What to do after a Total Knee Replacement

When considering rehabilitation from your knee replacement, it is important to firstly understand what exactly has happened in your knee. When you have a knee replacement, it is usually because the cartilaginous surface (outer lining) of your femur (thigh bone) and tibia (shin bone) have worn away, resulting in the underlying bone rubbing, as shown in the picture on the left. On the right, you can see what your new knee looks like. The ends of the bone have been removed and replaced with prostheses. In some cases, the under surface of the patella (knee cap) is also replaced. This is dependent on the amount of wearing of the cartilage on the patella. Your physio can help explain this further if needed.

The rehabilitation process starts the day of your surgery and can take up to 2 years to achieve full strength and function in your knee. Obviously the majority of your gains will be in the vital first few weeks. As physiotherapists, there are a number of areas that we work on following a knee joint replacement. These include strength, stiffness, gait pattern and swelling. We use many techniques to achieve your goals and often there is the need to be customised as each person has different problems and responds differently to different techniques. Therefore recipes are not the answer, but rather customised programmes.

• Strength
• Following surgery there is usually wasting of the muscles around the knee, in particular the quadriceps (thigh muscle). Strength training starts as soon as possible in the hospital, to reduce the amount of muscle wasting and start to improve strength
• As you improve, the exercises that you are doing will need to be progressed to avoid plateauing prior to achieving full strength
• Stiffness
• Stiffness is a common problem after knee joint replacements. This is due to a range of factors including pain, swelling, bruising and scar tissue. It is important to start range of movement exercises early prior to the development of scar tissue, as scarring will make it much harder to achieve full range of movement. Often your perceived success will be judged on your movement gains.
• The average range of movement gained following a knee replacement is 120 degrees. This can take a few months to achieve.
• If your knee is really stiff and not making improvements, your surgeon may recommend a “manipulation under unaesthetic”. In this procedure, they put you under anaesthetic and bend your knee as far as possible. Following this, most people find they can maintain a much better range of movement. But does require another anasthetic and is best avoided if possible.
• Gait pattern
• Following surgery, you will initially use a frame to walk, before being progressed onto crutches. Most people use their crutches for about 6 weeks after the surgery.
• It is common to walk with a limp for some time after surgery. Physiotherapists can help to improve your gait pattern and get you walking normally again. Ironing out any gait problems and habits that may have been present for years.
• Swelling
• It is normal for swelling to last 3–6 months after surgery
• Swelling can be managed by:
• Ice (initially for 20 minutes, every 2 hours)
• Rest (make sure you do take time to rest and elevate your leg, don’t overdo the walking)
• Tubigrip (compression bandage)

Common Questions following a knee replacement:

• When can I drive?
• This is up to your surgeon, but is usually at around 6 weeks. You should be able to walk comfortably without crutches first.
• Can I kneel after my knee replacement?
• There is no reason why you can’t kneel, but it is often uncomfortable. Everyone is different so you will need to use your pain as a guide. You may find it helpful to kneel on a foam mat (such as those used for gardening)
• Can I run after my knee replacement?
• Low impact exercise will help to increase the longevity of your knee and are preferable to high impact exercise such as running
• Will I need any aids at home?
• It is common to need a chair to put over the toilet, as it is often challenging to get up from a low toilet seat initially. Also, a chair for the shower allows you to sit in the shower, which will be much easier. These can often be hired from your local chemist or rehabilitation equipment hire companies
• You will also most likely need crutches for a few weeks after your surgery. These can also be hired from your local chemist or rehabilitation equipment hire companies

Infection/Blood clots:
It is important to know the signs of infection and blood clots and to speak to your GP if you notice any of these.

• Signs of infection:
• Wound breakdown (oozing or pus)
• Significant increase in pain (that does not seem to be related to an increase in activity)
• Redness
• Heat
• Unpleasant smell
• Signs of blood clots:
• Pain in your leg or calf unrelated to your incision
• Tenderness or redness above or below your knee
• Increased swelling of your calf, ankle or foot

Hawthorn Physiotherapy Clinic has been working closely with Melbourne’s top surgeons for 40 years. Our physiotherapists are very experienced in treating post-operative patients and are at St Vincent’s, Kew on a daily basis seeing patients pre and post operatively. If you have any questions regarding your total knee replacement, please contact us at the clinic.

(03) 9819 2827