Preparing for your total knee replacement

So, you are taking the plunge and have scheduled a total knee replacement (also known as a total knee arthroplasty)!

Evidence shows that preoperative therapy for patients undergoing total knee replacement has a positive impact on early postoperative recovery.  And patients that prepare for knee surgery by strengthening muscles and improving flexibility in the region of the knee PRIOR to surgery experience: less pain, improved physical function more quickly, and a reduced hospital stay.

 

What to anticipate during recovery

To help you better understand strategies to build physical strength BEFORE surgery, it is helpful to recognize three important objectives on which to focus AFTER surgery:

1. Prepare for temporary barriers to walking

Although your mobility will be temporarily impacted, moving your knees immediately following surgery will be encouraged.  Initially, you will likely be provided with a walking aid (walking frame, or “walker”). Many people progress quickly to a walking stick prior to hospital discharge.  Therefore, ensure that you have clear and wide pathways in your home to accommodate your movements with a walking aid.

2. Maximize knee bending angle

Be aware that following the surgery you will be working to bend the operated knee to at least 90 degrees within the first few days.

3. Strengthen the muscles around the knee and hips

Following a total knee replacement, rehabilitation strategies immediately focus on strength and mobility of the quadriceps (the muscle group extending between knees and hips). The strength of the quads serves a critical role in the correct alignment and function of the knee and kneecap. And stronger quads can reduce your level of postoperative pain and result in a more rapid recovery.

 

A strong body supports a strong recovery

These exercises help strengthen your knee and supporting muscles, improve flexibility, and aid in faster recovery.  Above all, it is advantageous to practice them before surgery.  Too, you will likely continue to perform these movements after surgery, as part of your recovery.

 

1 |  Seated static quads contraction

An exercise for improving quadriceps activation and knee extension mobility

  1. Sit upright in a chair.
  2. Extend the affected leg out straight in front of you.
  3. Tighten your thigh muscle.
  4. Hold this for 5 seconds and repeat 10 times.
  5. Repeat this exercise with the other leg.

2 | Inner Range Quads strengthening

An exercise to build the quadriceps muscle that attaches to the knee

  1. Lie on your back with a rolled towel under your knee.
  2. Tighten your quadriceps (front thigh) muscle and push your knee down into the towel.
  3. Your foot should lift, and your knee straighten.
  4. Hold this position for 5 seconds and repeat 10 times.
  5. Repeat this exercise with the other leg.

3 | Straight Leg Raise

An exercise to help build your quadriceps and hip flexor muscles. This is especially important for regaining strength after surgery and will assist you getting in and out of bed.

  1. Lie on your back with one knee bent and the other leg straight.
  2. Lift the straight leg ~30 cm (1 foot) off the floor and hold for 5 seconds.
  3. Repeat 10 times.
  4. Repeat this exercise with the other leg.

4 | Half squat

An exercise to strengthen the quadricep muscles that extend between the hip and knee

  1. Stand with feet hip-width apart and arms out in front.
  2. Bend at the hips and knees lowering your buttocks into a half squat.
  3. Return to standing.
  4. Repeat 10 times.

5 | Chair dips

An exercise to strengthen your upper body and assist you with getting out of a chair and out of bed immediately after surgery

  1. Sit on a chair (towards the front edge) and place your hands on the arms of the chair.
  2. Lift your body and buttocks off the seat of the chair by straightening your elbows.
  3. Bend your elbows to lower your body to the seat of the chair.
  4. Repeat 10 times

Once you fully recuperate from a total knee replacement, it is important to treat your knees with care  — while continuing to strengthen them.  Here is an article that describes strategies for avoiding future knee injuries related to a specific task, such as gardening.


References:

  1. Vasileia D, Drosos,G et al(2022) Does preoperative physiotherapy improve outcomes in patients undergoing total knee arthroplasty? A systematic review. Musculoskeletal Care https://onlinelibrary.wiley.com/doi/10.1002/msc.1616