This post details what my spouse and I did to modify my diet after I had knee replacement surgery. Our focus was on supporting muscle and bone healing after the surgery, using food to supplement medicine and exercise. Frankly, during all of my meetings with medical professionals, diet to support healing was never discussed. The only related thing told to us, was that I would do better if I lost weight (like that was going to happen with minimal post surgery movement). But both my spouse and I knew, there were things that we could do with my diet to support healing, and to prevent a number of very specific complications (constipation, swelling, clots, etc.). This is a post about what changes we made to my diet to support recovery from knee replacement surgery.
Remember: I am not a doctor, nutritionist, nor dietition. I am just a cook and am looking into these issues as a cook who wants to feed her family and friends healthy, biologically supportive food.
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Knee Replacement Happens…Often
I have lived decades with arthritic knees that over time have slowly prevented me from exercising or even moving the way I want. Before surgery I could not attend events where standing for more than 10 minutes was required for it hurt too much, I always had to be moving. Walking on hard surfaces, like asphalt or concrete, have been super painful, and I had lost completely the ability to squat, get onto my knees kneeling, or easily get up from sitting on the floor. Finally, after numerous surgeries on various parts of my knees, topicals (cold, heat, salves, CBD creams), and shots in both knees, I turned to a total knee replacement on my worst leg. Since I was 43 years of age I was told I needed a knee replacement, and at 65 years I decided all other options were used up, and it was indeed time.
History + Stats
The development of the total knee arthroplasty began in Germany (1860) when Surgeon Themistocles Gluck, surgically implanted the first primitive ivory hinge joints (1). But, the American Academy of Orthopedic Surgeons (AAOS) writes that the first human knee replacement surgery, as we currently understand it, occurred in 1968.
The MayoClinic writes that 800K knee replacements occur each year in the USA; defined as surgery (that) removes damaged or diseased parts of the knee joint and replaces them with metal or plastic parts. Also called knee arthroplasty. My knee has titanium metal caps on both bones with a plastic joint between the two metal parts to keep them smoothly operating.
The AAOS gives details on the effectiveness of this type of surgery:
1) 90% of people with a knee replacement experience significant reduction in pain.
2) Over 90% of replaced knees are still functioning after 15 years.
3) A 2019 research report states 82 percent are still functioning after 25 years. Amazing results!
My Knee Surgery
I slept well the night before as I tend to be very “Buddhist” when it comes to anticipating potentially scary and hurtful things. I was going to head to the hospital having consumed a minimal amount of liquid for over 14 hours, so was slightly dehydrated going into this procedure. However, I was required to drink a special, carb-type liquid at 6 am on the day of surgery.
Once we arrived, it was the typical preparation for surgery. Gave my spouse a very large hug and kiss, followed the nurse to undress, bagged up my clothes and shoes, and got into their very light and very open gown. Then, after a long wait in a very cold room, the activity heated up just as the person currently in the operating room before me was finishing.
The nurse installed an IV in my arm and a drip was connected, then she started shaving from mid-thigh, over and under the knee, to mid calf/shin. She doused the whole area with an iodine antiseptic. Covered the area and left me for a while. Then one of the surgeons came by and the last pre-op memory I have is the spinal procedure she did to provide a pain block to my leg. Actually that was not as bad as I had anticipated, the idea of a needle inserted into the spine just sounds awful.
Some anesthesia must have been applied at this point for I do not remember the ride into the operating room.
When I recovered, from the successful surgery, I was perscribed a number of pills that my spouse had to pick up from the pharmacy before I could go home. I took all of them for two weeks, then started to wean off all but the pain and blood thinners. After a month I was off the baby aspirin, and after 8 weeks was off the norco and ibuprofen; however I still have some of these pain pills on hand to help ease any night pain, so sleep is not disrupted.
- The list included baby aspirin, Tylenol, Ibuprofen, and Oxycontin, along with an anti-dizziness/nausea pill, stool softener, and anti-constipation pill.
- These medications were to help with knee and leg swelling, medication induced dizziness, blood clots, pain causing sleep disturbance, constipation, and ongoing daily pain.
What got me through all of this and allowed me to cut back quickly on the dizziness and constipation meds was a combination of a good diet, plenty of liquid, and consistent exercise.
