Post op, knee replacement recovery.

[Barney16]

Just looking for some advice about my elderly mum. About three weeks ago she had a full knee replacement, operation went well but I'm not sure whether the recovery is really going well. There's nothing medically wrong with the knee replacement but she is really immobile, other than walking to the toilet, which she does with a walking frame she isn't doing anything else. She will move from the sofa to the bed, bed brought downstairs but that's it. She isn't getting dressed either, just wearing a random collection of pjs, no physio as of yet. I'm at a loss really. I don't know whether it's usual or if something else is going on. Perhaps confidence? She is late eighties and perfectly rational, obviously in a lot of pain, maybe I'm just being unrealistic, so wondered if anyone had any experience to share.

With elderly MIL we got a physio to come and do exercises with her. She was resistant! Unless she does the exercises religiously she won’t get an improvement in mobility even if pain has gone (once post op pain goes). Frankly MIL never managed to walk without a zimmer and not at all far. I’ve got other elderly rellies who were similar. I’ve also got a cousin in her 60s with 2 new knees who has just cycled across Italy! Keep encouraging the exercise!

my dad had a knee replacement and was doing daily exercises and increased walking every day. They advise you to keep mobile. He went from 2 crutches to one within a week and then no crutches from three weeks.
he is late 70’s but I don’t have anyone else to compare him to.

My mum was given exercises to complete everyday for weeks and was encouraged to get moving including doing the stairs and continue getting on with normal life as recovery allows. It wasn't easy getting use to it. New knee did feel different. I want to say mum saw a physio around 6 weeks post op at her consultant check up and then started attending group physio from there. My mum was younger at 67 though.

Was she not given exercises to do before leaving the hospital? My Dad was given a set of exercises to do several times a day and a decade later he still has to do them daily.

I had a total knee replacement just over 3 years ago and I was told by my surgeon that if I didn't exercise every day, it would have been a waste of money (I went private). I got myself a physio through my medical insurance and did the exercises religiously. It took me a year to fully recover, which I expected, but it was definitely worth it as I am now pain-free.

Exercise is an absolute must - I cannot emphasise that enough.

I had a total knee replacement just over 3 years ago and I was told by my surgeon that if I didn't exercise every day, it would have been a waste of money (I went private). I got myself a physio through my medical insurance and did the exercises religiously. It took me a year to fully recover, which I expected, but it was definitely worth it as I am now pain-free.

Exercise is an absolute must - I cannot emphasise that enough.

Thank you for your replies. She was given an exercise sheet when she left hospital but hasn't done any of them. I have offered to get a private physio, she's thinking about it. It's very very odd. When I see her walk to the toilet I think she's moving fine. But she doesn't seem to think so. Very limited range of things she's doing for herself too, she does say her knee feels very odd. I'm really bemused by what's happening, before the op her mobility was awful but she was very active. She is now just sitting still.

“She was given an exercise sheet when she left hospital but hasn't done any of them”

OP, she absolutely must - it’s vital! I was told to do them three times a day, which I did. To start with, your knee doesn’t bend that much, but it very quickly gets better. If your DM doesn’t do any exercises, her knee won’t improve and they might as well not have bothered. And it can take a long time to get used to your new knee, but you do have to use it. After a few weeks, they’ll assess her and see if she’s ready for group physio - she needs to be doing the exercises at home to get ready for that.

She keeps saying moving makes her feel funny. I can't seem to get her to understand that although the exercises will hurt they are really important. Everyone is getting a bit fed up of waiting on her hand and foot too, so everything is getting quite tense.

It doesn’t exactly hurt to do the exercises, it just feels strange because you need to get used to your new knee. She should be able to start walking up the stairs, too - she’ll have to hang on to the banister, but it should be possible. Someone needs to get hold of her exercise sheet and get her moving and doing them. Didn’t they make her walk when she was in hospital? Normally they get you up and make you walk up and down the corridor, and even up and down the stairs. How did your DM manage when they took out the staples? Surely she had to move for that?

Is she icing it every couple of hours. That’s essential along with physio. Can you pay for physio for her?

Icing and exercises are both vital. Does she have any physio contact/support from the hospital/GP? If not private as you've said.

She must exercise and move. It is vital or it will all seize up and all the trouble and pain will have been pointless. Sometimes a sheet of paper with exercise instructions is not enough and encouragement from a physio is needed.

She has to do the exercises and they will feel a mixture of impossible and deeply unpleasant.

It doesn't need a physio to go through her exercise sheet with her every day, you could get a carer to do it with her daily.

