Hi everyone, are you preparing yourself for a total knee replacement surgery?
This week we are looking at the first of a 2-part series preparing for, and then recovering from, a Total Knee Replacement.
Most orthopaedic surgeons want you to start moving your knee as soon as you wake up from the anaesthetic. Often you will also be up walking on your new knee the same day. It is important to know what you need to be focusing on to assist your recovery.
There are 3 areas that you need to pay attention to after your surgery. Your physiotherapist will help each step of the way.
Directly after the operation and often on the same day once the anaesthetic has worn off your physiotherapist will help you to get up and walk. This is to help reduce the risk of post-operative complications such as blood clots and chest infection. This is usually with a walking frame for good support, and then as you improve you can transition to a walking stick or in some cases crutches.
Before you leave the hospital, your physiotherapist will teach you to go up and down the stairs so they know you will be safe when confronted with stairs when you go home or in the community. It is worth practising going up and downstairs with a walking stick before you go in for your operation. Here is what you will be asked to do:
Stand at the bottom of the stairs. Hold onto a rail and use your walking stick as needed. When going up the stairs, follow this sequence:
- place your good leg on the step first
- bring your other leg to the same step
- finally, bring your walking stick up to join your feet on the step.
Stand at the top of the stairs. Hold onto a rail and use your walking stick as needed. When going down the stairs, follow this sequence:
- place your walking stick on the step you are going to move down to
- put your weakest leg /operated leg down on the same step
- finally, bring your other leg to the same step
- Movement of the replaced knee joint:
After the surgery it is important to start moving your replaced joint so you can gain full range quickly.
The knee can be swollen and painful, so it is important to ensure your take you prescribed pain medication and use ice to help the swelling. This will also help you be able to bend and straighten your knee through a good range of movement after the operation.
Most surgeons aim for at least 90 degrees knee bend in the first few days after the operation. You will find you need at least that amount of knee bend to get in and out of a car and get up from a chair comfortably.
- Strength of the muscles around the knee:
We focus on the quadriceps immediately after the operation. The knee is essentially a hinge joint that gains a lot of strength and stability from the muscles surrounding the knee in particular the quadriceps muscles at the front of the thigh. The strength of the quads can play a critical role in the correct alignment of the knee and kneecap, as well as how much pain you can experience.
Getting the quads as strong as possible before your operation is therefore very important, it is advised that you practice some of the basic strengthening and stretching exercises before your surgery. This will make it easier for you to do them afterwards as you will be familiar with them. It will also help strengthen the muscles around the knee to give it as much support as possible and help you recover.
Here are a few exercises that you will likely be asked to do after the operation:
Inner Range Quads:
- Lie on your back with a roam roller or rolled towel under your knees and let your legs hang over in a comfortable position
- Straighten your affected knee by tensing the thigh muscles, so that your heel comes off the table and the knee straightens.
- Hold this position, then control the movement back down to the start position and
- Repeat x 20
Straight Leg Raise:
- Lying on your back with one knee bent and the affected leg straight
- lift the straight leg ~30 cm off the floor and hold
- Repeat x 10
Assisted knee flexion stretch:
- Sit in a chair and bend your affected knee back as far as you can
- Place the ankle of your good leg over the front of your affected leg and use it to bend your knee back further
- Hold this position for 10 seconds
- Repeat x 5
Passive knee extension:
- Sit upright in a chair and place the leg with the affected knee as straight as possible on an opposite facing chair.
- Keep the leg extended and straight for a few minutes.
- Slowly take your leg out of this position as it will be a little stiff.
Hope this helps,Deb