Home And Outpatient Physical Therapy
If you are sent home from the hospital, you may choose to have a home care physical therapist come to your house for your rehabilitation. This is usually reserved for people who may have a difficult time traveling to an outpatient physical therapy facility.
The focus of home physical therapy is to maximize your safe functional mobility in your home. You will likely continue on working on knee ROM and strength. Functional mobility like walking and stair climbing may also be a part of your home physical therapy after TKR.
As your surgical incision heals, your physical therapist may begin gentle scar tissue massage and mobilization to help improve the mobility of your incision. This can help the skin and other tissues around your knee move better and more freely.
If you are able to travel to a physical therapy facility, you may begin outpatient physical therapy. Here, your physical therapist will continue to work on improving your knee ROM, and it is expected that you are able to bend your knee to a 90 degree angle be the end of week 2.
How Do I Know If Can Have An Outpatient Knee Replacement
Patients who are in good general health, do not smoke, are motivated and have a good support team at home are the best candidates. Those who qualify are given special education on their recovery, which must be followed closely. HSS joint replacement specialists perform a thorough evaluation of each patients individual circumstance in order to determine their eligibility for outpatient knee replacement surgery.
If you can answer “yes” to all of the below questions, you may be able to have outpatient knee replacement surgery.
- Are you between the ages of 18 to 70?
- Will you have support at home from a family member or friend after your discharge?
- Are you generally healthy, with no significant medical conditions ?
Consult one of our knee replacement surgeons to find out if you are an appropriate candidate for ambulatory joint replacement. All patients who express interest in the ambulatory joint replacement surgery program are evaluated by both the orthopedic surgeon and our multidisciplinary team. HSS joint replacement specialists perform a thorough evaluation of each patients individual circumstance in order to determine their eligibility for same-day knee replacement surgery.
Alternatives To Total Knee Replacement Surgery
There are several different conservative or less invasive options that may be attempted prior to having a total knee replacement.
Injections are often used in an attempt to decrease inflammation, friction, and pain in the joint. Surgical options to consider aim to preserve or restructure remaining tissue and to prevent or put off a total knee replacement.
Physical Therapists provide non-invasive treatment options to improve strength, flexibility, and body mechanics for functional activities to reduce knee pain. PTs can also educate patients on an exercise program for improving body composition.
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Stair Climbing And Descending
The ability to go up and down stairs requires both strength and flexibility. At first, you will need a handrail for support and will be able to go only one step at a time. Always lead up the stairs with your good knee and down the stairs with your operated knee. Remember, “up with the good” and “down with the bad.” You may want to have someone help you until you have regained most of your strength and mobility.
Stair climbing is an excellent strengthening and endurance activity. Do not try to climb steps higher than the standard height and always use a handrail for balance. As you become stronger and more mobile, you can begin to climb stairs foot over foot.
Stair climbing and descending using a crutch
Walking After Total Knee Replacement
How important is walking for tkr rehab? How much, how often??
0 likes, 7 replies
Posted 4 years ago
One of the most recommended things but you have to avoid any impact…no running, jogging, etc. Most docs will recommend an elliptical machine which has zero knee impact. If on a treadmill, you walk slowly, heel and toe. On hard concrete, get fitted for a fantastic, cushy pair of walking shoes. It’s all about keeping pressure and impact off the knee.
How often is measured in steps. Push the knee too far and it swells. Get a pedometer and track your steps. Find your “pain point” …back off…increase gradually. I did 8,200+ steps at 5 weeks and ended up with a hot-air balloon for a knee. Never did that again. Slow and steady increases. By 8 months, I was doing 11,000+ steps with zero swelling or pain.
There is no set of guidelines. Everyone is different. You have to find your own limits and proceed from there. Believe me…your knee will yell at you when you’ve exceeded your current limit. So again…it’s not miles…it’s the steps that matter. You can walk every day if you like…just watch the steps. Take a day off here and there when you are tired or are experiencing pain or swelling. All very personal. Listen to your knee…….
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Why Would I Need A Knee Replacement
Knees that are damaged by arthritis or injury often fail to function properly. The purpose of the knee, which is the bodys largest joint, is ambulation. Without a properly functioning knee joint, you will have trouble doing the simplest of tasks, such as walking from your bed to the restroom or sitting down and getting up from your couch. When your knees continue to worsen you may even have trouble sleeping because of pain in your knees.
