So, you are taking the plunge and will be undergoing a total knee replacement (also known as a total knee arthroplasty) or perhaps it will be something you need to consider in the future.
Evidence has shown that preoperative rehabilitation in people undergoing total knee replacement has a positive impact on early post–operative recovery. People can often experience less pain, improved physical function, and spend less time in hospital if they participated in rehabilitation exercises and preparation before their knee operation (1)
Here are a few things you need to do to help prepare your body, build up your strength and allow yourself to become familiar with the exercises and routines you are likely to encounter following the surgery.
There are 3 important areas to focus on:
1. Your mobility and walking
2. Gaining maximum knee bend and straightening of the operated knee joint
3. Gaining good strength of the muscles around the operated leg in particular the knee and hips.
1. Walking and mobility
Directly after the operation, and often on the same day once the anesthetic has worn off, your physiotherapist will help you to get out of bed and walk with a walking aid (usually a walking frame). Walking and moving soon after the operation can help to reduce the risk of postoperative complications such as blood clots and chest infections. It also helps get the knee moving well.
As your mobility improves you can transition to a walking stick, or in some cases crutches, before leaving the hospital. Before you leave the hospital, your physiotherapist will teach you to go up and down the stairs so you will be safe when confronted with stairs when you go home or into the community. It is worth practicing going up and down stairs with a walking stick before you go in for your operation.
Here is an example of the instructions:
Going upstairs: Stand at the bottom of the stairs. Hold onto a rail and use your walking stick as needed in the hand opposite to the operated leg.
- Lead with the good (unoperated) leg first, then
- follow with the operated leg and your walking stick
Going downstairs: Stand at the top of the stairs. Hold onto a rail and use your walking stick as needed in the hand opposite to the operated leg.
- Lead with the walking stick and the operated leg then
- Follow with the good leg.
2. 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 you take your prescribed pain medication. Additionally, you can use ice to help reduce the swelling. 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 to get up from a chair comfortably.
Try this exercise before the operation so you are familiar with what to do afterwards:
Assisted knee flexion stretch: Sit in a chair with your thighs parallel to the floor and bend your affected knee and take your foot back as far as possible under the chair. You can place the ankle of your good leg over the front of your affected leg and use it to bend your knee back a little further. Hold this position for 10 seconds and repeat 5 times.
3. Strength of the muscles around the knee and hips
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 quadricep 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.
Here are a few exercises that are commonly used after the operation:
Static quads:
Sit upright with your legs out straight in front of you. Tighten your thigh muscle, pushing the back of your knee down. Hold this for 5 seconds and repeat 10 times.
Inner Range Quads:
Lie on your back with a rolled towel under your knee. Tighten your quadriceps (front thigh) muscle and push your knee down into the towel. Your foot should lift, and your knee straighten. Hold this position for 5 seconds and repeat 10 times
Straight Leg Raise:
Lying on your back with one knee bent and the other leg straight, lift the straight leg ~30 cm (1 foot) off the floor and hold for 5 seconds. Repeat 10 times
Half squat:
Standing with feet hip-width apart and arms out in front, bend at the hips and knees lowering your buttocks into a half squat. Return to standing.
Written by Deborah Hunter
Principal Physiotherapist
Move Better for Life Armidale
References:
- Vasileia D, Drosos,G et al(2022) Does preoperative physiotherapy improve outcomes in patients undergoing total knee arthroplasty? A systematic review. Musculoskeletal Care https://onlinelibrary.wiley.com/doi/10.1002/msc.1616
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