From Bone-On-Bone Pain To Confident Steps: How Preparation Transforms Knee Replacement Recovery

How Do You Prepare And Assist Patients With Knee Replacement Surgery?

Bone-on-bone pain can make every step feel like a decision. We take you behind the scenes of knee replacement to show how preparation, smart pain control, and a safer home setup turn fear into measurable progress. Dr. Noelle DiGioia Guthrie explains when surgery makes sense for end-stage osteoarthritis, how the implant caps worn bone to restore smooth motion, and the differences between cemented and cementless components. Physician Assistant Tiffany Belculfine walks through real timelines—clearances, insurance approvals, smoking cessation, medication adjustments—and why a reliable coach at appointments changes everything.

We dig into prehab as a performance multiplier: rebuilding range of motion, waking up the quadriceps, and practicing simple routines that become second nature after surgery. You’ll hear how early mobility works in the hospital, from spinal anesthesia and sensory nerve blocks that reduce pain while preserving strength, to continuous passive motion devices and day-one PT. We balance internet horror stories with evidence-based pain strategies, setting realistic expectations without sugarcoating the work.

Finally, we turn recovery into a home game: clearing clutter for a walker, planning bathroom access, staging a main-floor sleep space, and using aids like elevated toilet seats and shower chairs. We even talk pets, pickups, and the surprise hazards people forget to plan for. If you want a clear, step-by-step view of what to expect—and how to stack the odds in your favor—this conversation gives you a practical blueprint to move from hesitation to healing.

If this guide helped, follow the show, share it with someone weighing surgery, and leave a quick review so more people can find reliable joint care advice.

To learn more about The Bone and Joint Center at Magee-Womens Hospital visit:  https://www.pghbjc.com
Dr. Noelle DiGioia Guthrie
300 Halket St. 
Pittsburgh, PA, 15213 
412-683-7272  

To learn more about The Wellness Center for Bone and Joint Health visit:  https://www.boneandjointhealth.org
Tiffany Belculfine
300 Halket St., Suite 1601 
Pittsburgh, PA, 15213 
412-641-8594  

Transcript

SPEAKER_00 0:04

Welcome to the Joint Effort Podcast, where mobility meets reality and your future self says thank you. Your host, Dr. Noel DeJoy Guthrie of the Ponent Joint Center of the Game Women's House, and Tiffany Elkafine, position assistant at the Wellness Center of the Ponent Joint House, serving the dogs across Western. If you're gonna put it on your side, you're in the right place. Every day, help break it down and build you back up with a personalized plan for real life. Now, let's get you moving. Here are Dr. Noelle and Tiffany.

SPEAKER_03 0:54

Today we're breaking down what really happens before and after knee replacement surgery and how the right prep makes all the difference. Welcome everyone. I'm Julie Schwenzer, co-host and producer with Dr. Noelle DeJoy Guthrie of the Bone and Joint Center at McGee Women's Hospital, and Tiffany Belkafine, physician assistant at the Wellness Center for Bone and Joint Health. Hi, ladies. Thank you for joining us. Good morning. Hi, good morning. So, Dr. Noel, could we start with you describing knee surgery in general, the replacement and why it's needed? Sure, of course.

How The Implant Works

SPEAKER_02 1:28

And um, you know, for people who listen, we kind of talked about osteoarthritis a lot in previous episodes. So the reason why we do a total knee replacement is if someone who has um we call it end stage arthritis, and a lot of patients know this as bone-on-bone arthritis, where all of your cartilage um within your knee has basically just been um rubbed off the end of your femur and the top of your tibia. So your bones are essentially rubbing every time you take a step or walk. So, you know, we talked a lot about conservative treatment, meaning try to modulate your pain, but then at some point, you know, your pain becomes so bad that it is refractory to conservative management. And that's when we start talking about surgical options. Um and total knee replacement, total knee arthroplasty, the same, same thing. Um, that's kind of our tried and true method of curing arthritis. So a total knee replacement is surgery. Um, it's elective, obviously. Um so patients and doctors work together to find out when is the best time. Um surgery, basically, we um the best way I describe it to patients is actually kind of like capping. If you think about how you cap a tooth, it's kind of similar to that. So basically we shave off um the cartilage, or I'm sorry, shave off some of the bone where your arthritis is at the end of your femur on the top of your tibia, and then usually the underside of your patella, and we cap that femur with a metal component. Same thing with the tibia, we cap the tibia with a tibial component, which is also metal. Um, and then there's a plastic piece that goes in between those that kind of act as your new cartilage. Um, and then on the underside of your patella, we shave the arthritis off the underside and then replace that with a plastic piece as well. Um, usually all those pieces, besides the plastic um insert, um, are affixed to your bone with cement that we use, um, kind of like a grout, if you think about it that way. Um, there are options to use not to not use cement. They're called um, you know, cementless implants, and they actually have a porous substance on the underside of the metal components that actually grow into your bone. So they become part of your body. Um, so those are that's just the general overview of total knee replacement of the the technical aspect of it.

