Considering Total Knee Replacement? Know Your Rehab Protocol Before Hand

on Thursday, 09 February 2012. Posted in Exercises for diseases, Exercise and Fitness Written By: Dr. Vindhya Asthana

Considering Total Knee Replacement? Know Your Rehab Protocol Before Hand

Often when someone is suffering from terrible knee pain for a long time, with or without any deformity and all sorts of other treatments seem to have failed; there might come suggestions for a knee replacement surgery from the orthopedic surgeon.

This advice brings lots of confusion, coupled with innumerable suggestions from family and friends, with details on failed or successful surgeries. Keep faith and do not panic, it is going to be your decision. A prior knowledge about what is going to happen with your knees on the surgical table, along with a basic understanding of your rehabilitation will definitely make things easier for you.

What is the aim of Total Knee Replacement (TKR)
• To relieve excruciating pain.
• To provide mobility.
• To correct deformity.

The Knee Replacement Surgery
• Partial Replacement
Here, both the inner and outer compartments of the knee joint which is formed by our leg bone tibia, and thigh bone femur, are replaced by implants & the knee cap is left intact.
• Complete Replacement
The lower surface of femur bone, the upper surface of tibia bone and the knee cap are replaced by an artificial prosthesis. This surgery is most commonly performed today.

Detailed rehab program for your knees
A good rehabilitation starts with a thorough assessment before surgery.

Pre-operative assessment
• Pain – The level and the site of pain is noted.
• Mobility – The therapist checks for complete movement done by you and evaluates the stability around the knee.
• Deformity – Presence of concavity or convexity of legs.
• Strength – Evaluation of endurance in thigh muscles, calves and muscles of hip.
• Swelling – may be present.
• Walking pattern – Notice any swaying, limping or stooping.

Post-operative regime
Once you are operated upon, always remember never to hurry up in doing things. Coming back to your routine takes time and the outcome is best when you go slow and steady. The entire program is divided in few weeks.

First week
• Do lot of deep breathing.
• Position your leg with heel resting on a pillow.
• Place a towel under knee and rhythmically contract and relax your knee cap. This reduces swelling.
• Pull ankles towards yourself and contract the knee cap, count ten and relax.
• Standing with the help of walker and taking few steps is encouraged.
• Bed to chair transfers is done.

Second week
• Now you should be able to bend your knee a little more towards 90 degrees and lift your leg straight up.
• Assisted walking begins without wearing knee braces.
• New intensified exercises are added, like sitting at the edge of bed and straightening the knee with 1 kg weights.

3 to 6 weeks
• Stitches are removed and walking with single stick is encouraged.
• Emphasis on posture and walking pattern.
• Stair climbing with assistance.
• Hydrotherapy exercises are ideal at this stage if your wound has healed.

6 weeks onwards
• Exercises with weights must be carried on.
• Backward bending of the knee for more mobility.
• Gentle squatting with wall support.
• Holding the back of a chair and standing on toes and heels alternatively helps stretching the entire leg.

Therapeutic Treatment
Generally, patient suffers from slight pain for few days after surgery; hence physical therapy treatments like TENS or IFT are given.

What are the precautions you must take?
• No hot fomentation lifelong.
• No self use of any electrical gadgets.
• Restrict use of Indian style toilets.
• Avoid anything which is strenuous for knees.
• Always continue to exercise and walk.
• Climb 8-10 stairs at least once a week.

With an overall positive attitude towards your health, you’ll be able to sail through this towards total recovery; just fine.

This article has been contributed by Physiotherapist; Dr. Vindhya Asthana. To ask a query contact Dr. Asthana through our section - Ask The Tzars or write in to her at - This email address is being protected from spambots. You need JavaScript enabled to view it.

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