You will be seen by a physiotherapist before your operation
To assess your pre-operative level of activity, joint movement and muscle strength.
To discuss post operative routine and explain the recovery process so that you are prepared for the various stages you will go through.
This is a bony operation and bone in the leg takes approximately 3 months to heal. This doesn't mean that you will be incapacitated for this length of time, mobility will gradually improve week by week but during this initial period nature will tell you when enough is enough, you will be wise to listen. Exercise is vitally important to regain movement and strength, however there is a fine line between doing enough exercise and overdoing it, your physio is there to help you find the optimum level of activity at each stage of recovery. The physios' role is largely advisory and supervisory it is up to you to do your exercises regularly at home.
During the initial phases, exercise should be little and often, 5-10 minutes of specific exercises done 5-6 times daily are better than 40-50 minutes in one go. Activities such as walking, standing or pottering about the house and garden are also exercise and should be interspersed with formal exercises and REST. Too much exercise, particularly activities involving standing or pottering may irritate the knee and result in aching, increased swelling or a feeling of heat. If this occurs you will not have caused damage but you need to allow the inflammation to settle and perhaps slow down a little.
In Hospital
Immediately after your operation you may wake up to find your leg on a CPM (continuous passive movement) machine, this may be left on overnight.
Most people find this quite comfortable and are able to sleep without a problem.
The machine moves the leg very slowly and prevents the knee becoming too swollen or stiff and it also helps to get your circulation moving again.
You will get out of bed for the first time the next day, the physio will help you and depending how you are, you may take a few steps and sit out in the chair for a short while. You will be encouraged to bend the knee yourself and begin bracing exercises for the quadriceps (the muscle on the front of your thigh). You will be asked to do these basic exercises regularly through the day (usually hourly) and additional ones will be added as you progress, so that you can exercise both in the chair or on the bed.
Crutches
Initially you may walk with a frame but you will quickly progress to crutches when you have adequate balance and muscle control.
Crutch Sequence: Crutch, Operated Leg, Un-operated Leg
At this stage it is important not to overdo things and cause the knee to swell, swelling makes knee bending more difficult and prevents the thigh muscle working efficiently. Exercises are designed to gradually increase bend (mobility exercises) and to strengthen muscles (strengthening exercises) and you will be expected to regularly do both types.
You will also be asked to spend a few minutes with just your heel supported, to allow the knee to straighten fully this is called an extension stretch and needs to be done 4/5 times a day (many people have not been able to do this properly for some time before surgery; in this case you must persevere with the stretching to achieve full extension - the knee is designed to be straight when you walk on it)
Going Home
The average length of stay following a total knee replacement is 4 days, but can vary by 1-2 days either way depending on the individual. If you have a unicompartmental replacement then your stay could be as short as 4-5 days. Whichever operation you have, you will be walking independently with crutches or sticks, able to safely negotiate stairs and have at least 90 degrees of knee bend before you are discharged.
The physio will also go through a home exercise programme which you will be expected to continue with. If you live locally, appointments will be arranged for you to come for physiotherapy, usually once or twice weekly to begin with. If you live some distance away then it is advisable for you to make contact with a local physio prior to surgery (your GP will recommend someone in your area).
At Home
Initially it is sensible for you to follow a similar daily routine to that in hospital. Rest is still important; length of time spent on your feet and distance walked needs to be increased gradually. If, at the end of the day, your knee feels tight, warm or particularly achy, this is nature telling you that you have perhaps pushed things too much. No harm done but reduce activity slightly to let the knee settle and then build up again slowly.
Remember that too much standing, or being on your feet and just 'pottering' about the house and garden, are activities which are likely to irritate the knee in the early weeks. Joints prefer movement rather than being static especially when weight-bearing.
Stairs sequence:
Upstairs:Un-operated leg, followed by operated leg and crutch together
Downstairs:Operated leg with crutch, followed by un-operated leg.
Going for short walks is good and you can progress by gradually increasing the distance you walk, do the same distance more often (twice a day instead of once), or try to do the same distance slightly more quickly.
Your physio will progress your specific mobility and strengthening exercises when you are ready. As a rough guide you could ride a static bicycle at two weeks (although you may not get the pedals all the way round immediately), have the saddle high and minimal resistance initially; you will probably progress to normal stair climbing at 3-4 weeks (going up will be sooner than coming down), and you should be safe to drive at 4-6 weeks.
These are a guide only everyone is different and individual progress will vary.
Most patients make rapid progress in the first few weeks, however it is common for this to slow, usually at around 4-6 weeks. Many people describe reaching a plateau, don't get depressed if this happens it is normal, soon passes and improvement moves on again.
