By Michael Ryan PhD, C. Ped (C)

Total knee replacement (TKR) is a game-changer for those struggling with chronic knee pain from arthritis or injury. It restores mobility, reduces pain, and helps you get back to the activities you love. But let’s be real—recovery isn’t always smooth sailing. Many patients unknowingly make mistakes that slow their progress or lead to complications.

In this article, we’ll break down the most common pitfalls before and after surgery—and, more importantly, how to avoid them.

1. Skipping Prehabilitation (Prehab)

Think of prehab as training camp for surgery. The stronger and more flexible your knee is beforehand, the better your recovery will be. Research shows that patients who do pre-surgery strengthening exercises experience less stiffness, better mobility, and a faster return to normal activities (McKay et al., 2019).

Unfortunately, many people skip this step, making post-surgery rehab harder than it needs to be. Dr. Sernik from Vernon, BC, is pioneering a new approach by bringing surgeons, rehab specialists, and patients together before surgery to set personalized goals and develop a seamless prehab and post-op plan.

We’re working on bringing a local expert to our #KintecVernon location this June for a live seminar, where they’ll explore strategies for managing knee health and optimizing recovery before and after surgery. Stay tuned!

2. Poor Pain Management

Pain management is a balancing act. Too little pain control makes rehab unbearable, leading to stiffness and setbacks. Too much reliance on opioids brings risks like dizziness, constipation, and dependency.

The best approach? Multimodal pain management—a mix of medications, ice therapy, nerve blocks, and gentle movement. Studies suggest this leads to the best recovery outcomes (Beloeil & Sulpice, 2019).

3. Not Committing to Physical Therapy

Your knee won’t rehab itself. A structured physiotherapy routine is crucial for regaining strength, flexibility, and function. Research confirms that patients who stick to their rehab plans recover faster and see better long-term results (Pua et al., 2017).

Skipping sessions or not pushing yourself enough can lead to stiffness, weakness, and long-term mobility issues. Igor Kharif, physiotherapist and owner of Coast Therapy, puts it bluntly: “If you can’t commit to rehab after surgery, you may want to reconsider having the surgery in the first place.”

4. Expecting a Quick Fix

A total knee replacement isn’t an overnight cure—it’s a process. While you’ll likely feel relief within a few months, full recovery can take up to a year (Gandhi et al., 2020). Patients who expect to be pain-free in a few weeks often get frustrated. Having realistic expectations and staying committed to the long game is key to success.

5. Ignoring Signs of Infection

Infections are rare but serious. If you notice persistent redness, swelling, fever, or drainage from the surgical site, don’t ignore it. Early detection is crucial—untreated infections can lead to major complications, including prosthetic joint infections that may require additional surgery (Liu et al., 2018). If something doesn’t feel right, call your healthcare provider immediately.

6. Overdoing It Too Soon

We love seeing patients eager to get moving, but pushing too hard, too soon, can backfire. High-impact activities or excessive movement before your knee is fully healed can lead to increased swelling, pain, or even implant failure (Petersen et al., 2021). Stick to your rehab plan, listen to your body, and ease back into activity gradually.

7. Neglecting Nutrition

Recovery isn’t just about movement—it’s also about fueling your body for healing. Proper nutrition plays a huge role in how well and how quickly you bounce back.

Key nutrients like vitamin D, calcium, and magnesium help with bone strength, while omega-3 fatty acids and collagen support joint health and reduce inflammation. Protein is also essential for muscle recovery. Studies show that nutrient deficiencies can slow healing and increase complication risks (Trevino et al., 2020). Talk to your healthcare provider about optimizing your diet—it can make a world of difference.

8. Overlooking Mental Health

Surgery isn’t just tough on the body—it’s tough on the mind, too. Anxiety, depression, and fear of movement (kinesiophobia) can significantly impact recovery. Studies suggest that patients with higher anxiety levels tend to have worse rehab outcomes (Riddle et al., 2017).

Support from family, counseling, or mindfulness practices can help keep you motivated and overcome psychological barriers. Recovery is both a physical and mental journey.

9. Skipping Blood Clot Prevention

After surgery, you’re at risk for blood clots like deep vein thrombosis (DVT) or pulmonary embolism (PE), especially if you’re not moving enough. To reduce this risk, follow your doctor’s recommendations on blood thinners, compression stockings, and early movement (Anderson et al., 2019). Skipping these preventive steps can lead to life-threatening complications.

10. Not Communicating with Your Healthcare Team

Your healthcare team is there to support you, but they can’t help if they don’t know what’s going on. Some patients don’t ask enough questions, fail to mention symptoms, or misunderstand post-op care instructions. Be proactive, track your progress, and speak up—good communication can make a big difference in your recovery.

Final Thoughts

A total knee replacement can be life-changing, but your success depends on what you do before and after surgery. By focusing on prehab, committing to rehab, managing pain wisely, and staying in close contact with your healthcare team, you’ll set yourself up for the best possible outcome. Avoid these common pitfalls, and you’ll be back on your feet—stronger and more confident—in no time.

References

• Anderson, D. R., Dunbar, M., Murnaghan, J., Kahn, S. R., Gross, P., Forsythe, M., … & Kovacs, M. J. (2019). Aspirin or rivaroxaban for VTE prophylaxis after hip or knee arthroplasty. *New England Journal of Medicine, 380*(8), 699-707.
• Beloeil, H., & Sulpice, L. (2019). Pain management after knee arthroplasty. *Anaesthesia Critical Care & Pain Medicine, 38*(1), 63-68.
• Gandhi, R., Wasserstein, D., Razak, F., Davey, J. R., Mahomed, N. N., & Toronto Arthroplasty Research Group. (2020). Predictors of time to return to work after total knee arthroplasty. *Canadian Journal of Surgery, 63*(3), E251-E256.
• Liu, J., Zhang, X., Ai, F., & Du, Y. (2018). Diagnosis and treatment of prosthetic joint infection after total knee arthroplasty. *The Knee, 25*(1), 1-7.
• McKay, C. D., Griffith, L. E., & Richardson, C. G. (2019). The effect of prehabilitation on outcomes in total knee arthroplasty. *Journal of Physiotherapy, 65*(3), 138-144.
• Petersen, W., Rembitzki, I. V., Koppenburg, A. G., Ellermann, A., Liebau, C., Bruggemann, G. P., & Best, R. (2021). Anterior knee pain after total knee arthroplasty: A narrative review. *International Orthopaedics, 45*(5), 1131-1140.
• Pua, Y. H., Ong, P. H., Clark, R. A., & Chong, H. C. (2017). Physical therapy post–total knee arthroplasty: A review of the evidence. *Physiotherapy, 103*(3), 213-222.
• Riddle, D. L., Stratford, P. W., & Dumenci, L. (2017). Knee osteoarthritis and anxiety: Is fear of movement or activity associated with poor function? *The Journal of Rheumatology, 44*(3), 432-438.
• Trevino, S., Quintero, P., Nunez, E., & Speisky, H. (2020). Nutritional interventions and total knee arthroplasty outcomes. *Clinical Nutrition, 39*(4), 1000-1012.