Rehabilitation after Knee Surgery

One of the most critical factors in achieving successful total knee replacement depends upon your diligence in physical rehabilitation. You must actively participate in the rehab process, working diligently on your own, as well as with the physical therapists, to achieve optimal results.

Your recovery program usually begins the day after surgery. The rehabilitation team will work together to provide the care and encouragement you need during the first few days after surgery.You may be given a device called an incentive spirometer that you inhale and exhale into. It measures your lung capacity and assists you in taking deep breaths. These exercises reduce the collection of fluid in the lungs after surgery, preventing the risk of pneumonia. Coughing is an effective tool for loosening any congestion that may build in the lungs following surgery.

The physical therapists will begin as early as 1-2 days after surgery. They will teach you simple exercises that can be performed in bed to strengthen the muscles in the knee and lower extremity. They will also guide you through safe technique to Moving up and down in bed, Going from lying to sitting, Going from sitting to standing, Going from standing to sitting, Going from sitting to lying. Whilst these are all simple movements it is important that they are done correctly following surgery.

Another important goal for early physical therapy is for you to learn to walk safely with an appropriate assistive device (usually a walker or crutches). Your surgeon will determine how much weight you can bear on your new knee, and the therapist will teach you the proper techniques for walking on level surfaces and stairs with the assistive device. Improper use of the assistive device raises the chance for accident or injury. The occupational therapist will teach you how to safely perform activities of daily living, and will provide you with a list of hip precautions which are designed to protect your new knee during the first 8-12 weeks following knee surgery. The occupational therapist will also instruct you in the proper use of various long-handled devices for activities of daily living.

Before Your Operation

You will meet the physiotherapist responsible for your care. This may be in the pre-assessment clinic.

They will ask you about; your mobility, general health, home circumstances etc. Assess your knee movements and walking patterns. Teach you the exercises that you will be doing after the operation.

After your operation

With the physiotherapist’s guidance you will commence your exercise programme that will
consist of:

Ankle exercises to prevent circulatory problems.

Breathing exercises to prevent chest complications after the anaesthetic.

Knee exercises to improve your joint mobility and muscle power.</span>

Guidance on walking with appropriate walking aid.

Walking

At first you will need to use a walking frame or crutches to ease the weight on the new knee. Some patients progress to using 2 sticks.

Stairs

If appropriate, you will be taught to negotiate steps by your physiotherapist before going home. Most patients find it best to follow this sequence; Going up stairs – un-operated leg (good) leg first, then operated (bad) leg, and finally sticks or crutches. Use banister or rail with free hand if possible. Going down – sticks/crutches first, then operated leg, and finally un-operated leg.

General Advice/Information

Most patients are mobilised on first day post surgery. Patients are initially mobilised with a Zimmer frame and progressed to two sticks as assessed by the physiotherapists. Patients are required to be able to safely negotiate stairs prior to discharge home. My average length of stay for primary knee surgery is 3 to 5 days.

Patients need to work hard on building up their thigh or quadriceps muscles, getting thier knee fully straight and bending it to 110-120 degrees.

For the first two weeks recovery can be slow. Patients are advised to take painkillers as is appropriate, you may find that the bruising comes out and that elevating the leg and applying frozen peas or ice pack on it help with this period. Most patients start to recover and are more active, between 2-4 weeks post surgery. Patients are followed up in outpatients at 6 weeks.

Patients are not allowed to drive for 6 weeks post operativly. And can expect to be off sedentary work for 6 weeks and more physical work for 6 weeks to 3 months.

After 6 weeks you may return to full function and activity. It is important that you stretch out your scar tissue and build up your leg muscles. Exercises will be shown and explained to you to help facilitate this. In my experience to date, most patients return to 95-98% of normal function and activity approximately 9 to 12 months following surgery.