Total knee replacement (TKA) is typically required when the knee joint has severe, chronic deterioration, often due to advanced osteoarthritis. While surgery offers a long-term solution, the waiting period can be challenging as pain and limited mobility impact daily life. These interim months require a proactive strategy to manage discomfort, maintain physical function, and prepare the body for a smoother post-operative recovery. Targeted medical treatments, physical activity, and environmental adjustments can significantly improve quality of life while awaiting the procedure.
Medical Interventions for Acute Relief
Managing pain and inflammation often involves pharmaceutical treatments. Over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, reduce inflammation and provide temporary pain relief. Acetaminophen can also be used for pain control, though it does not address the underlying inflammation. Consult a physician before long-term use and adhere strictly to recommended dosages due to potential side effects on the stomach, liver, and kidneys.
Stronger prescription NSAIDs may be utilized when OTC options are insufficient, but they carry similar systemic risks. For localized, acute relief, intra-articular injections directly into the knee joint are a common strategy. Corticosteroid injections deliver a powerful anti-inflammatory agent that can provide pain relief lasting from a few weeks to several months.
The timing of these injections is crucial when TKA is scheduled. Professional societies recommend an interval of at least three months between the injection and the planned surgery. This waiting period is advised because an injection given too close to the operation may increase the risk of a periprosthetic joint infection. Viscosupplementation, which involves injecting hyaluronic acid to supplement the joint’s natural lubricating fluid, is another option that can provide pain relief lasting six months or longer.
Low-Impact Exercise and Physical Therapy
Engaging in active physical management, often called “pre-habilitation,” is an effective way to prepare for TKA and manage pain. The goal is to maintain or improve the strength of the muscles surrounding the knee and preserve the existing range of motion. Patients who enter surgery with stronger muscles and better flexibility often experience a faster and less complicated recovery.
Physical therapy should focus on low-impact activities that minimize stress on the damaged joint surface. Stationary cycling and aquatic therapy, such as swimming, are excellent choices because the buoyancy of the water or the non-weight-bearing nature of the bike reduces joint loading. Specific isometric exercises, like quadriceps sets, are valuable because they strengthen the thigh muscle without requiring the knee to move.
A physical therapist can design a customized program that includes exercises such as heel slides to maintain knee flexion and straight leg raises to build quadriceps and hip flexor strength. These movements counteract the muscle weakness and joint stiffness that develop when avoiding painful movement. It is important to distinguish between the dull ache of muscle fatigue and sharp, new joint pain, and to immediately stop any activity that causes the latter.
Adjusting Body Mechanics and Environment
Adjustments to body mechanics and the immediate environment can significantly reduce the daily mechanical stress placed on the knee joint. Weight management is a powerful tool, as research shows that every pound of body weight lost results in an approximate four-pound reduction in the load exerted on the knee joint during each step. Even modest weight loss can decrease cumulative pressure on the joint throughout the day.
Assistive devices can offload the painful joint, providing immediate relief and improving walking stability. A cane should be held in the hand opposite the painful knee to effectively transfer weight and reduce the force across the joint during the gait cycle. Proper fitting is essential, ensuring the cane height allows for a slight bend in the elbow.
Modifying the home environment is useful for reducing strain and preparing for the limited mobility following surgery. Removing tripping hazards, such as throw rugs and electrical cords, is an effective safety measure. Installing grab bars in the bathroom and using a raised toilet seat or shower chair can significantly reduce the stress on the knees when standing up or sitting down.