I hope you have enjoyed our blog posts on how to best recover from your Total Knee Arthroplasty/Replacement. We have talked about sleep, swelling (2 parts) and hydration. We are going next with a HUGE topic, nutrition. What can you eat to help to optimize your healing?
Let's first look take a broad view of nutrition. Now I am not going to tell you to eat this food or that food. Some people are on special diets, i.e. vegan (no animal products), carnivore (only animal products), omnivore (eats plants and animals)... There is not one diet that is better than another, eat what seems to help you feel your best. However, there is one concept that I want to hit home here. What are your tissues made of? That is right, what is your skin made from, your toes, your bones, your muscles, your brain... It is an interesting question. Someone will say protein or fat. Okay what is that made from? Amino acids, triglycerides. Okay what is that made from? It seems that I am going smaller and smaller, more reductionist. In fact, I am trying to do the opposite. All of the above tissues are made from one thing! One thing! What is that one thing, you might ask?
THE FOOD THAT YOU EAT.
Everything in your body is made from the food that you eat. With this one concept in mind, do you want your TKA healing to be helped by potato chips, crackers and pop? Or would you rather have your TKA healing be helped by vegetables, fruit and meat/fish/eggs?
I will never forget the encounter I had with a mid 40's man while working on 4W (4West = 4Best), when it was KGH's main hip and knee surgical floor. The client was complaining about the terrible hospital food. He said something along the line of, "I cannot wait to get picked up by my wife. We will stop on the way home to get some good food, like McDonalds". I looked at him and said "really, which part of your knee repalcement is going to be made of the quarter pounder and which part is going to be the fries. Your body is made from the food that you eat". He shied away and said "you are probably right". Any type of fast food, even though you are likely to crave it during your recovery is probably not going to be the best to rebuild your tissues.
With that being said, let's look at our body's and what the structures in our body are made from. Ligaments, muscles, tendons, skin and bone are all primarily made up from one macronutrient. There are three main macronutrients; carbohydrates, fat and protein. Everything in the list, above, is primarily is made up from PROTEIN. Protein is the building block of life. Skin and bone are mainly made up of the same type of collagen, a certain type of protein. The main difference is that bone has a bunch of different minerals, i.e. calcium, magnesium mixed into the collagenmatrix to make it hard/rigid.
Protein is the main building block of recovery from an injury. Surgery is an injury, the broken bones, cutting of the skin, snipping of tendons, stitiching of the skin, tendon, muscle and ligaments back together. The body does not make the judgement of what is happening is either good or bad. The body knows that it has to heal itself. Our brains and our thought processes make that judgement of the injury, i.e. surgery, if it is good or bad.
Let's talk about about how protein intake/eating affects the body. When we are young, in our teens to 30s, if you eat a meal with about 20g of protein in it, 2 events take place. 1) your body turns on the muscle protein synthesis, i.e. you start to build muscle and 2) your body turns off the break down of muslce in the body, preserves your muscle mass. As we age, we become more resistant to the first. It becomes harder to build muscle in the body. As we get older, into our 50s and 60s and beyond, you need much more protein to turn on the switch for muscle synthesis. That means eating between 30-50g of protein IN ONE MEAL! That is a lot of protein, i.e. 2-3 quarter pound beef patties or ~4.5-7.5 ounces of steak or 5-8 eggs in a meal. This can be difficult to do because protein makes you feel full and you do not want to eat. The good thing is if you increase your protein intake there is defintiely less room for junk food. The other thing that is very important, especially after surgery, is that eating protein also preserves your muscle mass. It stops the body breaking down muscle in the body to use the protein to heal the injury/surgery. This is the reason that your surgical knee stays warm for so long. The increased metabolic activity, i.e. the breaking down of dead tissue and the rebuilding of new tissue, is doing so much work that it creates extra heat at the site of injury. There is some evidence to suggest that icing slows down this healing process and can prolong the healing process. That means just because your TKA knee is warm, a month after surgery does NOT mean that you have to ice your TKA knee continuously (see previous blog posts on swelling 3a and 3b).
The RDA, recommended daily allowance, for protein is 0.8 g of protein/ kg of body weight. That is quite low. I have read some reasearch that suggests that protein requirements of the body increase by about 400% post joint replacement surgery. The researchers stated that 1.0 - 1.4 g of protein/ pound of body weight (yes I know I switched units) = 2.2 - 3.0 g of protein/ kg of body weight. I find that to be a bit too much for people to swallow (pun intended).
I recommend to my clients about 0.7-1.0 g of protein/ pound of body weight. If you weigh 200 lbs, that is between 140 - 200 g of protein per day! It is much more than people think. Consider 100g of chicken breast has about 31g of protein in it. That means that you would have to eat about 645g of chicken breast, per day, to reach 200 g of protein. That is about a 1.5 pounds of chicken breast = 3-5 chicken breasts/day!
Protein takes a long time to digest, probably somewhere in the range of 6-8 hours. One study looked at the eating habits of men and women post joint replacement surgery in Germany. They found that women tend to eat very little protein at breakfast, a little at lunch and the majority at supper. Men, on the other hand, at some a breakfast, more at lunch and the majority at supper. If you should be eating, for example, 120g of protein /day, you should ideally be eating 40 g of protein at breakfast, 40g of protein at lunch and 40 g of protein at suppertime, spread throughout the day. Spreading your protein throughout the day keeps a steady supply in your blood and for your body to use when you are sleeping. (You do remember that 90-95% of your healing takes place while you are sleeping, see blog post 2, sleeping)
What if you are vegetarian or vegan? How do you get that much protein in your diet? There are many plant based protein powders out now and you can have a couple of protien shakes/smoothies during the day. Different kinds of beans can have a lot of protein, for example garbonzo beans (chick peas) have about 19g of protein / 100g. It is definitely more challenging but but remember you are worth the effort to get that protein in your body to help you heal as fast as you can.
Here is a list of protein content in some foods. There are many more foods that can be eaten, this is NOT a comprehesive list of foods. How to Google for protein content? Simply type in "food name" protein content and Google will give you an idea of how much protein is in the food. There are also many apps on the market for your smartphone that can help you out. My favourite app, not an endorsement, is myfitnesspal. On that app, you can scan food labels/UPC's and it will give you the amount of protein in your food. But you have to weigh your food to get an accurate amount.
Chicken breast = 31g /100g
Tuna = 28g/100g
Top sirloin steak = 27g/100g
Chicken thigh = 24g/100g
Kidney beans = 24g/100g
Pork chop = 24g/100g
Pinto beans = 21g/100g
Salmon - 20g/100g
Garbonzo bean = 19g/100g
Greek yougurt = 10 g/100g
Baked beans = 6g/100g
Green beans = 1.8g/100g
Obviously if your doctor put you on a low protein diet for some reason, talk with them before increasing your protein intake. Ideally you would do this before surgery. Speaking of that, increasing your protein the week before surgery keeping it high post surgery can really help to decrease muscle loss/wasting from the surgery itself.
Next week, we will touch on the exercises to start with after surgery. If you have any comments or questions, please leave them below.
If you are getting ready to have a knee or a hip replacement, have a plan in place and call New Leaf Physiotherapy for your inhome/mobile physiotherapy needs. 250-826-7300 to talk with Lyndsey, a certified Rehabiliation Assistant, to help you book your assessment.
New Leaf Physiotherapy is a mobile physiotherapy service that sees clients in West Kelowna, Kelowna and Lake Country.
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