total knee replacement

Introduction

The orthopedic surgeon has advised you to replace the knee joint with an artificial joint, so called prosthesis. In this brochure you can review the information that has been given to you by the orthopedic surgeon concerning the rehabilitation after the surgery.

Physical Therapy

It is advised to bring your own crutches with you at admission. Physical Therapy will begin in the hospital soon after the operation. When you can walk independently and safely with no complications discharge can occur within 3-4 days. Naturally the discharge has to be medically justified. The orthopedic surgeon will decide together with you and in accordance with the physical therapist and nurse when you can go home.

Rehabilitation Schedule in the Hospital

Knee movements and walking are important for your recovery. Therefore physical therapy is an extremely important part of rehabilitation and requires full participation of the patient for an optimal outcome. Physical therapy will start immediately after the operation.

Day of Operation

After surgery you will be moved to the recovery room, where you will remain for 1 to 2 hours while you recover from surgery. Some degree of pain, discomfort, and stiffness can be expected during the early days. When you awake and have stabled vital signs, you will be taken back to your hospital room. To restore movement in your knee and leg, besides the active physical therapy, a CPM device (continuous passive motion) can be used, if indicated. The following exercises will be encouraged soon after surgery to increase blood flow in your leg muscles to help prevent leg swelling and blood clots:

• Foot and ankle movements.
• Actively bend and extend the knee or move it sideways while lying in bed.
• Stretching the leg. Don’t support the knee by putting a pillow under it.

Day One

The physical Therapist will visit you in the morning hours. You will be encouraged to exercise, sitting on the side of the bed to move your legs actively and passively with the help of the physical therapist. You will try to stand up and walk a few steps with the support of a walker or crutches. It is important to put weight on the operated leg unless the orthopedic surgeon decides differently. You will be asked to sit up in a chair. Also while sitting up in a chair you can do your exercises for better function and to prevent thrombus-embolism by bringing your foot upwards and downwards. Upon completing your exercises a nurse will take you back to your bed.

Day Two

The second day post-op you will try together with the nurses to get out of bed into a chair. This is so the physical therapist can work directly with you. The goal for this day is to be able to walk independently with a walking aid. Exercises will be expanded to increase mobility and strength of the muscles around the knee. On this day you will also start to learn how to walk up and down the stairs.

Day Three

On day three you will try to increase your walking distance with crutches. The physical therapist will work together with you to walk up and down stairs. When walking staircases the following rules need to be applied:

• To walk up the stairs: non-operated leg first, followed by the crutch and the operated leg.
• To walk down the stairs: crutch first followed by your operated leg, then the non-operated leg.

Discharge

On the day of discharge, it is important that you are able to walk safely with your crutches. The knee should have the possibility to bend around 90 degrees and extend fully. Furthermore you should more or less be able to independently lift up your leg in an extended position. You will continue the Physical Therapy after your discharge. The first weeks after discharge physical therapy will continue at least 3 times a week. Preference is to arrange transportation to the clinic since there are more possibilities to exercise. An alternative is to start the physical therapy treatment at home until the transportation is arranged.You will visit the orthopedic surgeon for a follow-up 2 weeks postoperatively. This visit will address wound control, removal of stitches, function control and a 6 weeks post X-Ray.

Useful Advise Post Operation

• After 3 days you are allowed to shower (in consultation with the nurses). It is best to wash the skin around the wound with your hands (no cloth) in an up and downwards motion (not sideways). Don’t use any creams or lotion near the wound to decrease the risk of infection 
• Use a higher chair to sit on; it will be easier to stand up and it will make it possible to do bending exercises with the operational knee by placing your foot on a towel on the floor and moving it backward and forward. 
• When walking stairs use the handrail when present.

Gradually increase your walking distance, initially in your home and later outside. It is necessary to try to walk as often as possible.

• Swimming is only allowed after approval of the (orthopedic) surgeon 
• If the bending movement of the knee is sufficient you can start riding a bike in consultation with the physical therapist. 
• Driving usually begins when your knee bends sufficiently so you can enter and sit comfortably in your car. Most individuals resume driving approximately 6 weeks after surgery. Consult your insurance company before starting to drive.