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What to do after a Total Knee Replacement

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Total knee replacements are one of the most common orthopedic procedures performed on older adults. From 1979 to 2002, the number of total knee replacements (TKR) among people age 65 and older increased approximately eightfold; performed more frequently on women than men. Because this procedure is so common, research has proven that Physical Therapy is mandatory for proper, FULL recovery.

As a Physical Therapist Assistant, I have found that most people who decide to have this joint replacement are very unaware of what recovery and therapy will be like post-surgery. The first few days of recovery should include gentle range of motion (ROM) exercises, walking, and edema/pain control. It is imperative that the hospital gets the patient up and walking on their new knee 1 to 2 days after surgery. After leaving the hospital, patients will either go home or go to a short-term rehab facility where Physical Therapy must occur.physical therapy after knee replacement

Again, it is important to try to reduce swelling and pain as much as possible in the first few days of recovery so range of motion exercises and walking are easier. The surgeon makes it very clear that the patient should be trying to bend and straighten the knee throughout the day.

Patients need to understand that it is very common to experience increased stiffness and pain in the morning because the knee is not moved throughout the night. This is why performing the exercises every day is a MUST!

Often patients are unaware of how intense therapy can be to regain range of motion after a TKR. The joint must be pushed into flexion (bend) and extension (straight) in the beginning of therapy. Research has proven that patients that regain their ROM in the first few weeks of therapy recover quicker, become stronger, and experience less pain. If ROM is not being improved early in therapy, it will be even harder later on.

In general, the knee should have zero degrees of extension, meaning the leg should be able to extend and be perfectly straight, and 125 to 135 degrees of flexion or bend. This is compared to the non-operative knee to determine what the norm is for each individual. So, if the other knee is able to flex to 125 degrees and straighten to zero degrees, the new knee should be able to do so as well.  This amount of bend enables a person to ride a bike and go up and down stairs.

Here are some general ROM exercises and edema pain control techniques a patient would perform during physical therapy:

  • Quad sets: with the operative leg straight, push the knee down and hold 5 seconds, contracting the muscle on the front on the leg (quadriceps muscle). Make sure the knee cap and toe are facing up.
  • Heel slides: lying on your back, bend the knee as much as possible keeping the heel on the table. Hold the bend for 5 to 10 seconds. A strap can be hooked on the foot, pulling the knee into more flexion. This can also be performed lying on the stomach, bending the knee up as much as possible.
  • Heel-toe walking: Begin trying to walk as normal as possible. Concentrate on striking the heel first; this will help get the knee straight as you walk. Roll through the step forward toward the toe. Then, bend the knee up. Walk slowly and exaggerate the motions to normalize gait. knee exercises

These exercises can be performed 10 times each, every hour. Ice should be applied multiple times throughout the day, with the leg elevated and supported by pillows to reduce inflammation.

  • Patients need to understand the knee will be swollen for a while after surgery, and everyone’s recovery time is different. Definitley ask your doctor questions about rehab after surgery. While pain is greatly relieved after this type of joint replacement, realize that physical therapy is extremely important to regain a full range of motion and you must work at your recovery!

Contributed by Krista Magnoli, PTA at The Physical Therapy Center of West Palm Beach

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