my right leg. Having been sliced and diced, stitched and stapled, it was seemed as if I had gained ten pounds, all in that leg. Swollen beyond recognition and riddled with pain from the bone to every inflamed ligament and tendon, it was appalling.

When the nurse needed to adjust me in bed, I'd have to use both hands to lift the leg in its plastic leg cradle, which was strapped on to force stability, day and night.

The First "Powerful P" Experience: Pain. A couple of weeks before surgery, we were asked to attend an education session where everything that would happen to us was explained clearly by the orthopedic staff. One of the repeated requests was that we help the nurses monitor our pain.

"Don't let the pain get to be bad," the teaching nurse told us. "If it goes beyond a certain point, the pain is much harder to get under control. So, when you are in pain, tell us so that we can regulate the painkillers. We don't want you in pain."

They meant it, and the nurses at the hospital (St. Thomas Hospital, Nashville, TN) were unbelievably wonderful. They checked in every hour, adjusted the Percocet dripping through the intravenous (IV) tubes, and asked repeatedly about my "level of pain." Unfortunately, while the pain was being contained, my reaction to the narcotic was nausea, no appetite, more nausea and a headache to beat all headaches.

(I had been that child in line to get the polio or smallpox shot in elementary school who fainted within ten minutes of getting it. I'm not frightened of shots; my body just doesn't like foreign stuff running through my veins).

At any rate, the first night I was pretty out of it, but constantly sick, and the night nurse worked compassionately to find a pain-killing combination that would work for me. She switched me to codeine + acetaminophen (Hydrocodone), and I stopped wanting to vomit all the time. The pain and headache went away. So did my appetite and my gastrointestinal functions.

"Some people want a nice meal three hours after surgery," the nurse had said. "That's great! We'll take care of that for you. But others may want just a little something, or nothing at all until morning. All of it's normal. It's just up to you." It was six days later at home when I thought I could manage some simple oatmeal. My appetite didn't return for weeks; I just forced myself to eat something once a day.

The Second "Powerful P" Experience: PT (Physical Therapy). Before being discharged, I had to demonstrate I could get into a (simulated) car, walk up stairs and walk steadily using a walker. It was the second morning after surgery. I did it all with that heavy leg, and not for the first time since this all began, gave thanks that my husband was by my side. I don't know how someone could function those first couple of weeks without someone right there to provide security and real help.

More than that, I dreaded the upcoming five consecutive days of PT. Southern Joint, the group that did my surgery, is rated the #1 orthopedic group in Tennessee, and #4 in the nation. Unlike some other fine groups, Southern Joint prescribes PT on a five-day schedule the first week after surgery. All this because one of the most important things PT does is get your knee moving so that scar tissue doesn't form. You'll never fully recover (be free of pain and walk normally) if scar tissue is present. In fact, I've known several people who neglected their PT (it is very painful) and had to have a second surgery to deal with the scar tissue.

The first PT session I wasn't sure I could do anything. I shuffled with my walker to the first station: the bicycle. I can hardly explain what trying to ride that bicycle was like that first week. But the PT therapist stood by my side, patiently waiting for me to get pumping, and so I did. Pain, agony, pain, and then some semblance of bearable pain as I peddled away.

I found the PT therapists and assistants to be genuinely thoughtful people, while keeping a perceptible wall between themselves and their patients. I can see why: I came in with lots of complaints, not having slept more than a few hours for days, weeks, and sometimes months. Despite my pain, their job was to push me hard, create even more pain as I worked the stations, and give me encouragement when it was warranted. They were not my friends; they were my determined physical therapists and their job was to get me to the next level of flexibility. I learned not to expect warmth.

After six weeks of progressively productive PT, I could bend my knee 115%. That was good news. However, 120% was ideal, so I had more work to do. As I write this today, the swelling remains in my knee, fifteen weeks post-surgery, but I am nearly able to create a natural bend. I figure that it will take another two months to achieve a pre-surgery bend. Not bad.

Which brings us to the final "P."

The Third "Powerful P" Experience: Patience. I have gone back and forth on whether it should be patience or perseverance. Actually I needed both in big doses. If someone tells you you'll walk without pain in ten weeks, I think you need to have more patience. If another someone tells you you'll be dancing the night away before you know it, have patience.

What really happens, I think, is that my orthopedic surgeon was exactly right when he said, "It will take a full year to be fully healed." Amen, doctor. The good part is, you won't have to do formal PT all that time. After six or ten or more weeks, you probably will be able to do your PT at home, in your gym, or club. That's if you have worked really, really hard at the formal PT for all those weeks, two to three times a week.

In the end, it takes a ton of patience and a determination to persevere. Both in great big gulps.

Coming next: Europe on a Brand New Ten-Week-Old Knee. What Your Doctor Didn't Tell You About Cobblestones.
Martha Nelson is an award-winning journalist and a former educator, nonprofit executive, chef, and musician. Her first novel, Black Chokeberry, was published in April 2012 and is available on and from her website,