Continuous Passive Motion Machines
Some doctors prescribe continuous passive motion machines after surgery. A CPM machine slowly moves the affected leg, causing it to repeatedly straighten and bend, while the patient is lying on his or her back. A patient may use a CPM machine for up to 8 hours a day, in between sleeping and physical therapy.
Evidence suggests CPM machines help patients regain range of motion more quickly,1 which can facilitate a faster hospital discharge. Some patients are also prescribed CPM machines for temporary use at home after discharge.
Not all insurance companies cover CPM machines and, while they do help patients regain flexibility sooner, there is no definitive evidence that the CPM use affects risk of DVT, long-term knee range of motion, or knee function.2
Lose Weight To Lessen Stress On Your Knees
Extra weight puts pressure on the knees and increases stress on the joint, increasing pain and making it hard to exercise. Research compiled by the Johns Hopkins Arthritis Center confirms that carrying extra pounds raises your risk of developing knee arthritis and speeds up the destruction of cartilage that cushions the joint.
Its not easy, but losing weight can help, whether youre dealing with arthritis in one or both knees. If you are overweight or obese, consulting with a nutritionist or a bariatric specialist may be the right place to start.
Sleeping On Your Side
Some people find sleeping on their sides more comfortable, and if you are one of them, do not lie on your operative side. Also, put a cushion or pillow between your legs to provide cushion to the knee. In case you need more support, add another pillow to pad your knee to make the leg comfortable.Sleeping on the side can be painful because the leg is not straight enough. However, gradually, you can start sleeping on your side as the knee heals. But avoid sleeping on the operative side at all costs, as it puts a lot of pressure on the surgery site.
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Range Of Motion Basics After Knee Replacement Surgery
First, we need to start off by saying that everyone is different. Some people are naturally born with more flexion and extension in their knee joints, some people have complications or severe osteoarthritis degradation to overcome, some people may experience knee stiffness, and so forth. In fact, one of the best indicators of your knee range of motion after surgery is your ROM before surgery.
A completely straight, unflexed knee joint will measure 0° of flexion. A fully bent knee will max out at about a full range of motion of 135° degrees of flexion.
As a general rule, a knee flexion of about 125° will allow you to carry out most normal activities. For daily living, a minimum flexion of around 105°-110° is required. Heres the approximate range of motion flexion required for everyday activities:
- 65° to walk
- 70° pick an object off the ground
- 85° to climb up stairs
- 95° to stand from a sitting position
- 105° to tie shoelaces
- 115° to squat or sit cross-legged
- 125°+ covers most activities. However, squatting or sitting on your heel may always prove challenging.
Taking Precautions After Knee Replacement
You may have to make adjustments to your lifestyle while your knee heals. Some of these changes might seem obvious, but they make a difference in the long-term use of your knee. Here are three important precautions to take after knee replacement:
- Start with a cane or walker: While you ease back into walking without help, use a cane or walker to prevent falls. Accidents can damage your knee, disrupting healing or requiring another surgery.
- Make your environment accessible: If possible, prepare your home before your surgery. Plan where youll be spending time so you can skip unnecessary trips on the stairs. Consider what youll need and keep essential items nearby.
- Do your physical therapy exercises: Physical therapy strengthens the muscles around your artificial joint. That support is necessary for functionality and long-term use. Physical therapy teaches you how to restore your knee without causing damage.
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Kneeling After A Total Knee Replacement
Hi my favorite readers! One of my previous blog posts consisted of an exercise involving kneeling after a total knee replacement, done on the floor. In the blog post I stated that I could do it. After giving it some more thought, I realized that was an understatement. A heavy duty understatement. Heres the true story.
The end of this week will be my one year post-tkr date. How hard could it be to kneel on the floor? I found kneeling on the floor after a total knee replacement to be a curious endeavor since in theory it seems like a great way to get more flexibility in my tkr knee. So, anywaysI tried the exercise out for size.
Kneeling on the floor involved my hanging on for dear life to something with each of my hands as I SLOWLY lowered my body to the floor. It was not a pretty sight.
Once my knee hit the floor, I would not call it kneeling. It was more like a dreaded bend that was begging to be stopped. So after two seconds, I did.
As I held on to the sofa with one hand, and my exercise bike with the other hand, I started to lift myself back up. Sure is good that neither of those two vices could tip over. My return to an upright position was another vision for sore eyes.
Im glad that exercise is over.
Find this post about kneeling after a total knee replacement interesting? Kindly shareThanks!