Preparing Patients And Timelines

SPEAKER_03 3:39

Thank you so much, Dr. Noel. And Tiffany, how do you prepare and assist patients with this big surgery?

SPEAKER_01 3:46

So I think one thing that's always important is sometimes people have the idea that when they go to meet the surgeon, they're going to have the surgery that day. And that's not the case. We have to go through a lot of information with patients to let them know what the process is going to look like. And, you know, the provider offices, the doctors have to talk with their insurance companies and get approval. And sometimes people have to do things like stop smoking beforehand, or they might need to lose some weight so that they are at their best health in order to recover and do well and accept the knee replacement surgery. So, and sometimes people are on medications that they have to stop taking before they have surgery. So it's a very long process. It's not something that's going to happen as you have an appointment on Tuesday and you get surgery on Wednesday. Very rarely does that happen. Um, hardly ever, actually. Um, because people need a, you know, they need approval from their PCP that says yes, they're fit to have surgery. They need to make sure they have people to drive them because they can't drive afterwards. You know, they have to get physical therapy set up. There's a lot of ins and outs of the process that people have to go through.

SPEAKER_03 4:54

Could they still do a patch or something if they're trying to quit smoking? I'm just curious now because that's a that's a big one.

Smoking, Meds, And Clearances

SPEAKER_01 5:00

Yes. So there are lots of different options that people can pursue for smoking. It really depends on the length of time that they have before their surgery, but we want to make sure that smoking is not a factor during the time of their surgery because that could really impact their healing process and cause much complication for them.

SPEAKER_03 5:18

And now you both have spoken about how important it is to be active, you know, before and after any procedure. And hopefully you can avoid that procedure. But what are some of the prehab exercises or mobility work that you suggest that patients do?

Prehab To Boost Recovery

SPEAKER_02 5:34

You can tip that. Yeah, sure. No, that's a good question because particularly with knees, so knees can get really stiff pre-operatively with arthritis. Just arthritis is an inflammatory process. It makes your knee hurt. You don't want to move it. So patients do become very stiff, and stiff meaning they can't flex it back as much as they normally could before. Um, and a big thing with knees post-op is definitely range of motion, because even think about after after you have surgery, you're very swollen. And the more swell the swollen you are, the less you're gonna want to move it, the more stiff you become. So we a big thing when we talk about knee replacements is that prehab, we call it, which is PT before surgery, dictates your post-op rehab. Um, so we give patients a booklet with pretty simple exercises, you know, exercises that increase your range of motion, that help um activate your quadriceps and stretch your hamstrings. Um, we give that to patients. They can do on their own. We recommend doing it as many times as you can a day, you know, one or two times a day. Um, we also sometimes if patients are pretty stiff, I'll send them to PT before, just so they can get their range of motion better, they can get their quadriceps strong, and then that helps them put them in a good position after surgery to work on their range of motion. And um, you know, we do a lot of things post op too to help with your range of motion. There's a motion machine, it's called a passive, continuous passive motion machine that actually just moves your knee slowly after surgery. So you're not doing it, but someone's doing it for you. So it helps, you know, the more your knee moves, the better it feels, and your range of motion feels better. Um, you know, obviously we start PT from, you know, you wake up from surgery, your spinal's wearing off. We have you go PT to like an hour after, maybe an hour after your spinal wears off and whatnot. But we have you doing steps, you're you're able to bear weight. Um, and and obviously I'm talking about a surgery, a first surgery that, you know, is routine, not any types of revision surgery, which means a redo of the surgery. Um, but you know, you're doing stairs, you're doing the bike, you're doing as much as you can. I know a lot of patients say, oh my gosh, I'm gonna be doing, you know, exercises a few hours after my surgery. I say, Yeah, we're we want you to get you get you back to where you want to be as soon as possible. So um, definitely a good question. And that's a big topic, particularly for knees.

