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.
Outpatient Therapy After A Total Knee Replacement
So you had you a total knee replacement and have been through post-operative rehabilitation in the hospital. You may have even had physical therapy at home. What’s next? Well, in order to maximize your functional mobility after total knee replacement, you may want to consider outpatient physical therapy.
If you are able to leave your house after total knee replacement surgery, your healthcare providerr may refer you to outpatient physical therapy. This type of physical therapy occurs at an outpatient clinic. Many clinics are privately owned and operated by physical therapists, while other clinics are operated by larger hospital organizations. Ask your healthcare provider to help you find the right physical therapist and outpatient clinic for you.
How Can A Physical Therapist Help
The physical therapist is an integral part of the team of health care professionals who help people receiving a total knee replacement regain movement and function, and return to daily activities. Your physical therapist can help you prepare for and recover from surgery, and develop an individualized treatment program to get you moving again in the safest and most effective way possible.
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How Long Does A Knee Replacement Last
About 90% of first-time knee replacements last at least 15 years,4 and many last at least 20 years.5
Patients can extend the life of their knee replacements by complying with their physical therapy routines and avoiding high-impact activities, such as jumping or jogging. High impact activities cause friction between the man-made components of the replacement knee, causing wear and tear.
Revision Knee Replacement SurgeryIf the initial knee replacement components need to be replaced for any reason, a second surgery called a revision total knee replacement may be needed. Wear-and-tear on components, component loosening, infection, and knee joint instability are the most common possible causes for needing revision surgery. Other reasons include knee stiffness and bone fractures.
Patients should talk to their doctors about when is the best time to schedule knee replacement surgery.
Right After Knee Replacement And Range Of Motion
When I arrived in my hospital room one of the first things that I noticed was how swollen my leg was. The knee was huge but so was my thigh and ankle.
Because of the swelling, I had very little flexion but I could straighten my leg. During the in-hospital therapy sessions the therapists were mostly concerned about getting me on my feet, walking with a walker, and taking the stair test.
They never measured any range of motion during my stay in the hospital. When the doctor arrived the morning after surgery he did mention that after the surgery they saw a gain of 7 degrees when straightening my knee. That was a pleasant surprise.
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Learn What To Expect And How To Prepare From The Doctors Who Perform This Operation Every Day And The Patients Who Have Been Through Knee Surgery Successfully
If your knee arthritis has gotten so bad that your medication and physical therapy are no longer enough to keep the pain at bay or prevent mobility issues, it is a good time to consider knee replacement surgery. The procedure has come a long way from the extended hospital stays, bed rest, and narcotics-based pain relief of the past.
Fifteen to 20 years ago we told patients to wait until they could no longer take the pain of osteoarthritis to consider surgery, but thats not the case anymore, says P. Maxwell Courtney, MD, assistant professor of orthopaedic surgery at the Rothman Orthopaedic Institute at Thomas Jefferson University Hospital in Philadelphia. With todays advances, minimally invasive techniques, and accelerated rehab and recovery protocols, we now tell patients if the pain is limiting your daily activities and youve exhausted conservative options like injections and physical therapy its time to consider surgery.
That was certainly the case for Sharon Barnes, a teacher from Maine whose pain got so bad she couldnt sleep. My doctor said I had osteoarthritis in both knees it was literally bone on bone, she remembers. We did hyaluronic acid injections, and that got me about a year then didnt work as well. Thats when we started discussing surgery.
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
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Peer Review And Public Commentary
Following the formation of a final draft, the CPG review draft was subjected to a 4-week peer review for additional input from external content experts and stakeholders. More than 350 comments were collected via an electronic structured review form. All peer reviewers were required to disclose any potential conflicts of interest, which were recorded and, as necessary, addressed.
After modifying the draft in response to peer review, the CPG was subjected to a 2-week public comment period. Commenters consisted of members of the APTA Board of Directors , the APTA Scientific and Practice Affairs Committee , all relevant APTA sections, stakeholder organizations, and the physical therapy community at large. More than 194 public comments were received. Revisions to the draft were made in response to relevant comments.
