Physiotherapy For Total Knee Replacement Surgery
A total knee replacement (TKR) or total knee arthroplasty is a surgery that replaces an arthritic knee joint with an artificial metal or plastic replacement parts called ‘prostheses’.
Total knee replacement is usually recommended for older patients who suffer from pain and loss of function from arthritis. Those selected for a total knee replacement have usually tried many other forms of conservative therapy.
The typical knee replacement, replaces the ends of the femur (thigh bone) and tibia (shin bone) with plastic inserted between them and usually the patella (knee cap).
Most patients who have TKR are between 60 to 80 years, but each patient is assessed individually and patients as young as 20 or old as 90 are occasionally operated on with good results.
Indications for Total Knee Replacement
By far the most common indication for a total knee replacement is the irreversible effects of arthritis. The artritic knee usually has little to no cartilage, it is inflammed and swollen, the joint space is significantly narrowed and there are prominent bone spurs about the edges of the knee joint. The combination of these factors leads to a knee that is extremely painful and stiff rendering the sufferer mostly immobile.
Other than arthritis, other causes include:
* Trauma (fracture)
* Increased stress e.g., overuse, overweight, etc.
* Connective tissue disorders
* Inactive lifestyle- e.g., Obesity, as additional weight puts extra force through your joints which can lead to arthritis over a period of time.
* Inflammation e.g., Rheumatoid arthritis
Each knee is individual and knee replacements take this into account by having different sizes for your knee. If there is more than the usual amount of bone loss sometimes extra pieces of metal or bone are added.
Surgery is performed under sterile conditions in the operating theatre under spinal or general anaesthesia. The damaged portions of the femur and tibia are then removed and the new prosthetic knee inserted. Your surgeon will carefully aligned your knee and ensure that it is moving properly.
Once stable, you will be taken to the ward. The post-operative protocol is surgeon dependant, but in general you will sit out of bed and start moving your knee and walking on it within a day or two of surgery. The dressing will be reduced usually on the 2nd post of day to make movement easier. Your rehabilitation and mobilisation will be supervised by an in-hospital physiotherapist.
Getting The Best Results From Your Total Knee Replacement With Post Op Physio Care
Many of the long term results of knee replacements are dependant on how much work you put into it following your operation.
Usually you will be in hospital for 5-7 days and then either go home or to a rehabilitation facility depending on your needs. You will need physiotherapy on your knee following surgery.The hospital physio will generally give you some early exercises to get started on and these will be progressed to more difficult ones by your own physiotherapist as you get better and stronger.The most important thing to remember is to do the exercises in small amounts and often.Increased pain or swelling are your indication that you’ve done too much and this will generally respond to ice packs.
You will be discharged on a walking aid either on a frame or crutches and usually progress to a walking stick as you are able.
Bending you knee is variable, but by 6 weeks it should be to 90 degrees. The aim is to get 110-115 degrees of movement.
Once the wound is healed, you can take a shower. You can drive at about 6 weeks, once you have regained control of your leg. You should be walking reasonably comfortably by 6 weeks.
More physical activities, such as sports may take 3 months or more to be able to do comfortably and this will be at the discretion of your surgeon.
When you go home you need to take special precautions around the house to make sure it is safe like lifting any rugs that you could trip over. You may need rails in your bathroom, a toilet seat raise to enable you to get on and off the toilet when your knee can’t bend properly and you may need to organise alternate sleeping arrangements if your bedroom is upstairs.
You will usually have a 6 weeks check up with your surgeon who will assess your progress.
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