What Can Diet Offer
Drink to Clear Chemicals
When you come home, your body is probably dehydrated from not having fluids for quite a while, although you probably did have fluids via the IV. But remember that your body is now full of chemicals that were inserted or applied to your body. You will have had anti-infection liquids applied to your surgical and procedure areas, perhaps some medication, then anesthesia, followed by anti-nausea or dizziness pills, and finally blood thinners and pain medications, including narcotics. Whatever it may be, you are coming home loaded with chemicals you did not have going into the procedure.
The best way to get rid of some of those chemicals is to drink water and pee them out. In some cases you may need electrolytes, so follow the medical instructions supplied by your doctor as we are all different (1). I drank mainly hot or iced tea (both black and green), water, with an occasional plant milk with morning cereal.
I did not drink any alcohol while still on the narcotic because alcohol is contraindicated for the narcotic pain medication. Water will not flush narcotic drugs from my body (2), all I could do was to wean off the dose per medical instructions, then wait up to 90 days for for the chemicals to be fully out of my system.
Eat Food When Taking Medication
The medication schedule was crazy and a major reason why I would never choose to recover at home without help. The initial schedule (lasting around 4 weeks) were seven pills disbursed at different times daily: 8 am, 12noon, 4pm, 8pm, 10pm, 2am, and 4am. Thankfully, my spouse took over scheduling the medication, and made sure I ate something before the meds (3) and drank plenty of water with the meds.
What I ate with the pills were saltines, dried toast, or graham crackers. All starchy things that were easy to chew, and easy to swallow with a little water. This was done with the twin goals to prevent nausea or an upset stomach. All I had to do initially was sleep, do exercise, ice the knee and take pills. For my spouse it meant nearly two weeks of not getting 8 hours of uninterrupted sleep a night. Eventually we removed pills and changed up schedules so we could both get a good nights sleep, but it was a rough two weeks.
A bit later my body started reacting negatively to the ibuprofen and we had to mix up the pills and I had to eat more at pill time, sit up for an hour after taking them, and eat neutral foods for a bit. Eventually the stomach discomfort calmed down and the recovery continued.
Eat to Promote Blood Health + Energy
Some doctors want people to consider eating food high in iron (or cooking with cast-iron pans) to support building up spent blood stores. However, with modern knee replacement procedures there are minimal blood losses these days and this may not be as important as in previous decades. But remember everyone is different and we each have our own knee conditions.
But even if not necessarily needed by me, I still ate plenty of lentils, garbanzo beans, spinach and other dark leafy greens. While initially not moving much, it took concentration and energy to do exercises, and to deal with pain.
Promote Bone + Tissue Healing
Protein is important to help your knee replacement heal. PeerWell wrote: When it comes to wound healing and the promotion of recovery, the body needs a surplus of protein. Amino acids are the fundamental make-up of protein and serve a wide array of bodily and structural functions. Proteins give us antibodies to keep our immune system in check and to regenerate tissue and heal wounds. Structurally, our body uses protein as building blocks for muscle, collagen, elastin, and keratin. Collagen is the main component in many tissues such as skin, tendon, muscle, ligaments, cartilage, blood vessels, bone and teeth. So we made sure we upped our protein by consuming protein with every meal. This included adding eggs, lentils, garbanzo beans, cottage cheese, lean chicken, etc.
Calcium is another element that really helps with bone health, blood clot prevention, and nerve signaling (4). So we consumed beans and green veggies, along with calcium enhanced plant milk and cheese.
Vitamin C, which helps our body repair damaged tissues, keeps bones strong, and helps in the absorption of iron. Specifically, Dr. Paul Jacobs wrote: This vitamin is essential for the formation of collagen which is present in the ligaments and tendons that connect the bones and muscles. So, I drank tea with lemon each day, consumed shakes with pineapple or strawberry, and ate cantaloupes and potatoes. This was critical since one of the issues longer term is the growth of scar tissue and the limiting nature of that scar tissue for normal knee cap movement. So I consumed Vitamin C foods and my spouse would help massage the area to keep my knee cap moving properly side-to-side and up-and-down.
Zinc (along with VitC + protein) can, according to OrthoGate, substantially speed up the recovery after an orthopedic surgery. Deficiency of the same is associated with poor bone health. Zinc has been shown to aid wound healing, unite bone fractures and prevent osteoporosis due to its role in collagen synthesis. This mineral is mostly found in animal foods. Oysters, meat, dark poultry etc are considered to be the best non-vegetarian sources of protein. On the other hand, fortified cereals, dairy, beans, nuts etc. also provide moderate amount of zinc.
