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Total Knee Replacement Rehabilitation Protocol

How Your New Knee Is Different

Total Knee Replacement Exercises | Total Knee Replacement Surgery Recovery | Phase 3

Improvement of knee motion is a goal of total knee replacement, but restoration of full motion is uncommon. The motion of your knee replacement after surgery can be predicted by the range of motion you have in your knee before surgery. Most patients can expect to be able to almost fully straighten the replaced knee and to bend the knee sufficiently to climb stairs and get in and out of a car. Kneeling is sometimes uncomfortable, but it is not harmful.

Most people feel some numbness in the skin around their incisions. You also may feel some stiffness, particularly with excessive bending activities.

Most people also feel or hear some clicking of the metal and plastic with knee bending or walking. This is normal. These differences often diminish with time and most patients find them to be tolerable when compared with the pain and limited function they experienced prior to surgery.

Your new knee may activate metal detectors required for security in airports and some buildings. Tell the security agent about your knee replacement if the alarm is activated.

Improving Adherence And Dealing With Missing Data

To prevent missing follow-up assessments, all participants will be reimbursed for testing and parking expenses and the research coordinator will interview them regularly by telephone to promote engagement in the study. We will also attempt to collect follow-up data for as many of these subjects as possible. For example, if a participant cannot come for an in-person follow-up assessment, the participant is offered to complete the surveys at home and mail them back to the study staff. Of note, subjects in the three study arms will participate in exercise programs and will likely have positive expectations of treatment benefit, which should facilitate study retention and decrease missing data. Despite attempts to improve adherence, some missing data are expected. To deal with missing data, baseline characteristics between patients with and without the assessment at 3 and 6 months will be compared to assess potential biases in the complete case analysis. We will also try to obtain reasons for study drop out to assess the missing data mechanism . We will use several missing data methods for imputing data and re-analyze using intention to treat to assess the impact of missing data on our conclusions as recommended .

Total Knee Replacement Recovery And Rehabilitation

When you have total knee replacement surgery, recovery and rehabilitation is a crucial stage. In this stage, youll get back on your feet and return to an active lifestyle.

Each surgeon may have different protocols, and each persons recovery is unique. This article outlines a general recovery timeline.

The 12 weeks following surgery are very important for recovery and rehab. Committing to a plan and encouraging yourself to do as much as possible each day will help you heal faster from surgery and improve your chances of long-term success.

Read on to learn what to expect during the 12 weeks after surgery and how to set goals for your healing.

Rehabilitation begins right after you wake up from surgery.

Within 24 hours after surgery, a physical therapist will help you to stand up and walk using an assistive device. Assistive devices include walkers, crutches, and canes.

A nurse or occupational therapist will help you with tasks such as changing the bandage, dressing, bathing, and using the toilet.

The PT will show you how to get in and out of bed and how to move around using an assistive device. They may ask you to sit at the side of the bed, walk a few steps, and transfer yourself to a bedside commode.

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Continuous Passive Motion Machine

The PT will also help you use a continuous passive motion machine. This device moves the joint slowly and gently after surgery. It helps prevent a buildup of scar tissue and joint stiffness.

Youll probably use the CPM machine in the hospital and possibly at home, too. Some people leave the operating room with their leg already in the device.

Some pain, swelling, and bruising are expected after TKR surgery. Try to use your knee as soon as possible, but avoid pushing yourself too far too soon. Your healthcare team will help you set realistic goals.

What can you do at this stage?

Get plenty of rest. Your PT will help you get out of bed and walk a short distance. Work on bending and straightening your knee, and use a CPM machine if you need one.

On the second day, you might walk for brief periods using an assistive device. As you recover from surgery, your activity level will increase gradually.

Pain Or Swelling After Exercise

Knee Exercise  Dr. Sharat Kumar

You may experience knee pain or swelling after exercise or activity. You can relieve this by elevating your leg and applying ice wrapped in a towel. If you use ice, it should be placed on the knee for 20 minutes and then removed for 20 minutes this sequence should be repeated for about 2 hours.

Exercise and activity should consistently improve your strength and mobility. If you have any questions or problems, contact your orthopaedic surgeon or physical therapist.

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How To Shower After Knee Surgery

If the surgeon used waterproof dressings, you can shower the day after surgery. If they used dressings that arent waterproof, youll have to wait for 57 days before showering and avoid soaking for 34 weeks to let the incision heal fully, according to the American Association of Hip and Knee Surgeons .

The PT may ask you to use a regular toilet rather than a bedpan and ask you to try to climb a few steps at a time. You may still need to use the CPM machine.

Work on achieving full knee extension at this stage. Increase knee flexion by at least 10 degrees if possible.

What can you do at this stage?

On day two, you can stand up, sit, and change locations. You can walk a little further and climb a few steps with help from your PT.

If you have waterproof dressings, you can shower the day after surgery. The PT may ask you to use a regular toilet in preparation for returning to your activities of daily living.