By approximately 3 months you will be largely back to normal activities but improvement continues for at least 1 year.
Hydrotherapy
Some patients get the opportunity to go in the pool whilst in hospital, however this is dependant on various factors such as timing; swelling in the knee and staff availability. Bring your swimsuit into hospital so that you can take advantage if the opportunity arises. Failing this, patients who come to Droitwich for their post-operative physio will go in the pool during weeks 2 and 3 or as appropriate.
Finally, work hard, listen to advice and be sensible, then you will reap the benefits of your new knee and improved function in the minimal of time.
Physical therapy
Following hospital discharge (or discharge from inpatient rehabilitation), patients who undergo total knee replacement will participate in either home physical therapy or outpatient physical therapy at a location close to home.
The length of physical therapy varies based upon patient age, fitness, and level of motivation, but usually lasts for about six to eight weeks. Two to three therapy sessions per week are average for this procedure.
At first, physical therapy includes range-of-motion exercises and gait training (supervised walking with an assistive device, like a cane, crutches or walker). As those things become second nature, strengthening exercises and transition to normal walking without assistive devices are encouraged.
How can rehabilitation be done at home ?
All patients are given a set of home exercises to do between supervised physical therapy sessions, and the home exercises make up an important part of the recovery process. However, supervised therapy--which is best done in an outpatient physical therapy studio--is extremely helpful, and those patients who are able to attend outpatient therapy are encouraged to do so.
For patients who are unable to attend outpatient physical therapy, home physical therapy is arranged.
Usual response
No two patients are alike, and recovery varies somewhat based on the complexity of the knee reconstruction, and the patient's health, fitness, and level of motivation.
Most people walk using crutches or a walker for 3-4 weeks, then use a cane for about 2-3 more weeks; sometime between one and two months post-operatively, most patients are able to walk without assistive devices.
Most patients obtain and keep at least 90 degrees of motion (bending the knee to a right angle) by the second week after surgery, and most patients ultimately get more than 110 degrees of knee motion. Most patients can return to sedentary (desk) jobs by about 4-6 weeks; return to more physical types of employment must be addressed on a case-by-case basis.
Most patients are back to full activities--without the pain they had before surgery--by about three months after the operation.
Risks
This is a safe rehabilitation program with little risk.
Long-term patient limitations
The goal of total knee replacement is to return patients to a high level of function without knee pain. The large majority of patients are able to achieve this goal. However, since the joint replacement components have no capacity to heal damage from injury sustained after surgery, we offer some common-sense guidelines for athletic, leisure, and workplace activities:
Recommended : -
Swimming
Water aerobics
Cross-country skiing or Nordic Track
Cycling or stationary bike
Golf
Dancing
Sedentary occupations (desk work)
Permitted : -
Hiking
Gentle doubles tennis
Gentle downhill skiing
Light labor (jobs that involve driving, walking or standing but not heavy lifting)
Not recommended : -
Jogging or running
Impact exercises
Sports that require twisting/pivoting (aggressive tennis, basketball, racquetball)
Contact sports
Heavy labor
Since the joint replacement includes a bearing surface, which potentially can wear, walking or running for fitness are not recommended. Some patients feel well enough to do this, and so need to exercise judgment in order to prolong the life-span of the implant materials. Swimming, water exercises, cycling and cross country skiing (and machines simulating it, like Nordic Track) can provide a high level of cardiovascular and muscular fitness without excessive wear on the prosthetic joint materials.
The list of of Knee Joint Replacement Hospitals in India is as follows : -
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Email : - info@wecareindia.com
Call: +91 9029304141 (10 am. To 8 pm. IST)
(Only for international patients seeking treatment in India)
For a detailed evaluation send patient’s medical reports / X rays / doctors notes to info@wecareindia.com
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Immediately after your operation you may wake up to find your leg on a CPM (continuous passive movement) machine, this may be left on overnight.
Most people find this quite comfortable and are able to sleep without a problem.
Crutch Sequence: Crutch, Operated Leg, Un-operated Leg
At this stage it is important not to overdo things and cause the knee to swell, swelling makes knee bending more difficult and prevents the thigh muscle working efficiently. Exercises are designed to gradually increase bend (mobility exercises) and to strengthen muscles (strengthening exercises) and you will be expected to regularly do both types.
Stairs sequence:
Upstairs:Un-operated leg, followed by operated leg and crutch together
Downstairs:Operated leg with crutch, followed by un-operated leg.
