Move into higher gear with your new knee

For patients with severe arthritis of the knees, a total knee replacement (anthroplasty) surgical procedure helps reduce chronic pain and improves the quality of life. Once surgery has been completed, rehabilitation aimed at achieving a functional recovery as soon as possible is considered pivotal for a successful recovery (1). Moreover, the success of a recovery is directly associated with therapy that incorporates movement and exercise.

Following a knee replacement procedure, there are three important goals for recovery. These priorities are introduced during a hospital stay, and should continue following hospital discharge:

  1 | Increase mobility and walking

  2 | Maximize extension and flexion of the replaced knee joint

  3 | Strengthen the muscles around the operated leg (knee and hips)

 

Increase walking and mobility

Directly following an operation — and often on the same day — a physiotherapist will assist a patient with getting out of bed and walking with a support aid, such as a walking frame.  Physical movement directly after an operation helps reduce the risk of post-operative complications such as blood clots and chest infection.

As a patient’s mobility improves,  they may transition to a walking stick (or in some cases, crutches).   Before leaving the hospital, a physiotherapist will demonstrate how to traverse stairs in either direction to ensure stair safety.

UP STAIRS.  Stand at the bottom of the stairs. Hold onto a rail and use your walking stick as needed in the hand opposite to the operated leg.

1.  Lead with the good (unoperated) leg first.

2.  Follow with the operated leg and your walking stick.

DOWN STAIRS.  Stand at the top of the stairs. Hold onto a rail and use your walking stick as needed in the hand opposite to the operated leg.

1 Lead with the walking stick and the operated leg, then

2 Follow with the good leg.

 

Maximize extension and flexion of the replaced knee joint

In addition to walking, it is important to perform exercises that encourage a full range of joint movement. Since scar tissue in the knee begins to form immediately after surgery, knee motion should be maximized to prevent stiffness following a knee replacement. Therefore, your recovery should focus on both extension (straightening) and flexion (bending) of the knee after your operation.

Most orthopaedic surgeons recommend attaining a  minimum of a 90-degree  knee bend a few days after the operation. This level of flexibility should enable a patient to get in and out of a car and get up from a chair comfortably.

Inflammation, swelling and pain of the knee joint are common consequences of surgery, and often hinder both physical movement and the desire to move. In order to combat these issues that are barriers to movement it is important to:

1 | Take prescribed pain medication

2 | Use ice for 10 – 15 minutes, 2-3 times a day in the first 2 weeks

3 | Keep the recuperating leg elevated when resting

 

Strengthen the muscles around the knee and hips

Rehabilitation strategies also focus on strengthening the quadriceps (the muscle group extending between knees and hips on the front of the thigh). The strength of the quads serves a critical role in the correct alignment of the knee and kneecap and will assist your post-operative recovery.


These following exercises help maximize extension and flexion, strengthen your knee and supporting muscles, improve flexibility, and help you recover faster.


1 |  Assisted knee flexion stretch

An exercise to improve range of motion

  1. Sit upright in a chair (with your thighs parallel to the floor).
  2. Using your affected knee, slide your foot back as far as possible under the chair.
  3. You can place the ankle of your good leg over the front of your affected leg and use it to bend your knee back a little further.
  4. Hold this position for 10 seconds and return your foot to the front. Repeat this sliding sequence 5 times.

knee flexion exercise


2 | Half squat

This exercise strengthens 3 of your 4 quadricep muscles that extend between the hip and knee at the front of the thigh

  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 (not a deep squat).
  3. Return to standing.

half squat


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. Lisi C, Caspani P, Bruggi M, et al. Early Rehabilitation After Elective Total Knee Arthroplasty. Acta Biomedica. 2017; 88(Suppl 4): 56–61 [NIH]