Total Knee Replacement: Role of the Physiotherapist.

Ms. Nathalie Agius

The knee joint may become severely damaged by arthritis or injury, making simple activities, such as walking or climbing stairs, difficult and painful! In some cases, the knee may become painful even while sitting or lying down. Total knee replacement (TKR) is indicated when other treatments, such as medications and exercise are no longer helpful. Joint replacement surgery is a safe and effective procedure to relieve pain, correct leg deformity, and help you resume normal activities.

Healthy Knee Joint vs. Arthritic Knee Joint

In a healthy knee, the bones are covered with articular cartilage (menisci). This cartilage is a smooth substance that protects the bones and acts as shock-absorbents. Ligaments and muscles give the knee strength, while fluid lubricates the cartilage, reducing friction to nearly zero in a healthy knee. Normally, all these components work in harmony, however disease or injury can disrupt this harmony, resulting in pain, muscle weakness and reduced function!

Osteoarthritis, rheumatoid arthritis or post-traumatic arthritis may cause the cartilage to soften and wear away. This leads to bones rubbing against one another with consequent pain and stiffness.

A knee replacement is a procedure that replaces the surface of the bones in the knee joint. The decision to have total knee replacement surgery should be a cooperative one between you, your family, your primary care doctor, and your orthopaedic surgeon. Your doctor may refer you to an orthopaedic surgeon for a thorough evaluation to determine if you might benefit from this surgery.

Most people who have total nee replacement surgery experience a dramatic reduction on knee pain, and a significant improvement in the ability to perform common activities of daily living. But total knee replacement will not allow you to do more than you would before you developed arthritis. With normal use and activity, every knee replacement implant begins to wear in its plastic spacer. Excessive activity or weight may speed up this normal wear and may cause the knee replacement to loosen and become painful. Therefore, high-impact activities such as running, jogging, jumping, or other high-impact sports are not recommended.

Realistic activities following total knee replacement include unlimited walking, swimming, golf, driving, light hiking, biking, ballroom dancing, and other low-impact sports. With appropriate activity modification, knee replacements can last for many years.

Your recovery after surgery...

Physiotherapy start soon after surgery. The physiotherapist will teach you specific exercises to strengthen your leg and restore knee movement to allow walking and other normal daily activities. You will be able to walk with crutches soon after surgery.

Exercise is a critical component of your care, particularly during the first few weeks after surgery. You should be able to resume most normal activities within 6 weeks following surgery. The physiotherapist may recommend that you exercise up to 3 times a day. Some of the exercises below may be suggested, however, be sure to check with your physiotherapist before performing any of the exercises below, to ensure a safe recovery.

Post-surgery exercises

Following your surgery, exercise aims to improve circulation, which is important for preventing blood clots. They will also help strengthen your muscles and improve knee movement. Exercises should start as soon as you are able. They may feel uncomfortable at first, but these exercises will help speed your recovery and actually diminish your pain. Some bed exercises recommended may include:

• Pump your ankles,

• Tighten your thigh muscles, while straightening your knee,

• Tighten your buttocks muscles,

• Bend your knee, assisting with your arms if needed, &

• Straighten your knee, with a towel under the thigh.

You may also attempt to bend and straighten your knee while sitting. Your physiotherapist will guide your exercise progression as you improve.

Walking

Soon after surgery you will begin to walk short distances in your hospital room. At first you will walk with a walker or crutches. Your surgeon and physiotherapist will show you how much weight to put on your leg. Walking will help you regain movement in your knee, and improve strength and endurance. As you progress you will be able to walk longer and put more weight on your leg. The physiotherapist will also show you how to go up and down stairs.

Pain and Swelling

Pain and swelling can be relieved by elevating the leg and applying ice wrapped in a towel.

Outcomes

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 pf motion you have in your knee prior to surgery. Most patients can expect to be able to fully straighten the knee and to bend sufficiently to allow stair management.

Protect your Knee Replacement!

• Maintain proper strength and mobility by participating in regular light exercise;

• avoid falls and injuries;

• avoid high impact activity, such as jumping and running; and

• maintain a healthy body-weight.