Early Post-Op Motion And PT

SPEAKER_03 7:48

And how do patients describe how they feel right after they're getting out of surgery? I mean, we know there's a lot of pain, um, but it's is it at like at a different level where it's just, you know, something so new to people? And how do they describe it to you and how do you help them through that?

Pain Control Myths And Methods

SPEAKER_02 8:04

Yeah, for sure. I mean, you know, on all the social media platforms these days, Facebook, Instagram, I think there's a lot of platforms talking about patients who've had certain experiences, terrible experiences, talking about how bad the pain is, other people talking about their greed experiences. So kind of runs the gamut. And I always, I mean, I think it's good for patients to be within a community like that, but also everybody's different. Every experience is different. So, you know, I don't, I try to uh, you know, tell people you can't really uh your experience is not going to be like someone else's experience one way or another. So um we do a lot of things pre-operatively to help with pain. So I actually do a procedure called Ayavera. It's basically numbs the sensory nerves in your knee, so it helps with post-op pain. We do it pre-operatively to help with post-op pain. Um, we use a spinal, like I mentioned, anesthesia, which is really nice because you don't have to have a tube down your throat. So patients wake up in the packet, they're pretty with it, you know, and their spinals. It does, it makes you numb. You basically all your both of your legs for a few hours, it helps with the pain. Our anesthesia team's office, we actually do blocks that help with your pain post-operatively that last for at least 12 plus hours after surgery. And there's sensory blocks, so you still can can walk and everything, but it helps numb your sensory nerves. Obviously, we use medicines to give you that. We use a really good anti-inflammatory post-op. So we kind of come, we have a lot of tools to come out your pain because I think that's the biggest factor with total knees that um people are afraid of and a big barrier to having surgery. Um, and then also that motion machine I talked about helps. So, like I said, multiple different ways to come out your pain and make your experience a better one.

SPEAKER_03 9:45

And is age really a key factor, or like you said, is it or you reference it, it really just depends on the person.

SPEAKER_02 9:53

I mean, it it definitely depends on the person. There's 95-year-olds who are healthy and active, and the biggest thing in their life is they have bad arthritis and they can't move. You know, so um, and then on the contrary, we have 50-year-olds who maybe aren't as healthy, have a lot of things that we need to work on before surgery. So I think age is just a number sometimes. I mean, there's obviously risks when you get older for having anesthesia and having surgery. Um, but you know, like Tiffany talked about, we really work with our, you know, primary care doctors, our specialists to make sure everything's safe. But, you know, and I talked about this before, I really don't think there's an age limit to having a knee or a hip replacement. I think it's as long as you're careful about it and you make sure that you're safe from a medical perspective, it's okay to proceed.

Age, Risk, And Eligibility

SPEAKER_03 10:40

And Tiffany, what indicators tell you a patient could be like mentally um strong enough? I don't know if that's the right, you know, words to use or physically prepared to move forward with the knee replacement.

Mindset, Support, And Coaching

SPEAKER_01 10:51

Yeah, that's a question that does come up a lot. I think that a lot of times people are so wrapped up in the worry, as Dr. Guthrie said, that, you know, they are so fearful of what's going to happen that they can't necessarily realize that it's intended to help them. I think that people definitely need to have a strong support system at home. They need to have friends and family that they can rely on to help them. It's important to have a surgeon who explains things properly to tell people exactly what to expect because yes, it's a surgery. There is going to be pain afterwards. But I think people think very different things about, you know, what that process looks like, especially if they've never had a procedure before. They don't know what it's like to wake up in an operating room setting or, you know, they don't know what it's like to not have use of their legs. They could panic, you know, they could really be very fearful of that when their legs are numb after the spinal anesthesia. So it's important to have that open line of communication, to have, you know, all of the staff members who are involved in the surgery from start to finish. So whether that is the nurses or the PAs or the nurse practitioners and then the physicians, and then also the people who schedule the surgery and who do the patient teaching. There's a lot of information that gets thrown at people. And I think unfortunately, the first time people hear all the information, it sort of becomes like Charlie Brown's teacher is the one talking to them, where they're kind of like, surgery, recovery. You know, they don't always get all the words around it. So once they're actually focused and they bring someone with them to help listen, then they get all those details that they missed. And it's really helpful to prepare people to have that sense of support.