Sports With High Impact Or Quickly Changing Directions
While recovering from knee replacement surgery, avoid participating in contact sports or sports that may lead to a sudden twisting or jerking of the knee. Some examples include:
. Its important to work with your orthopedic surgeon after surgery to build the best program possible.
Here are some examples of exercises that surgeons recommend at different stages of recovery.
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Why Would I Need Surgery
Osteoarthritis is the main reason why people go for knee replacement surgery. The age-related condition is very common and occurs when cartilage — the cushion between the knee and the bone joints — breaks down.
Other reasons include:
- Rheumatoid arthritis: Rheumatoid arthritis is when the bodyâs immune system attacks and destroys the lining of the knee.
- Deformities: People with bowed legs or âknock-kneesâ often get surgery to restore the position of the knee.
- Knee injuries: A broken bone or torn ligaments around the knee sometimes will result in arthritis that causes great pain and limits your movement.
Sitting Unsupported Knee Bends
While sitting at bedside or in a chair with your thigh supported, bend your knee as far as you can until your foot rests on the floor. With your foot lightly resting on the floor, slide your upper body forward in the chair to increase your knee bend. Hold for 5 to 10 seconds. Straighten your knee fully.
Repeat several times until your leg feels fatigued or until you can completely bend your knee.
Sitting unsupported knee bend
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Physical Therapy After Knee Replacement Surgery
Outpatient physical therapy is typically prescribed after discharge and will usually begin within a week of surgery. A physical therapist will teach the patient:
- Knee strengthening exercises
- Knee exercises to encourage range of motion and reduce scar tissue
- How to use assistive walking devices, such as a walker and cane
Other Drugs And Treatment
Its also important to discuss any dental work or other surgical procedures that you might need.
Your surgeon may prescribe preventive antibiotics to reduce the risk of a possible infection from these events.
It is also best to tell your doctor about any new medications or supplements you start taking, as well as any health conditions you develop.
Some medications can negatively interact with other medications or supplements. They can also make certain health conditions worse.
Regular follow-up appointments are an important part of your recovery process.
They give you an opportunity to:
- ask questions
- discuss your progress
- learn about your rehabilitation
Follow-up visits also give your surgeon and physical therapist the chance to monitor your progress and address any problems that arise.
Take responsibility for your health by attending regular follow-up appointments and following your prescribed treatment plan.
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Characteristics Of Severe Arthritis Of The Knee
Pain is the most noticeable symptom of knee arthritis. In most patients the knee pain gradually gets worse over time but sometimes has more sudden flares where the symptoms get acutely severe. The pain is almost always worsened by weight-bearing and activity. In some patients the knee pain becomes severe enough to limit even routine daily activities.
Morning stiffness is present in certain types of arthritis. Patients with morning stiffness of the knee may notice some improvement in knee flexibility over the course of the day. Rheumatoid arthritis patients may experience more frequent morning stiffness than patients with osteoarthritis.
Swelling and warmth
Patients with arthritis sometimes will notice swelling and warmth of the knee. If the swelling and warmth are excessive and are associated with severe pain, inability to bend the knee, and difficulty with weight-bearing, those signs might represent an infection. Such severe symptoms require immediate medical attention. Joint infection of the knee is discussed below.
The knee joint has three compartments that can be involved with arthritis . Most patients have both symptoms and findings on X-rays that suggest involvement of two or more of these compartments for example, pain on the lateral side and beneath the kneecap . Patients who have arthritis in two or all three compartments, and who decide to get surgery, most often will undergo total knee replacement .
How Can I Ease Arthritis Pain
If you are looking for ways to reduce arthritis pain or maintain your knee surgery results, there are a number of things you can do to help alleviate pain. While there is no true cure for arthritis, there are many things you can do to help reduce arthritis pain. Some of those things include:
- Maintain a healthy weight
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Nerve And Other Tissue Damage
Theres a small risk that the ligaments, arteries or nerves will be damaged during surgery.
- Fewer than 1 in 100 patients have nerve damage and this usually improves gradually in time.
- About 1 in 100 have some ligament damage this is either repaired during the operation or protected by a brace while it heals.
- About 1 in 1,000 suffer damage to arteries that usually needs further surgery to repair.
- In about 1 in 5,000 cases blood flow in the muscles around the new joint is reduced . This usually also needs surgery to correct the problem.
How Massage Helps With These Issues After Knee Replacementsurgery
After the home therapists first visit, she gave me the okay to begin massaging the area around and behind my knee .
She explained that massage helps to stimulate blood circulation around the muscles, which increases the flow of oxygen and nutrients to them. She emphasized that massage may also aid in improving range of motion and flexibility .
