Rehabilitation After Knee Surgery
Knee replacement surgery is a complex procedure, and physical knee rehabilitation is crucial to a full recovery. In order for you to meet the goals of total knee surgery, you must take ownership of the rehabilitation process and work diligently on your own, as well as with your physical therapist, to achieve optimal clinical and functional results. The knee rehabilitation process following total knee replacement surgery can be quite painful at times. It is however important that you persist, and that if you have concerns on pain levels, to address that with your therapist and doctor.
Your orthopaedic surgeon and/or physical therapist will most likely assign a specific protocol to you, based on your rehabilitation needs. The following protocol is meant only to give you an idea of the kind of exercises you might do during rehabilitation. When in doubt about an exercise, follow the protocol outlined by your surgeon and/or physical therapist. This means they will work out a programme tailor-made for you and your specific circumstances.
Your knee rehabilitation programme begins in the hospital after surgery. Early goals of knee rehabilitation in the hospital are to reduce knee stiffness and maximise post-operative range of movement as well as to help you get ready for discharge. The following steps may be taken to help maximise your range of movement following surgery.
- Strict adherence to the post-operative exercises recommended by your surgeon or physical therapist and if you have been given a Continuous Passive Movement (CPM) Machine to use - adhere to the regime recommended by the surgeon
- Early physical therapy (day 1 or 2) to begin a range of movement exercises and walking programme
- Oedema (excess water/fluid) control to reduce swelling (ice, compression stocking, and elevation)
- Adequate pain control so you can tolerate the rehabilitation regime
Outpatient Physical Therapy
Your outpatient knee rehabilitation programme will consist of a variety of exercises designed to help you obtain range of movement in the knee and build strength in the muscles which support the knee. You will follow an advanced strengthening programme, adding weights as tolerated. A stationary cycle and walking programme will be used to help increase range of movement and stamina, and an aquatic therapy programme may be added as well.
Typical Home Exercises
Instructions in your home exercise programme may include the exercises shown below. Consult your therapist regarding the appropriateness of the exercises. Remember that not all exercises will be appropriate for all persons - always stick to the exercises that the doctor and physical therapist have instructed you to do.
Ankle Pumps - Flex ankle up and down.
Quadriceps sets - Tighten thigh muscles and hold contraction for five seconds.
Heel slides - Flex your hip and knee. Return knee to the straight position.
Leg lifts - Raise leg 15cm above the floor, keeping knee straight.
Knee extension - Place a pillow under your knee. Lift your foot off the mat.
There are several things you can do at home to make your knee rehabilitation more successful. First of all, do the home exercise programme as prescribed by your physical therapist. Next, follow these suggestions and considerations, including warnings for daily activities (check these listed activities with your physical therapist before commencing with it. There may be reasons why you should not do some or all of them!):
- Sitting: Use a chair with arms to help you rise to a standing position. Avoid sitting for longer than an hour if possible. If you must sit for a longer time, elevate the foot to avoid swelling.
- Walking: Do not put weight through the joint until you’ve been cleared to do so by your surgeon.
- Lifting: Do not lift more than 4.5kgs.
- Showering: Showering is preferable to bathing because of difficulties getting in and out of the bath.
- Exercising: Do the exercises that were recommended by your doctor and physical therapist. Go to physical therapy as prescribed and get advice from your therapist as to whether you’re doing the exercises correctly.
- Getting into a car and driving: Get into a car by sitting on the edge of the seat, then pulling in the legs and turning to face forward. Driving is usually not recommended for the first six weeks after the operation. Talk with your surgeon about driving sooner.
Long-Term Knee Rehabilitation Goals
Once you’ve successfully completed your knee rehabilitation therapy and provided there have been no other complications or risks that have materialised, you can expect a range of movement from 100-120 degrees of knee flexion, mild or no pain with walking or other functional activities, and independence with all activities of daily living.