Recovering From a Total Knee Replacement
A total knee replacement (TKR), medically referred to as a total knee arthroplasty (TKA), is indicated when pain becomes high enough to severely effect function. Often, this pain is the result of degenerative arthritis. X-rays will frequently reveal decreased joint space and may include spurring and uneven joint surfaces.
The surgery most often involves an implant attached to the distal (bottom) end of the femur as well as an implant attached to the proximal (top) end of the tibia. An implant is affixed to the underside of the knee cap and a spacer is then inserted between the implants to maintain optimum joint space and function. There are variations among surgeons and implants. Thus, it is best to speak with your surgeon to determine optimal procedure.
Physical Therapy (PT) often commences the day after surgery. Patients are often standing and walking short distances within the first few treatments. Goals during the hospital stay are pain control, ambulating short distances with equipment such as a walker, and trying to gain as much range of motion as possible. Patients may sometimes be placed on a continuous passive movement (CPM) machine to assist range of motion gains.
Upon discharge from the hospital, patients will begin outpatient Physical Therapy. This often involves some form of exercise, manual stretching of the knee, mobilization of the joint, soft tissue work, and modalities for pain control. Goals are typically set for patients to return to walking and to gain knee range of motion. A common goal is to have the knee as straight as possible and to bend the knee up to 120 degrees of knee flexion. It is important to realize that everyone has a unique response to surgery and timeframe in which they heal. Some patients may gain normal range of motion quickly and return to pain free walking within 1-2 months. Other patients may have a harder time, especially if pain is high, and they may be in PT for several months. It is important for patients to understand that healing takes time and although they may gain function quickly, pain and stiffness may remain for greater than 6 months.
It is imperative to recovery that patients take an active role in their rehabilitation and participate in exercises and stretches at home up to 5 times daily. The patients Physical Therapist should provide several exercises to complete at home. Strength is important, but early on, range of motion is likely to be the priority. Stretches will include bending the knee into resistance as well as trying to straighten the knee into full extension and applying overpressure as directed.
An example of a stretch to gain knee extension
Ice & Medication
Ice can be an important part of managing pain.Patients will commonly ice several times per day.The general recommendation is 15 minutes of ice every hour.It is important to seek professional advice as icing frequency may depend on swelling and tissue quality.
Medication can also be valuable in reducing inflammation and controlling pain.Each patient should seek medication advice from your pharmacist or physician and take it as advised.
Return to Function
Patients are often eager to return to their normal routine, including driving and getting in the pool.A return to driving often occurs at two months post surgery.It is important that patients are no longer taking narcotic pain medication for safety reasons.Returning to the pool is largely based on healing of the incision and tissue quality.It is important that the incision is well healed before getting into the water as any open wound or scab may be a potential site for infection.
Although the process is quite painful, patients can return to normal function and be pain free.Patients may be eager to return to certain activities.It is important to realize that more is not better and to heed the advice of your healthcare team.It is normal for pain to move locations, the knee to feel warm, and to feel swollen for several months.Just remember to work hard and seek encouragement from friends, family, and your healthcare providers.
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