Unless the knee has been injured in an accident of some sort, this is a gradual process where the joint gradually wears out over time. Your doctor may try a variety of treatments, from lifestyle changes, such as giving up running, to medications to help with the pain. For a time, you may try walking with supportive devices such as a cane or wearing leg braces. Eventually, though, when your efforts to manage the pain no longer work, its time to consider knee replacement.
Whats It Like To Recover From A Knee Replacement
As soon as you wake up from knee replacement surgery, your rehabilitation can begin. Patients are encouraged to begin walking with a walker, crutches, or a cane on the same day that their surgery occurred. Within three to six weeks after total knee arthroplasty, you will gradually resume many of your normal activities, but not all until you are released from a doctors care.
Your physical therapist will help you learn to safely use the new joint and will go over all of the aftercare necessary to recover successfully from the surgery. They will help you use a continuous passive motion machine, to gently move the joint to speed the healing process. Youll also learn to change your bandage, and practice how to get to and from the bathroom. Your physical therapist will also teach you the exercises necessary to help you regain the full range of motion in your new joint.
Typically, you will return home as long as you have a support system in place to help care for you during the rehabilitation process.
You will have some pain, bruising, and swelling after the surgery. Your doctor will likely prescribe some pain medications that are stepped down to over-the-counter anti-inflammatories and pain relievers over time. Your orthopaedic surgeon may have you wear a support hose or compression boots to reduce the risk of blood clots and cut down on leg swelling.
- Slow, careful stair climbing
- Achieving full knee extension and knee flexion
- Standing up and slowly walking
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What To Expect In The First Week After Knee Replacement Surgery
In the first week after a knee replacement, you’ll need to schedule an appointment to have your stitches or staples removed. This appointment should happen between 10 and 21 days after your knee replacement surgery.
Within a week, your knee will technically be able to bend 90 degrees, though it may be difficult due to pain and swelling. After 710 days, you should be able to fully extend your knee out straight. – healthline
You’ll still be walking with a walker for the first 1 to 3 weeks before switching to crutches and you won’t be able to drive. You’ll likely still be in a bit of pain and requiring assistance. However, within the first week, you’ll start to notice some improvements.
Straight away, you’ll need to work with a physiotherapist to keep your knee strong and mobile. Depending on your previous fitness levels and overall health, your physio schedule and the exercises you’ll do in therapy will vary.
What Are The 3 Most Painful Surgeries
Most painful surgeries
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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
Knee Extension Stretches And Exercises
Expect to perform a variation of these knee extension exercises:
- Quad Sets
- Seated calf stretch with towel/belt
- Standing TKE
Some patients will use a continuous passive movement machine that will repeatedly assist bending and straightening your knee slowly for hours each day for a couple weeks until they have reached a desired range of motion.
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How Long Will I Be In The Hospital After Total Knee Replacement
The length of hospital stay after knee replacement will depend on:
- Replacement and incision healing routinely.
- Manageable pain levels.
- The patient being able to perform bed mobility and walking without requiring someone else doing the majority of the work for them
- Help at home from family or friends for activities that will require assistance such as driving, cooking, cleaning, moving in and out of bed, sitting down and standing up, walking, or using stairs
These are important for ensuring a patient is safe to go home. The majority of patients meet these requirements and will be out of the hospital within 1-3 days.
If a patient has delayed healing or limited support at home, they may be a candidate to be transferred to a skilled nursing facility or rehabilitation hospital for 1-2 weeks for further recovery.
I Dont Kneel Because I Do Not Want To Damage The Hardware
The idea that doctors are not sure which knee replacement hardware will help the patient the most in their desire to kneel is reflected in the idea that maybe patients should avoid kneeling.
A June 2021 update study fin The Journal of Knee Surgery comes to us from researchers at Massachusetts General Hospital, the University of Miami Miller School of Medicine, and the Rothman Institute of Orthopaedics. In their study of 404 patients who had knee replacement and difficulty kneeling the researchers found:
- Sixty percent of patients were unable to kneel after total knee replacement
- Men and patients with occupations or hobbies requiring kneeling were more likely to kneel after surgery.
- People who had kneeling difficulties had:
- Too much weight or a high body mass index.
- It was too painful to kneel
- They did not have physical inability
- Fear of damaging the prosthesis. .
