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Common Conditions

Knee Replacement (Rehabilitation)

25/09/2020

The knee is the most commonly replaced joint in the body. The decision to have knee replacement surgery is one that should be made a consultation with an orthopaedic surgeon and a physical therapist. Usually, total knee replacement surgery is performed when people have knee joint damage due to osteoarthritis, rheumatoid arthritis, other bone diseases or fracture that has not responded to more conservative treatment options. Knee pain or alignment problems in the leg that cause difficulty with walking or performing daily activities which have not responded to more conservative treatment options is also another reason that leads to surgery.

A total knee replacement (TKR), also known as total knee arthroplasty, involves removing the arthritic parts of the bones at the knee joint (the tibia, sometimes called the shin bone; the femur, or thigh bone; and the patella, or kneecap) and replacing them with artificial parts. These parts consist of a metal cap 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. When appropriate, the back part of the kneecap also may be replaced with a smooth plastic surface.

The physical therapist is an integral part of the team of health care professionals who help people receiving a total knee replacement regain movement and function, and return to daily activities. A physical therapist can help prepare for and recover from surgery, and develop an individualized treatment program in the safest and most effective way possible.

The better physical shape one is in before TKR surgery, the better the results will be (especially in the short term). A recent study has shown that even 1 visit with a physical therapist prior to surgery can help reduce the need for short-term care after surgery. Before surgery, a physical therapist may teach exercises to improve the strength and flexibility of the knee joint and surrounding muscles, demonstrate how to walk with assistance after the operation, preparation for the use of an assistive device, discuss precautions and home adaptations.

The goal of the first 2 weeks of recovery is to manage pain, decrease swelling, heal the incision, restoring normal walking and initiate exercise. Following those 2 weeks, a physical therapist will tailor range-of-motion exercises, progressive muscle-strengthening exercises, body awareness and balance training, functional training and activity-specific training to address specific goals. Safe and effective range of motion exercises will be prescribed to restore movement (range of motion) to the knee. Strengthening exercises will also be advised. A physical therapist may also add agility exercises (such as turning and changing direction when walking, or making quick stops and starts) and activities using a balance board that challenge balance and knee control based on their examination of the knee. When the recovery progresses, functional training and activity-specific training will be incorporated. If in doubt, seek professional advice.