Extending The Life Of Your Knee Implant

Currently, more than 90% of modern total knee replacements are still functioning well 15 years after the surgery. Following your orthopaedic surgeon’s instructions after surgery and taking care to protect your knee replacement and your general health are important ways you can contribute to the final success of your surgery.

To assist doctors in the surgical management of osteoarthritis of the knee, the American Academy of Orthopaedic Surgeons has conducted research to provide some useful guidelines. These are recommendations only and may not apply to every case. For more information: Surgical Management of Osteoarthritis of the Knee – Clinical Practice Guideline | American Academy of Orthopaedic Surgeons

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Why Is Physical Therapy Important After Knee Replacement Surgery

Regaining your range of motion and strength after total knee replacement surgery is critical to regaining your ability to do the things that are important to you. You will start the following exercise program soon after your surgery. Your physical therapist will help you with the exercises initially and you will be expected to continue the exercises as instructed. As you recover, some exercises will be discontinued and others may be added. Please let your therapist or surgeon know if you are having difficulty with your exercises.

Rehabilitation Protocols Following Total Knee Arthroplasty: A Review Of Study Designs And Outcome Measures

Kneeling after Total Knee Replacement

Iciar M. Dávila Castrodad, Thea M. Recai, Megha M. Abraham, Jennifer I. Etcheson, Nequesha S. Mohamed, Armin Edalatpour, Ronald E. Delanois

Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore , USA

Contributions: Conception and design: IM Dávila Castrodad, NS Mohamed, TM Recai, MM Abraham Administrative support: NS Mohamed, JI Etcheson, RE Delanois Provision of study materials or patients: JI Etcheson, RE Delanois Collection and assembly of data: IM Dávila Castrodad, TM Recai, MM Abraham, A Edalatpour Data analysis and interpretation: IM Dávila Castrodad, TM Recai, MM Abraham, NS Mohamed, A Edalatpour Manuscript writing: All authors Final approval of manuscript: All authors.

Correspondence to:

Keywords: Total knee arthroplasty postoperative rehabilitation physical therapy physiotherapy

Submitted Mar 28, 2019. Accepted for publication Aug 02, 2019.

doi: 10.21037/atm.2019.08.15

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Inclusion & Exclusion Criteria

Publications were eligible for inclusion if they: examined postoperative exercise-based interventions in a rehabilitation setting they included participants who underwent primary unilateral TKA the study was performed in the United States of America, Canada, United Kingdom, or Australia and the level of evidence was III or higher based on the American Association of Orthopaedic Surgeons level of evidence classification . Studies were excluded if: they were written or published in a language other than English and the full text was not available they were systematic reviews, meta-analyses, study protocols for randomized controlled trials , feasibility or pilot studies, letters to the editor, surveys, or case reports . Two independent reviewers screened each title and abstract to determine whether the article met the inclusion and exclusion criteria. If the two reviewers agreed about the inclusion of a study, the study was selected for final analysis. If there was any doubt about a studys eligibility, a third reviewer was consulted.

Systematic review flowchart for study inclusion.

Revision Knee Replacement Rehab

Physiotherapy Guidelines

This is a guideline for your physiotherapist to help you progress through rehabilitation over the course of 12 weeks following your knee operation. A physiotherapist who is experienced in knee rehabilitation should be consulted throughout the programme to supervise and where necessary individually modify your programme.

Aims of Rehabilitation

To restore Range of Motion and Strength to the knee.

The final goal is to minimize knee pain and improve your knee function to improve your quality of life.

1-14 Days

Manual Physiotherapy

  • Intermittent cryotherapy to minimize joint swelling over first 4-5 days.
  • Cryotherapy after exercises. Heat packs may be used on the knee and thigh prior to exercises.
  • Circumferential compression dressing from ankle to thigh.
  • Elevate the affected limb to minimize swelling.
  • Ankle exercises for DVT prophylaxis.
  • Deep breathing exercises for basal atelectasis.
  • Range of Motion / Strengthening Exercises
  • Quadriceps sets, Gluteal sets.
  • Knee extensions supine over a roll.
  • Knee extensions from seated

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Circulation Exercise: Gluteal Sets

Lie on your back with your legs straight. Squeeze buttock together and tighten buttocks muscles. Do NOT hold your breath.

  • Repeat 10 times .
  • Do 2 sets a day.

Gluteal Sets

Lie on your back. Bend your surgical knee by sliding your heel toward your buttocks.

  • Repeat 10 times .
  • Do 2 sets a day.

You may be instructed to pull on a bed sheet hooked around your foot to help you slide your heel.

Heel Slides

Reproducibility Of Study Procedures

Knee Replacement Recovery Timeline

We will develop a Manual of Operations and Procedures to standardize all procedures and staff training in areas such as patient recruitment, measurement, assessment, data entry, management, analysis, and security. The MOP will also delineate the monitoring plans to assure patient protection and data integrity, thus facilitating consistency in protocol implementation and data collection. Reproducibility of testing procedures will be attained by conducting regular training workshops with the testers during which all the examination procedures will be reviewed and practiced. The training will be repeated yearly and involves role playing and observation of interviews carried out by the tester by experienced interviewers. Reproducibility of interventions will be maintained by regular meetings with the physical therapists and exercise instructors to review the research protocols to ensure treatment consistency.