SPEAKER_02 12:30

Yeah, we actually mandate that patients have a coach, um, which is a family member, you know, a friend, uh just a support person that comes to most of your office visits with you, particularly the pre-operative process, just because there is a lot of information we give. You know, they're the person who's going to be with you coming to surgery and with you after surgery. So I think that's a bit a very important part of our program.

Home Setup And Safety Gear

SPEAKER_01 12:52

And I think also it's helpful for people to think about the things that they take for granted. Um, you know, that they take for granted right now that yes, they're in pain and maybe they're stiff and sore, but they don't think about, oh, I have to rise from a chair and I have to walk to the kitchen and, you know, get my own lunch. Or, you know, they have to figure out how those things are going to impact them. So having that support is huge.

SPEAKER_03 13:13

And a last question for you both. You mentioned some of the, you know, pre-operative, um, I'm sorry, post-operative things that you're looking at with the coach. And like you said, you gotta think about like real life daily things that you need to get done. What about the home, the setup? What are you looking for for that patient to walk into, if they can, um, get back into you know their house? What should they be looking out for? What can they have prepared or have someone help prepare for them so that they're in uh as safe a situation as they can be?

unknown 13:46

Yeah.

SPEAKER_02 13:47

Yeah. So we we do ask those questions before surgery. We ask how many stairs you have at home, you know, how how far is your bedroom from your bathroom? Do you have a lot of stairs from your kitchen to your bedroom where you're gonna be? So we do try to optimize, you know, we say it's gonna be a little bit harder for you to get up in the middle of the night to go to the bathroom. So if you need to stay downstairs, maybe on your couch where bathroom's close, um, you know, and kind of eliminating things that you could run into, um, carpets that you could trip over. We always give patients walkers when they go home, no matter if they think they need it or not. I tell patients, use your walker for, you know, at least a week or so as you're getting used to your new knee, you know, or your new hip. Um, and then, you know, there's certain things we can give patients, you know, equipment-wise, an elevated toilet seat, um, something to have them help them in the shower that we always work with patients if they they think they need that. But definitely questions that we talk about before surgery so that they can be prepared when they get home for sure. Because there's little things like Tiffany said, you don't think about, you know, that you kind of take for granted. Um, but we we talk about that. We make sure, you know, it's a safe environment. Um, we make sure upstairs in our physical therapy gym that we have on our orthopedic floor, they can do stairs. We have a simulation car, getting in and out of car that we help them do before they leave the hospital. So all things that we, you know, work with them to maximize and make sure every safe living environment.

Pets, Clutter, And Real-Life Hurdles

SPEAKER_01 15:08

And another one that comes up a lot, as she already sort of mentioned, is clutter. Um, we want to make sure that people have clear paths for things so that navigating something when they're on their own two feet is very different than navigating with a larger walker that's going to need more space to clear around, you know, turns and corners and doorways. So we always want to make sure that people have things completely out of the way so that they're not adding a potential fall as a complication of their surgery, too.

SPEAKER_03 15:35

So a patient that may have a pickup truck with a golden retriever and is like a hoarder, that's probably one of the most challenging setups.

SPEAKER_01 15:44

Yeah, because you can't control where that dog's gonna run. I know.

SPEAKER_03 15:47

Wants to jump on jump on their parent and give them a big hug when they get home.

SPEAKER_02 15:51

Yeah, and I I do that's walker's good for that because it kind of scares off animals and little kids or just makes them think about coming closer to someone. So it gives them a force feel and protection. Yeah.

SPEAKER_03 16:05

Okay, well, you know, thank you both. I'm gonna use a term walking us through all of this. Thank you so much. We always appreciate your insights. Thanks, Julie.

SPEAKER_02 16:14

Thank you.

Appointment Info & Sign-Off

SPEAKER_00 16:19

That's today's dose of strength, balance, and better movement from the Joint Effort Podcast. Ready for care that fits your life and gets you moving? To schedule an appointment with Dr. Noel for your surgical and injection needs, call 412-683-7272, or visit PGHPJC.com. Or if you are looking for lifestyle changes that are not surgical, contact Tiffany Belcovine. Call 412-641-8594, or visit bone at jointhelp.org. Healthy bones and happy joints make every day better. Until next time, keep moving, stay steady, and take care of yourself.