What To Expect After a Total Knee Replacement
Total knee replacement surgery is a major surgery that requires careful preparation and an effective post-surgical rehabilitation program to ensure pain-free function and mobility of the joint. A total knee replacement involves removing the arthritic parts of the bones at the knee joint and replacing them with artificial parts. Physical therapists play a critical role in pre-surgery preparation and post-knee replacement rehabilitation, helping you improve mobility, decrease stiffness, manage pain, and gradually and safely restore function and range of motion in your new knee.
What is a Total Knee Replacement?
A total knee replacement is a major surgery that requires careful preparation and an effective post-surgical rehabilitation program to ensure pain-free function and mobility of the joint. The knee is the most commonly replaced joint in the body. Total joint replacement surgery is recommended as the last intervention for those with a severe knee injury or who have significant knee joint damage due to osteoarthritis, rheumatoid arthritis, other bone diseases, or a fracture that have not responded to more conservative treatments.
A total knee replacement involves removing the arthritic parts of the bones at the knee joint, including the tibia, femur, or patella, and replacing them with artificial parts. The damaged cartilage and bone are cut away and the artificial joint is put in its place. The artificial parts are made up of a metal cap that is placed at the end of the femur and a cemented piece of metal in the tibia with a plastic cap on it to allow the surfaces to move smoothly.
Pre-Surgery Physical Therapy
The more prepared you are for knee replacement surgery, the more likely you are to have a successful recovery. One of the key ways to prepare for knee replacement surgery is through pre-surgery physical therapy, which helps to strengthen the muscles around the joint and create stability around the joint.
Studies have shown that patients who engage in pre-surgery physical therapy regain function faster than those who did not do so, have less operative pain, fewer complications, and decreased hospital stay and recovery time. Pre-surgery rehabilitation is an exercise conditioning program to increase the patient’s stamina, flexibility, and joint mobility; normalize movement patterns prior to surgery, and enhance overall fitness. The physical therapist can also design a safe home exercise program for you to begin immediately after surgery, prior to your return to outpatient physical therapy post-surgery.
What to Expect During Recovery & Rehabilitation After Knee Replacement Surgery
Over 90% of patients who have knee replacement surgery experience a significant improvement in their pain and mobility within 3 months. Rehabilitation normally involves 12-14 weeks of intensive rehabilitation to restore the knee to pain-free functional movement and range of motion and a return to normal activities.
An orthopedic surgeon performs the knee replacement surgery, which can last between 90 minutes to 2 hours. Immediately following surgery, you will be monitored for proper incision healing and manageable pain levels. You may stay in the hospital for the next 2-4 days or be sent home directly depending on how your healing progresses. While in the hospital, you will work with a physical therapist to begin gentle mobility and range of motion exercises and begin moving with an assistive device.
Recovery at home: Once discharged from the hospital, you will be sent home. During this time, it is important to elevate the knee and ice the knee to control swelling.
Outpatient Physical Therapy:
Week 1-3: The physical therapist focuses on helping you reduce pain and gain confidence in moving. The therapist will start you on a daily routine of strengthening and flexibility exercises with the goal of you bending your knee, moving from sitting to walking and bending the knee at a 90-degree angle and fully straightening the knee. The therapist will also help you use assistive walking devices, progressing from a walker to a cane by week 3 or 4 of recovery.
Week 4-6: After one month of recovery, your knee strength improves and your pain and swelling decrease. During physical therapy, you will begin low-impact activities like cycling, swimming, or longer walks to improve endurance and bend the knee 120 degrees. The aim is to help you begin climbing stairs comfortably and returning to light household chores.
Week 7-12: At this point, you can return to more intense physical activities gently and slowly. You should be significantly more mobile and can engage in more intense strengthening, mobility, and aerobic exercises.
Week 12: By week 12, you will have a stronger, more resilient knee. While you may begin to taper off in-person physical therapy appointments, maintaining a home exercise physical therapy program is critical to sustaining the function, mobility, and range of motion you regained during rehabilitation. You can return to regular activities; however, avoid high-impact exercises like basketball or skiing initially.
Physical Therapy After a Total Knee Replacement
Physical therapists are an important part of your healthcare team as you prepare for and recover from a knee replacement. Physical therapy helps you improve mobility, decrease stiffness, manage pain, and gradually and safely restore function and range of motion in your new knee. A physical therapist creates a customized rehabilitation program based on your specific condition that can include:
Range of motion exercises: Swelling and pain immediately after surgery can make you move your knee less. However, the physical therapist helps you gently restore movement through range of motion exercises following surgery and progressing to more intense exercises as your knee heals.
Strengthening exercises: The physical therapist helps you to progressively strengthen muscles, particularly the quadriceps, hamstrings, and lower leg muscles that support the knee.
Body awareness and balance training: The therapist guides you through specialized training exercises to help your muscles relearn to respond to changes in your environment. Once you can put full weight on the knee without pain, the physical therapist adds agility exercises (turning and changing direction when walking or making quick stops and starts) and balance board training.
Functional training: When you can walk without pain, the therapist will add functional activities to help you test your abilities.
Activity-specific training: As you progress towards the 3-month mark post-surgery, the therapist will begin training exercises to help you meet the requirements of your job or the types of sports you play, such as climbing a ladder or swinging a golf club.
Knee replacement surgery is a major surgery requiring careful preparation and an intensive rehabilitation process. Our physical therapists are here to support you throughout the process, helping you effectively prepare for surgery and restore movement, strength, and function safely and gradually following surgery.