Is she on other medication? Could be worth reviewing these just to check they aren't making her worse.

its a massive operation for someone in their late 80s - it doesn't need for something to be medically wrong for things to not be perfect (there's the physiological stress response to surgery, sometimes a degree of post-op cognitive dysfunction that can really dent an elderly brain for a while) and it's not unheard of for people to need more help for quite a while post-op than they did before. Pain killers (+/- constipation) can cause lethargy etc. If there's no sign of anything medical going on (bloods ok?...hasn't had a heart attack?...hasn't had a fall she's just not told anyone about but has dented confidence) and she's on a sensible combo of drugs (sometimes BP meds need a tweak, or iron needs replacing) then time and doing the physio might sort things out. Some people do end up finding thought that although the procedure is great at reducing pain and improving quality of life in that respect, it actually comes with some real long term reductions in QoL.

She had a physio appointment but cancelled it because she didn't feel up to it. The doctor came to see her to check the wound and told her she must rest,which she seems to have taken to heart. I think what's so odd, ok, I will be honest, frustrating, is that she can walk really quite well when she's off to the loo, but then doesn't seem to do anything more. Maybe I'm expecting too much too soon. It's just that everything I read emphasises doing the exercises.

Thank you for your reply. I'm wondering about after effects unrelated to her actual knee. It's almost like she's been shocked by the whole thing. I have noticed she's having more trouble finding the right word than she did before. And some of the things she's doing are peculiar. She was rocking backwards and forwards the other day. I think I will give it a few more weeks and see if those things ease up.

Hello,
My DF has just had the same op, is the same age as your mum. He is one week post op now, came home on Wednesday having turned down the chance of a place in rehab because he didn’t like the food and was missing home (I have no words..). DM is very frail now and cannot look after him, but despite that he also turned down the offer of home care. The hospital really have tried to do their best. It says in his notes he was no compliant and had had a fall the first day back from the op. Again, no words. So he’s now at home and sat in a chair all day asleep, won’t do his exercises and won’t be told anything and complains it hurts. He also had the post op confusion which apparently is common but if the person is elderly, and has already had cognitive issues and the surgery is orthopaedic in nature there is a very high chance of it becoming chronic in nature so keep tabs on that. Another story, my MIL also had knee done two years ago, did the stairs in hosp, came home, got upstairs to bed and refused to come down for a few weeks then refused to have any thing to do with the physios as ‘didn’t like how the talked to me’
Unsurprisingly the knee has seized and she can hardly walk now. It’s frustrating and I can’t help but think there should be a more rigorous pre op assessment process to try and weed out elderly people unlikely to recover, especially when you consider the amount of younger people waiting for these operations whose ability to work and look after their kids is impacted.

If she doesn't do the exercises she will not get much benefit from the op. Both my parents had this done, one did the exercises consistently and it was like a new knee, the other didn't because they were painful and that knee never functioned properly.

My DF fell on his knee this morning and is back in hospital waiting for repair surgery. He really isn’t doing very well!

Hopefully they will make him have some rehab now.
I agree with you about only giving operations to people who will do the exercises afterwards. I have an arthritic knee that I know will need to be replaced in the future but at the moment exercises are keeping the pain at bay.

only giving operations to people who will do the exercises afterwards.

the problem with this is that all the patients say they'll do the exercises afterwards because they know they have to say that to get the operation. You can often spot who's likely to actually do them, but you can't just tell patients 'we think you're lying so you're not having an operation'.

I’d get her back to the doctor. And tell him/her everything, that she’s been rocking and doesnt seem herself. Won’t do exercises.

Get permission on the gp form for them to contact you going forward. she has to approve that though.

I’d then arrange the physio myself for her wirh my phone number if possible and be there. And daily while she does the exercises.

The rocking thing is worrying.
can you get her out and about? She sounds depressed or in pain.

do you have a power of attorney? Has she also done her will? Best to do them now while she is still with-it.

if she does not do the exercises, it is a waste of time having them done. sorry, I do not mean to be brutal, but this was drummed into my late dad when he had his done. sometimes they moan about them, but it is imperative to make sure they do the exercises. its ok going to bed to sofa or loo, but it does mean she is not getting mobile again; even if it is a short walk about the lounge or kitchen, it would be better. if she gets dressed, she will be feeling better.

I had mine done in 2011. The main exercise I did was to regain Range of Motion. Sit in a reasonably high chair, with both feet flat on the ground. Slide the foot of the operated leg back as far as you can. Do this frequently. To start with, I couldn't move it very far, but eventually I regained full movement.