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What Is A Knee Replacement Surgery

Knee replacement, also called knee arthroplasty or total knee replacement, is a surgical procedure toresurface a knee damaged by arthritis. Metal and plastic parts are used tocap the ends of the bones that form the knee joint, along with the kneecap.This surgery may be considered for someone who has severe arthritis or asevere knee injury.

Various types of arthritis may affect the knee joint. Osteoarthritis, adegenerative joint disease that affects mostly middle-aged and olderadults, may cause the breakdown of joint cartilage and adjacent bone in theknees. Rheumatoid arthritis, which causes inflammation of the synovialmembrane and results in excessive synovial fluid, can lead to pain andstiffness. Traumatic arthritis, arthritis due to injury, may cause damageto the cartilage of the knee.

The goal of knee replacement surgery is to resurface the parts of the kneejoint that have been damaged and to relieve knee pain that cannot becontrolled by other treatments.

Stair Climbing And Descending

Stair climbing is an excellent strengthening and endurance activity that also requires 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 negotiate stairs until you have regained most of your strength and mobility.
  • 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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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.
  • This exercise should take 3 minutes.

Sitting unsupported knee bend

Possible Complications Of Surgery

The Rehab Industry Wonât Tell You This (Part 4) | Total Knee Replacement Recovery Protocol

The complication rate following total knee replacement is low. Serious complications, such as a knee joint infection, occur in fewer than 2% of patients. Major medical complications such as heart attack or stroke occur even less frequently. Chronic illnesses may increase the potential for complications. Although uncommon, when these complications occur, they can prolong or limit full recovery.

Discuss your concerns thoroughly with your orthopaedic surgeon prior to surgery.

Infection. Infection may occur in the wound or deep around the prosthesis. It may happen within days or weeks of your surgery. It may even occur years later. Minor infections in the wound area are generally treated with antibiotics. Major or deep infections may require more surgery and removal of the prosthesis. Any infection in your body can spread to your joint replacement.

Blood clots. Blood clots in the leg veins are one of the most common complications of knee replacement surgery. These clots can be life-threatening if they break free and travel to your lungs. Your orthopaedic surgeon will outline a prevention program, which may include periodic elevation of your legs, lower leg exercises to increase circulation, support stockings, and medication to thin your blood.

Blood clots may form in one of the deep veins of the body. While blood clots can occur in any deep vein, they most commonly form in the veins of the pelvis, calf, or thigh.

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Recognizing The Signs Of A Blood Clot

Follow your orthopaedic surgeon’s instructions carefully to reduce the risk of blood clots developing during the first several weeks of your recovery. They may recommend that you continue taking the blood thinning medication you started in the hospital. Notify your doctor immediately if you develop any of the following warning signs.

Warning signs of blood clots. The warning signs of possible blood clots in your leg include:

  • Increasing pain in your calf
  • Tenderness or redness above or below your knee
  • New or increasing swelling in your calf, ankle, and foot

Warning signs of pulmonary embolism. The warning signs that a blood clot has traveled to your lung include:

  • Sudden shortness of breath
  • Sudden onset of chest pain
  • Localized chest pain with coughing

Home And Outpatient Physical Therapy

If you are sent home, you may choose to have a home care PT visit you. This option is usually for people who can’t travel to an outpatient physical therapy center.

Your goal for home physical therapy is to make sure you can move safely in your home. You will keep working on knee ROM and strength. Walking and stair climbing may also be a part of your home physical therapy.

Scar tissue will form as your incision heals. Your PT may use 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 more freely.

If you can travel to a physical therapy center, you may begin outpatient physical therapy. There, you will keep improving your knee ROM. You should be able to bend your knee to a 90 degree angle by the end of week 2.

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High Velocity & High Intensity Exercise

Rehabilitation protocol

As individuals age, several neuromotor changes occur, which leads to skeletal muscle weakness and reduced power. In TKA recipients, muscular strength and power decrease by at least 24% when compared to the contralateral side . Experts believe more demanding rehabilitation protocols may help overcome these deficits. Recent research focuses on rehabilitation strategies that incorporate movement velocity, a component of power. Given its preferential activation of type 2 muscle fibers, high velocity exercise is thought to improve functional mobility . This form of exercise is defined as performing a muscle contraction as quickly as possible, or in 1 second or less. In contrast to HV, a LV muscle contraction is performed in two seconds or more. Evidence indicates that HV exercises can improve static and dynamic balance while decreasing quadriceps impairment .

On the other hand, high intensity rehabilitation solely focuses on strength, defined as the contraction force. This program includes progressive resistance exercises and rapid progression to weight-bearing exercises. Several authors have expressed that the progressive strengthening and functional exercises according to clinical milestones promote positive outcomes . What is not yet known is whether a PRE-program restores function to levels comparable to healthy age-matched controls. Four Level-of-Evidence I studies regarding HV and HI exercise were analyzed in this systematic review .

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