Vitamin D also promotes bone health and while I do take a VitD capsule every day, we also decided that once I could walk (with a walker) to eat lunch outside each day so I would get fresh air and sunshine. HealthLine reports it has been concluded that adequate vitamin D levels decreased complications as well as joint infections post knee surgery (5).
Prevent Constipation
Fiber is the critical food component to preventing constipation. I have to admit that without the stool softener and anti-constipation meds I would have been in trouble for a week or so. As it was, it took me several days to have that first bowel movement post surgery, and from that point on, so long as I was taking narcotics I had to take medication every few days to assist.
Fiber food included added psyllium husks in some meals, raspberry, apples, lentils, sweet potato, popcorn, etc. But mainly, I ate lots of savory or sweet oatmeal dishes, which is something I love. Again, I also consumed lots of liquids and kept up with physical movement like walking.
Prevent or Limit Inflammation
I had an at-home physical therapist, Karen, for the first three weeks and she visited twice a week. Her focus was on three main things: maintaining and increasing my knee bending, straightening my leg, and reducing swelling. I ate foods high in antioxidants to help prevent ongoing inflammation.
So I ate:
- Mainly green-leafed, yellow and orange colored veggie-focused meals
- Occasionally some chicken (breast)
- Cooked lentils, but also some raw nuts
- Fresh, raw fruits like cantaloupes, apples, grapes, blueberries, strawberries, raspberries, etc.
Omega 3 fatty acids are also known for their anti-inflammatory properties and having a role in bone formation. DHA + EPA found in fatty acids have shown to aid bone formation and prevent bone loss. They also boast of anti-inflammatory properties that protect against the disease causing agents of the bone.
- Cold water, fatty fish like salmon or tuna
- Tofu, walnuts, canola and flax seeds
Food to Limit or Avoid
Eating with Medication
Avoid eating cow milk-based or highly acidic foods with some medication (6).
Limit Vitamin K Consumption
Blood clots and deep vein thrombosis is possible with joint replacement. As part of the regimen, I had to consume two 81mg aspirin tablets per day for about a month. While doing this, HealthLine recommended limiting VitK, as that vitamin promotes clotting. So we limited the following foods during the weeks I was on the aspirin:
- Broccoli, cauliflower, kale, cabbage, onions, and Brussels sprouts
- Liver
- Green beans, soy beans, etc.
This worked for me as I do not like some of the items listed anyway and would not think to eat them.
Alcohol + Added Sugar + Processed Foods
HomeCareAssistance (a website I pulled these graphics from) wrote: … alcohol slows down the rate of blood clotting and makes your blood thinner. This can cause your incision to take longer to heal and you will also have an increased risk of bleeding. But they also noted that alcohol can impair the immune system, putting you at a higher risk for infection. Following surgery, you will heal faster when there is less swelling. Alcohol causes blood vessels to swell. Needless to say, I did not drink for several months.
Ending
As I complete this post in November, I am at week 12 into my healing, and am fully aware that it will take up to a year (or so) to be back to normal.
I have done well, beating my home-visiting PT’s expectation during the initial weeks, which I attribute to my spouse and the careful attention given to my care and feeding. Yes, the post surgery has been painful at times, but after decades of dealing with arthritic knee pain, this is moderate and easy to deal with knowing (hopefully) this is a just temporary.
Clearly, from talking with others, everyone goes through this tough procedure individually and some find it easier while others find it harder. So I cannot offer too many specifics since they might not be right for you. But there are some clear things I can say to help others contemplating this surgery.
- While I did not find the procedure itself painful, the recovery (exercise + regaining mobility) is painful and really important.
- It will take up to a year (plus) to fully heal so be patient with yourself. Right now I do not feel pain most of the time, it is limited to: getting up from sitting >30 minutes, standing still >10 minutes, going down hill, and getting out of the car. Exercise, of course, still hurts but not as much now.
- Progress is not linear, so anticipate good and bad days. Every once and a while I still have painful nights that will keep me up.
- Exercise hurts but is important to do every day, 7 days a week.
- Follow directions and do not move too fast, but keep pushing yourself forward.
- Keep on the pain pill schedule to manage pain, do not stop the meds too early or abruptly.
- Focus on a healthy variety of food and drink while recovering.
- No matter what, please stay cautious when walking, doing stairs, going to the bathroom, to prevent falling. You and your doctors do not want you to fall!!
- Think about your goals when exercise times get rough.
My goals are to be able to walk 3 miles, stand still for 30 minutes without pain, and drive our future RV to wondrous places where I can hike with my spouse and dogs.
— Patty
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