Life After Knee Surgery
As a Physical Therapist, Ive seen firsthand the significant improvements in people following a knee replacement. However, there is no surgeon or PT out there who can 100% guarantee success. There certainly are risks following a surgery and this should be discussed with your doctor. But just as important, you should discuss the expected outcomes with your physician.
Returning to activities such as walking, golf, bowling, swimming, light dancing, and even light tennis is usually encouraged. However, ask your doctor about suggested timeframes for these activities.
Knee replacements have come a long way in the past 20 years and the technology continues to improve. Set your expectations appropriately with your physician and therapist. Heres to hoping your life after knee surgery is full of enjoyment and activity!
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Think That Walking And Moving Around Is The Major Achievement
Patients mistakenly think that walking is a major achievement after surgery and that walking without a walker is even better. Other healthcare professionals can misguidedly feed into that misconception making the problem even worse. The truth is that getting up and moving around after surgery is encouraged but for the first two weeks you should be protecting the joint from full weight bearing forces by using the walker. This allows you to carry a percentage of your body weight through your arms instead of on your surgical knee.
During your knee replacement surgery, the ends of your long bones have been cut and a prothesis placed over the top. Bone that has been cut can be very painful, just ask someone who has had a small piece of bone taken from their iliac crest for use in a back surgery. That bone removal site can ache for months.
If you walk around without any protection for your new knee you will likely inflame and aggravate the bones. This can cause a person to have a real problem controlling their pain. All things considered you dont want to be dealing with more pain than is already associated with the post surgical period. So use your walker.this means actually putting weight through your arms. A 4 wheeled walker is a horrible choice for this. Get the regular 2 wheeled walker and slow down a bit. Your knee will thank you and your recovery will go much faster.
Avoiding A Manipulation After Knee Surgery
A lot of factors that are out of your control, mixed with some bad luck, help determine who will experience knee stiffness and require a manipulation. However, there are some things that you, someone who is preparing for and recovering from a knee replacement, can do.
Heres how to avoid a manipulation after a knee replacement.
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How Long Do You Need Physical Therapy After A Knee Replacement
Of course, this will vary from patient to patient, depending upon your individual situation. However, in general, you can expect around 3 to 4 weeks of formal physical therapy from our experts.
Dr. Christian Eccles, our Fellowship-trained Hip and Knee Replacement surgeon, says Therapy is vital to obtaining the best functional outcome possible after a knee replacement as it can aid in pain control, improve motion, and expedite recovery.
Our patients typically are able to drive within 2 to 4 weeks, go back to work in 6 to 8 weeks, and golf in 6 to 12 weeks.
Your physical therapy exercises that you learn should be continued on your own for a minimum of two months after your surgery. They may also recommend some additional exercises such as riding a stationary bicycle after this period to help keep your knee flexible. This will also help build your muscle tone.
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.
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Timing Of Physical Therapy Matters
In the largest study of its kind, published in JAMA Network Open, Aoyagi and Deepak Kumar, assistant professor of physical therapy, and other collaborators, analyzed more than 67,000 patient records, and discovered that even low levels of physical therapy were associated with lower likelihood of long-term opioid use after total knee replacement.
Specifically, they found that participation in PT within 90 days before or after total knee replacement was associated with lower likelihood of long-term opioid use. Going further, they found that six or more sessions of outpatient physical therapy post-surgery was linked to reduced chance of long-term opioid use, as were instances when outpatient physical therapy was initiated within 30 days of surgery.
Kumar, a physical therapist by training, says the analysis reveals that the longer a patient waits to start outpatient physical therapy after surgery, the greater their odds of long-term opioid use.
But the exact reason why PT reduces the likelihood of opioid use is not yet clear. Aoyagi says a surprising aspect of the findings was that both types of physical therapyactive and passive were associated with reduced long-term opioid use.
More research is needed to understand the relationship between types of physical therapy interventions with the outcomes in people who undergo total knee replacement, he says.
What The Procedure Is Like
Also called arthroplasty, knee replacement is a procedure to resurface the damaged parts of your knee that have been causing you pain.
