Arthroplasty, or total knee replacement surgery, is a major surgical procedure and to ensure proper healing it is important to follow the directions given by your orthopedic surgeon. The knee bears a great deal of weight and a well designed physical therapy plan should be followed after knee surgery to ensure restoration of movement and mobility to the knee joint.

Very basically, arthroplasty involves replacement of the knee joint cartilage with a prosthesis made up of special metals and plastics and involves a hospital stay of 3 to 7 days after the knee replacement surgery. Most hospitals will not discharge a patient who has had replacement knee surgery unless they can walk with the aid of crutches. Knee rehabilitation therapy commences almost immediately after the surgery and can continue for several months. This is a crucial key to good recovery.

Since it can take up to 3 weeks after surgery before the repaired knee joint can be expected to bear any weight, it may be necessary for patients to receive in-home assistance. If in-home care is not available then there are rehabilitation centers that can provide that service. This would mean staying at the center for 2 or 3 weeks after the operation. During this time the leg should be kept elevated as much as possible and use ice packs to help minimise swelling.

Since we are all different with different health, fitness and motivation levels and the complexity of knee surgery varies with each operation, the recovery procedure and recovery time can vary. The following are guidelines only and can vary from case to case.

For the first three to four weeks after the knee replacement, walking with aid of crutches or a walker is necessary.

After that period the use of a cane is recommended for two to three weeks.

Usually, after around 8 weeks, most people can walk unaided.

It generally takes from 6 to 12 months for the knee joint to heal completely. This time frame is dependent on the knee exercises and rehabilitation program being followed and on the knee not being damaged by trying to pursue some activities too soon.

The level of mobility of the knee following the surgery varies from person to person, however, most people should be able to bend the repaired knee joint to 90 degrees with two to three weeks after their knee replacement surgery. Eventually, many will get over 110 degrees of motion in the repaired knee.

It should be possible to return to jobs that are sedentary by 6 weeks after surgery. More physical jobs should be looked at on an individual basis in conjunction with your health care professional.

After about 12 weeks, most people are back to their normal activities and the pain experienced before the knee replacement has usually disappeared by this time.

It is important to remember that the components used in the knee joint prosthesis are not able to heal if the knee is damaged and so common sense must prevail when considering undertaking leisure, sporting and employment activities to lessen the risk of injury. Here is a list of recommended activities, activities that are allowed in moderation and ones that should be avoided altogether.

Recommended activities

* Swimming and water aerobics

* Cross-country skiing

* Golf

* Dancing

* Cycling

*Using training machines like cross trainers and exercise bikes

* Desk work

Permitted: Allowable in moderation:

* Hiking

* Sports like gentle tennis or gentle downhill skiing

* Jobs that do not require heavy lifting (driving, walking, standing etc).

These activities should be avoided at all costs:

* Jogging or running

* Impact exercises

* Contact sports and those sports that put a lot of stress son the knee through pivoting or twisting e.g. basketball, squash, football etc.

* Heavy labor and lifting.

With the advances made in total knee replacement surgery procedures and prosthetics, almost full use of the knee can be expected for many years.

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Even though orthopedic knee surgery is a major operation the rehabilitation process commences almost immediately.

Prior to the knee surgery operation your orthopedic surgeon will discuss with you everything about the recovery period and what you should do to ensure the best possible recovery results. You’ll learn that knee replacement recovery can take from between six and eight weeks. In that period of time there will be certain exercises for you to do to help in the recovery process.  He will also discuss other things such as pain management, driving etc.

After the knee surgery operation you will be advised to keep your leg elevated and for a short period of time ice packs may be applied to help reduce swelling.

Usually within a day or two of the knee operation you will be expected to put weight on the knee and to start walking. Initially this will only be for short periods of time.  You will also be given other total knee replacement exercises to do to assist in your recovery.  You may have to do these exercises and others for 2 to 3 months.

When you first start to walk you will not be expected to do so unaided.  You should have access to a walker or crutches to help you.  Your orthopedic therapist will also be with you to advise and help.  It is important for your knee replacement recovery that you put as much weight on the knee as possible without it becoming uncomfortable.  However, if the pain becomes too much or swelling occurs then you are probably doing too much.  

You may experience some pain in the knee joint following the knee surgery.  This is completely normal and medication to relieve the pain should be available to you.  Once the pain ceases you should stop taking the pain medication.

Driving should not be attempted for at least 7 days after surgery and before commencing to drive consult with your therapist or doctor to ensure that it is OK to do so.

If you feel that recovery is not occurring as you feel it should, you feel an excessive amount of pain in your knee, it feels hot or there are signs of excessive swelling then consult with your doctor or orthopedic specialist.

For most people recovery from total knee replacement surgery is routine and complications are rare.

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Below we will discuss some of the issues involved in recovering and rehabilitating from this orthopedic surgery.

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Total knee replacement recovery exercises play a major part in your recovery following knee surgery.  Remember that your knee replacement procedure was a major operation and full recovery will take time. 

It is imperative that a regular exercise regime is commenced as soon as possible to help restore the mobility and strength to your knee.  This will help speed up your recovery so that you can return to your normal activities as quickly as possible.

Your orthopedic surgeon will recommend the knee exercises that you should do.  These will generally start off fairly light and gradually increase in intensity.  It is important to follow your surgeon’s instructions on this physical therapy.
As you gain more strength and confidence your knee therapy can consist of more advanced exercises.  Here are some which can be useful.  Before starting on these exercises please run them past your orthopedic surgeon or physical therapist.  These advanced exercises should be started until at least 4 weeks after your knee surgery.

AdvancedKnee Exercises

Standing Knee Bends

Stand up and using a walker or crutches to steady yourself, lift your thigh while bending your knee as much as you can.  Hold this position for between 5 to 10 seconds and then straighten your knee making sure that your heel touches the floor first.  Repeat this a few times but do not over do it.

Advanced Knee Bends

Lie on your back and bend your knee to about 45 degrees.  Place a rolled up towel over your ankle and take hold of each end.  Gently pull back on the towel to increase the angle of bend.  Hold for around 5 – 10 seconds.  Repeat this exercise several times.

Resistance Knee Exercises

Using light weights, repeat the above exercises with the weights wrapped around your ankle.

These resistance exercises should not be started until at least 4 – 6 weeks after your knee replacement surgery. 

You will need some light weights that can be tied around your ankle.  These can be obtained from most sports stores.  Start with one or 2 pound weights and slowly increase the weight as you regain strength in the knee joint.

Exercise Bike

Using an exercise bike is great way to increase mobility in your knee and muscle strength.

Make sure you set the bike up properly.  Adjust the height of the seat so that with your knee almost straight the bottom of your foot touched the pedal.  Keep the tension of the exercise bike fairly low so it is easy to pedal.

First of all pedal backwards.  When you achieve a pedalling motion that does not give you any discomfort then start pedalling forwards.  Do this twice a day for about 15 minutes and slowly increase the time.  When you feel comfortable in doing so, increase the tension.

Precautions

It is not uncommon for you to feel knee pain or swelling after knee physical therapy like this.  This can be relieved by applying ice to your knee and elevating your leg.  If you feel the pain or swelling is extreme, cease the exercises and consult your health specialist.

These exercises should be an integral part of your total knee replacement recovery regimen 

Written by Kerry N  

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