You are about to have Knee Replacement Surgery (TKR). A lot of the long term results of knee replacements depend on how much work you put into it following your operation. Patients who prepare for surgery and actively take part in their care can recover in less time and with less pain. This guide has general information along with tips for things to do before and after surgery to help you make it a success.
You may get different instructions from your surgeon, doctor or physiotherapist. Always follow the directions of your care team. This guide is meant to be used under the direction of your physiotherapist.
Caution: If you have too much pain in your knee to exercise, or if any of the exercises cause more pain or swelling in your knee, stop. Tell your physiotherapist or doctor. If your whole leg becomes swollen or hot, tell your doctor right away!
General Guidelines: Before Surgery
If you exercise before surgery you can have a faster and easier recovery. Exercise helps to:
- Maintain the range of movement of your knee
- Make your muscles strong
- Control your pain
- Build your knowledge of how to exercise after surgery
- Improve your sleep
Do activities that put less stress on your knee. Try cycling on a stationary bike (upright or seated) for 5-10 minutes, walking in water (water level should be atleast thigh deep). It is best to do specific knee movements and strengthening exercises (in guidance of physiotherapist).
- Always warm up before exercising. Your physiotherapist may tell you to:
- Apply moist heat to the front and back of your knee for 5-10 minutes OR Have a warm shower or bath
General Guidelines: After Surgery
Exercise after surgery will help you recover and regain the movement and strength of your knee. Exercise also helps to:
- Reduce swelling
- Prevent blood clots (Thrombosis)
- Control your pain
- Prevent constipation
- Improve your sleep
Tips to help you make the most of your Knee (TKR) surgery
- Take your recovery and rehab seriously. Exercise regularly as per the programme charted by your physiotherapist.
- Continue with your knee replacement rehab programme for at least 3 weeks after surgery, probably 3 months of physiotherapy guided knee exercises to get the best result from your knee replacement.
- Follow-up regularly with your surgeon, to monitor internal recovery.
- Walker or crutches should be used until discontinued by Doctor or Physiotherapist.
- Change knee position at least once an hour, while awake, to avoid stiffness.
- Home exercises should be performed 3 times everyday unless advised differently by your Physiotherapist.
- Walking is an excellent activity and you are strongly encouraged to gradually increase your walking distance after you leave hospital.
- Walk outdoors as long as sidewalks are dry. Consider going to a mall to walk when the sidewalks are wet and slippery.
- Swimming or walking inside swimming pool (where water level is at least till your thigh) is a very good strengthening exercise that prevents jerks and unnecessary strain on the knee.
- Stay positive and committed. Don’t give up, and do what you can to keep a good attitude.
Don’ts : For 6-8 weeks after surgery, avoid:
- Any pivoting (twisting) on your knee 2.Kneeling down 3.Squatting
- Avoid high impact activities that cause jerk and stress on the knee joint, example running, jogging, rock climbing etc.
- Avoid unnecessary stress on your knee by lifting very heavy objects. This can cause damage to your new knee.
- Avoid using Indian traditional toilet, instead use a Western Commode (WC) or toilet chair.
Immediately after surgery, you can continue to do the following in bed :
1. Deep Breathing and Coughing Exercises :
Until you are up and moving well, take at least 10 deep breaths, followed by a cough, every hour that you are awake.
2. Pump Your Ankles :
When lying down, move feet up and down and in circles. Repeat 10 -15 times every hour you are awake.
3. Buttock Contractions
Tighten your buttock muscle and hold for a count of 5 seconds. Repeat five to ten times, three to four times each day
Moving your new knee :
It is important to move your knee soon after the operation unless your surgeon or physiotherapist tells you not to. This will minimize stiffness, pain and swelling, and reduce the formation of scar tissue. Check with your physiotherapist for guidance about the best way to warm up your new joint.
To Keep Pain and Swelling under control, once you are home:
1. Rest Your Joint
- Change positions often (every 20 minutes) when you are awake. Try sitting, standing, and walking.
- Pace yourself. Take things easy and slow.
- Lie down 3 times a day for 30 minutes on your bed.
- Put your leg up and support it with a rolled towel or with pillows (as shown).
2. Use Ice
Ice your knee when it is hot and red, painful and after exercises. (If your knee is very stiff and painful, check with your physiotherapist before icing
Follow these steps:
- If your scar is not healed, cover it with a clean bandage and clean plastic wrap
- Put a damp hand towel over your knee
- Put a flexible gel pack, or plastic bag with crushed ice on your knee
- Leave the ice ON for 10 minutes. Take it OFF for 10 minutes. Put it back ON for 10 minutes. Repeat 4-6 times a day
- DO NOT use ice if your doctor has told you that the circulation to your legs is poor and that you should avoid using ice or heat
3. Use Pain Medicine
Use your pain medicines as prescribed by your doctor. Tell your doctor if the pain is too much or not improving.
4. Use Walking Aids
Use the walking aid that your physiotherapist has measured and recommended. Do not change or stop using the walking aid until your physiotherapist or surgeon tells you to. Walkers, crutches and canes help to:
- Reduce the stress on your knee Reduce pain Improve your balance and reduce falls
- Remember it is better to have a good walking pattern using two crutches than to limp and risk losing balance.
5. Sleep : It helps with rest and recovery. It is normal to have some sleepless nights up to 12 weeks after your knee surgery.
Consult an expert at ReLivaTM Physiotherapy & Rehab to learn more about rehab, Mobility Techniques and tips to make your Total Knee Replacement (TKR) Surgery a success.