My first massaging by my caregiver and myself was all by hand. I began massaging away from the incision area which is extremely tender and far from heeling .
My early massages were centered on the back of my knee and above my knee where the tourniquet was placed during surgery. These areas were still tender too and I started with very slight pressure, more of a rub .
Later I began massaging the sides of my knee still not anywhere near the incision. As time went on and the swelling went down, I was able to increase the pressure little by little .
Massaging helped increase the circulation increasing the blood supply to the knee, which is critical for healing. Along with frequent icings, massage also helped reduce the swelling.
I had to wait until my staples were removed and all the scabs had fallen off before I could begin to massage the scar itself. Massaging the scar helps to decrease scar tissue build up and may help to make your scar less noticeable.
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How Long Should I Place Ice On My Knee
According to Therapeutic Modalities Cryotherapy is usually applied for 20 to 30 minutes for maximum cooling of both superficial and deep tissues. In many physical therapy clinics, the common recommendation is 10-minutes of sustained application. A couple of considerations to determine the length of time ice is placed on your post-surgical knee include
1.) How cold is the ice pack?
2.) Are you placing a piece of cloth or other covering between the ice and your skin?
3.) Are you applying ice to a part of the body with a thicker fatty tissue layer?
When A Patient Says I Just Cant Kneel
Lets look at another study looking for answers, here we have doctors at the University of Bristol in the United Kingdom publishing in the journal Disability and Rehabilitation, April 2019
- The researchers here conducted telephone interviews with 56 patients who had extreme difficulty kneeling at 7-10years after knee replacement.
- Patients were asked about reasons for difficulty kneeling, how it impacted their lives, and experiences of healthcare services.
- Most people had difficulty kneeling because of pain or discomfort in the replaced knee.
- Many patients described how this limitation affected their daily lives, including housework, gardening, religious practices, leisure activities, and getting up after a fall.
- Patients often adapted to these limitations by finding alternatives to kneeling, assistance from others, or home adaptations.
- Many patients had accepted that they could not kneel, however some still expressed frustration.
- Few patients had consulted with healthcare professionals about kneeling difficulties, and unmet needs included the provision of information about kneeling and post-operative physiotherapy.
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Thoughts On Kneeling After A Total Knee Replacement
omg! i am so glad that you were the brave one to try this exercise. i am reading this and imagining the whole thing as you were going DOWN. too funny, but not to funny if you would of fell. hey you gave it your best shot. i am so gald that this excercise is only for the tkr people that are at 12 months post op. i have another 6 months to NOT think about doing this. take care and keep up the great writing. i love it!
I know how you feel. You were very brave to do this all by yourself.
My PT wanted me to get down on the floor. She said studies show that people who are able to get up off the floor are more satisfied with their TKR than folks who are unable to perform this exercise. She put a padded pillow on the floor and I slowly placed my unoperated knee on the pillow followed by the other one. Then I placed my hands on the massage table and pulled myself up. I thought that would be good enough but au contraire.
Next exercise was to get down on the floor AGAIN on all fours and using my legs pull myself up into an upright position. This did not happen! I ended up dragging my carcass over to the pillow and table and hauling my body up. End of that exercise.
What did I learn? Dont ever get on the floor unless I absolutely have to and I cant imagine what would cause me to do so at this point. The other thing I learned is if I must get down on the floor, make sure I have a muscle-bound man in the house make that a young and strong muscled man in the house.
Sleeping On Your Back
The best sleeping position just after your surgery is sleeping on your back. You should make sure that your operative leg stays as straight as possible to avoid hypertension of the knee and keep proper blood flow to the surgery site.If you are sleeping on your back, put the pillow under your calf and knee. This will not only cushion the knee from pressure but also keep your leg straight. If your pillow is flat, use a second pillow. You must, however, avoid placing the pillow under your foot, as it will put stress on your knees and increase your pain.
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How To Get Down On The Floor After Knee Replacement
Find the support of a chair or table. Put your hands on the arm area of a chair or hold the side of the table, then bend your non-surgical leg first and put your knee on the floor, then bend your surgical leg and afterward put both of your hands on the floor. Now you are in a position where both your legs and hands are touching the floor in this manner, place your one side hip on the floor and slowly sit down.
Keep Your Knee Straight
Its tempting to sit back and prop your leg on a pillow after knee surgery, but you should keep the joint completely straight after your procedure.
To support the healing process, keep your leg and foot pointing straight ahead whenever you lie down or sit. You should also avoid sitting in the same position for more than 45-60 minutes at a time and use a firm chair with armrests and a straight back, instead of stools, soft sofas, or low seats.
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