The knee is the meeting place for three basic bones: the tibia and femur meet at the joint and are each capped with cartilage to absorb the shock of everyday movement. Resting between them is a freestanding bone called the patella . Often using a spinal anesthetic like an epidural used in childbirth a knee replacement procedure involves an incision over the knee that allows your surgeon to resurface the tibia, femur, and patella with metal and plastic components to restore the cushioning you need to move your knee comfortably.
There are two general kinds of knee replacement surgery: partial and total.
In a partial knee replacement , only a portion of the knee joint is replaced. This procedure may be recommended for patients who have damage limited to just one area of the knee. Because a partial knee replacement is done through a smaller incision, the recovery time in the hospital is often shorter and people can resume their usual activities sooner. However, more surgery may be needed in the future if other parts of the knee become damaged.
Your surgeon will discuss which type of surgery is right for you based on your medical history and risk factors.
While patients will need help in the first weeks after surgery, most people will get their feet under them and regain independence at about six weeks after the procedure.
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Swelling After Knee Replacement
Leg swelling is going to be present after having a knee replaced. Swelling has a significant effect on knee flexibility and the ability for muscles to contract. Think of trying to roll up a full water hose versus an empty water hose.
It is important to monitor, limit, and attempt to reduce swelling as much as possible.& amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp lt br /& amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp gt & amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp lt br /& amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp gt & amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp lt br /& amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp amp gt & amp amp lt br /& amp amp gt & amp lt br /& amp gt Swelling management strategies include:
- Laying down with the surgical leg straight and elevated above the level of the heart with an ice pack for 20 minutes of every hour.
- A compression and cold therapy unit such as GameReady, Squid Compression, or Cryocuff may help to limit and reduce swelling.
It is also important to continue monitoring for blood clots and infection, as sometimes the onset of symptoms is delayed and requires immediate medical attention, possibly rehospitalization.
How To Massage The Knee After Tkr Surgery
Massaging your knee at the proper time after total knee replacement can aid in your recovery.
A general full body massage can help relieve tension, stress and anxiety. It also can increase circulation to the soft tissues that include muscles and tendons.
For your surgically repaired knee, massage can increase the blood supply to the area and promote healing. It can also help reduce swelling, relieve pain and just give you a general soothing feeling when your knee is aching.
Once my doctor gave me the okay to massage the area around my knee and the scar itself, I used my hands and an electronic massaging devise on a regular basis.
My wife was also kind enough to help out with these massages too.
Massage also helped me before many of my physical therapy sessions to loosen up the knee so I could do the required exercises. In this article I will share my experience with massage post TKR.
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Exercises To Increase Your Rom
If you worked at a PreHab program before joint replacement surgery, youll already be leaps and bounds ahead for achieving optimal range of motion. If youre reading this before your joint replacement surgery, great! In the weeks leading up to surgery, we strongly encourage you to start a daily PreHab program of exercises and everyday movements that will help build strength and movement in your joint.
If youre newly into recovery, you will likely be setup with a physical therapist or occupational therapist. Taking advantage of as many sessions as possible is key. However, strictly relying on in-class sessions to optimize your ROM isnt enough. Its absolutely, positively imperative that you supplement classes with an at-home guided ReHab program.
A great at-home program will include early exercises that will help get you mobile after surgery, functional exercises that will help bring back regular movements, advanced exercises that aim to build strength and push you further, and later stage maintenance exercises after the 12+ week mark where you engage in low-impact exercises to keep fit and keep moving.
Havent had surgery yet? Get matched to a top surgeon who has the tools to improve your ROM before surgery. The better your movement before surgery, the easier it will be to gain ROM in recovery.
Living With A Knee Replacement
Total knee replacement may greatly improve function, but most patients will not be able to do more than they did before the onset of arthritis.
A replacement knee may feel different than a natural knee. One small study3 found that most people report being aware of their new knees even 12 months after surgery. Their awareness was most notable when climbing stairs, kneeling, or rising from a chair. About half of the people in the study also reported symptoms such as knee stiffness , swelling, crackling, or numbness.
These symptoms can exist even though overall knee function is improved and knee pain is decreased. These symptoms do not mean the knee replacement surgery was not successful or that patients regretted having the surgery.
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