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How Long Does It Take To Recover From A Knee Replacement
Each year, around 600,00 people in the United States undergo knee replacement surgery, but how long does it take to recover from a knee replacement?
These surgeries are usually conducted when the knee is so damaged that you end up in pain and with difficulties walking, sitting, or conducting other normal daily activities. Its a very effective surgical procedure 90% of patients undergoing knee replacement experience a significant reduction in the pain they experience each day.
Activities With A High Risk Of Falling
After a total knee replacement, loss of strength, range of motion, and balance lead to an increased risk of falling. A fall can damage the prosthesis or interfere with the healing process.
A 2018 study found that 17.2 percent of a group of 134 people who had undergone a knee replacement fell at least once within 6 months of their operation. Roughly two-thirds of these falls occurred when walking.
Some lifestyle modifications to reduce your risk of falling include:
- using the handrail when going up and down the stairs
- using a rubber mat or shower chair when showering
- sitting down when putting on shorts or pants
- keeping the floor clear of stray toys, slippery rugs, and other objects that pose a tripping hazard
- avoiding slippery terrains like mud, ice, or wet grass
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Walking The Day After Knee Replacement
The morning after my surgery was my second opportunity to walk. My IVs were no longer attached and with the walker I walked to the bathroom and back to the bed where the physical therapist was waiting to take me on a short walk down the hall.
I walked down the hall by four adjacent rooms and turned around and walked back to my room. The physical therapist congratulated me on my success and said she would be back later in the morning to give me a stair test.
When she returned she gave me the choice of walking with the walker or riding in a wheel chair. I opted to walk. It turned out to be a longer walk, about 50 yards each way.
When I arrived at the physical therapy office there was a set of 4 stairs to walk up and down. She explained the technique I should use: good leg up first going up and bad leg first going down with a tight grip on the rail.
I completed the task successfully and walked back to my room about ten oclock. At noon I had my next opportunity to walk.
It was a short walk to the wheel chair that would take me out to the car waiting to take me home. At the car I used the walker to help position myself for entry in to the car.
When I arrived at my home I used the walker to go from the garage to my recliner in the living room. After arriving home that first day I only got up with the walker to use the bathroom.
Its Not My Knee Replacement That Is The Problem It Is My Other Knee Expanding On The Other Knee Problem
In Australia, doctors at the University of Wollongong, examining why patients who should be able to kneel after knee replacement, did not kneel, wrote in the Journal of Orthopaedics and Traumatology , about the problems of the other, non-replaced knee.
Here is what they found:
- Seventy-two percent of patients in this study could, or thought they could kneel at 12 months post knee replacement
- However, some did not because of the pain and discomfort they felt during kneeling.
- BUT, it was not the pain and discomfort in the replaced knee, 75 % of the patients in this study had other health concerns why they could not kneel including obesity, other health problems, but the number one reason was problems with the other knee.
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Prolotherapy And Platelet Rich Plasma Therapy
We are going to briefly address two treatment options that we offer here at Caring Medical. These are non-surgical, injections. These treatments may help the patient who has difficulty kneeling by restoring stability in a loose and wobbly knee following knee replacement.
Prolotherapy is an injection technique utilizing simple sugar or dextrose which causes a small controlled inflammation at weakened tissue. This triggers the immune system to initiate repair of the injured tendons and ligaments. Blood supply dramatically increases at the injured area. The body is alerted that healing needs to take place and reparative cells are sent to the treated area of the knee that needs healing. The body also lays down new collagen in the treated areas, thereby strengthening the weakened structures. Once the tendons and ligaments are strengthened, the knee, even one that has been replaced, stabilizes.
Platelet Rich Plasma Therapy is the use of a patients blood platelets and healing factors to stimulate repair of a tendon it is considered when tendon damage is more severe.
When the patients have already had a joint replacement, we will do a physical examination of the knee to assess how we may be able to help.
- Prolotherapy and Platelet Rich Plasma Therapy fix soft tissue, it cannot fix hardware failure,
- and Platelet Rich Plasma Therapy works by stabilizing the knee by strengthening the natural muscle and bone attachments, ligaments, and tendons.
How Long Does It Take To Recover From Knee Surgery
The timeline for recovering varies from patient to patient, but typically the rehabilitation process takes 10-12 weeks of therapy to reach goals of achieving range of motion, strength, and performing functional activities such as standing from sitting, walking, and climbing up/down stairs independently without difficulty or pain.
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