Total Knee Replacement(TkR) Rehabilitation
Total Knee Replacement Rehabilitation is aimed at preventing hazards of bed rest, help with adequate functional ROM and strengthening knee musculature to acquire independent activities of everyday living.
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A total knee replacement (TKR) is generally done as the surgical treatment option for advanced osteoarthritis from the knee joint. Throughout the surgery, the knee joint is substituted for artificial material. The knee joint consists of the femur (thigh bone), the tibia (shin bone), the patella (knee cap) and cartilage (usually worn-out because of OA).The end of the femur is taken away and replaced with metallic surface and the the surface of the tibia is removed and substituted for a plastic piece which has a metal stem. When the knee cap has additionally degenerated, a plastic piece might be added to the back surface to produce a smoother joint surface.
Indications for Total Knee Arthoplasty
Disabling knee pain with functional impairment
Radiographic proof of significant arthritic involvement
Failed conservative measures including ambulatory aids (canes), NSAIDS, and lifestyle modification. Contraindications for Total Knee Replacement
Absolute
Joint infection
Sepsis or systemic infection
Neuropathic arthropathy
Painful solid knee fusion (usually because of RSD. RSD is not helped by additional surgery)
Relative
Severe osteoporosis
Debilitated poor health
Nonfunctioning extensor mechanism
Significant peripheral vascular disease
Goals of Total Knee Replacement Rehabilitation
Prevent hazards of bed rest like DVT, pulmonary embolism, pressure ulcers.
Assist with adequate and functional flexibility.
Strengthen the knee musculature.
Assist patient in achieving functional independent activities of everyday living.
Independent ambulation with an assistive device.
Perioperative considerations for Total Knee Replacement Rehabilitation
Component design, fixation method, operative technique (osteotomy, extensor mechanism technique), bone quality will all affect perioperative rehabilitation. Implant could be posterior cruciate ligament (PCL) retaining, PCL sacrificing, or PCL sacrificing with substitution.
Rehabilitation of Patients with Hybrid Ingrowth Implant versus individuals with Cemented knee Implant
Cemented Total Knee Arthroplasty
Ability for standing and walking as tolerated (WBAT) with walker from 1 day postoperative.
Hybrid or Ingrowth Total Knee Arthroplasty
Arrive weight bearing (TDWB) only with walker for first 6 weeks. Next 6 weeks, begin crutch walking with standing and walking as tolerated. Surgeon's preferences might be different.
Preoperative Physical Therapy
Review bed to chair transfers, bathroom transfers, tub transfers with tub chair at home.
Teach postoperative knee exercises and provide patient handout.
Teach ambulation with assistive devices TDWB or WBAT in the discretion of the surgeon.
Review precautions.
Inpatient Total Knee Replacement Rehabilitation Goals
0-90 degree ROM within the first 2 weeks before discharge from an inpatient setting.
Rapid return of quadriceps control and strength make it possible for patient to ambulate without knee immobiliser.
Rapid mobilisation to reduce risk of bed rest.
Day 1
Ankle pump
Initiate isometric exercises.
Quads sets Lie lying on your back with legs straight, together, and flat around the bed, arms with you. Perform this exercise one leg at any given time. Tighten the muscles on top of one of your thighs. Simultaneously, push the back of your knee downward in to the bed. The result ought to be straightening of your leg. Hold for 5 seconds, relax 5 seconds; repeat Ten times for each leg.
SLR This exercise helps strengthen the quadriceps muscle also. Bend the uninvolved leg by raising the knee and keeping the foot flat around the bed. Keeping your involved leg straight, enhance the straight leg about 6 to 10 inches. Hold for 5 seconds. Lower the lower limb slowly to the bed and repeat 10-20 times.
When you can do 20 repetitions with no problems, you can add resistance (i.e. sand bags) in the ankle to further strengthen the muscles. The quantity of weight is increased in a single pound increments.
Ambulate twice daily with knee immobilizer, assistance, and walker.
Cemented prosthesis: Standing and walking as tolerated (WBAT) with walker.
No cemented prosthesis: TDWB with walker.
Transfer up out of bed and into the chair twice daily with leg entirely extension on stool or any other chair.
CPM machine- Do not allow a lot more than 40 degrees of flexion on settings until after 3 days. Usually 1 cycle each minute. Progress 5-10 degrees each day as tolerated.
Initiate active ROM and active assisted ROM exercises.
During sleep place a pillow underneath the ankle to help passive knee extension.
Ice: Ice can be utilized during your hospital stay and also at home to help reduce the pain and swelling inside your knee. Pain and swelling will slow how well you're progressing with your exercises. A bag of crushed ice might be placed in a towel over your knee for 15-20 minutes. Your sensation might be decreased after surgery, so use extra care.
Day 2-2 weeks
Continue isometric exercises throughout Total Knee Replacement Rehabilitation.
Perform vastus medialis oblique (VMO) strengthening by terminal knee extension-Lie lying on your back with a blanket roll beneath your involved knee so the knee bends about 30-40 degrees. Tighten your quadriceps and straighten your knee by lifting your heel from the bed. Hold 5 seconds, then slowly your heel towards the bed. You may repeat 10-20 times.
Begin gentle passive ROM exercises for knee- knee extension, knee flexion, heel slides, wall slides.
Begin patellar mobilization techniques when incision stable to prevent contracture.
Perform active hip abduction and adduction exercises.
Continue active and active assisted knee ROM exercises.
Continue and progress these exercises until 6 weeks after surgery. Give home exercises with outpatient physiotherapist following patient 2-3 times each week.
Plan discharge when ROM of involved knee comes from 0-90 degrees and patient can independently execute transfers and ambulation.
2-3 weeks
Continue previous exercises.
Continue walking with walker until otherwise instructed by surgeon.
Prescribe prophylactic antibiotics for possible eventual dental or urological procedures.
Driving isn't allowed for 4-6 weeks.
Orient family to patient's needs, abilities, and limitations.
Review tub transfers as a whole Knee Replacement Rehabilitation
Many patients lack sufficient strength, ROM, or agility to step over tub for showering.
Place tub chair as long ago in tub as you possibly can, facing the faucets. Patient supports to the tub, sits around the chair, and then lifts the lower limb over.
Tub mats and nonslip stickers for tub floor traction are also recommended.
6 weeks onwards as a whole Knee Replacement Rehabilitation
Begin standing and walking as tolerated with ambulatory aid, if the has not already begun.
Perform wall slides and lunges.
Perform step ups.
Begin closed chain knee exercises on total gym and progress over 4-5 weeks for bilateral lower extremities.
Perform cone walking with progression.
Progress to stationary bicycling.
Other Considerations For the following 4-6 weeks after surgery
Avoid sexual activity. Sexual activity can usually be resumed after your 6-week follow-up appointment.
You usually can return to work within 2 to 3 months, or as instructed because of your doctor.
You should not drive a car until following the 6-week follow-up appointment.
Continue to wear elastic stockings (TEDS) until your return appointment.
No shower or tub bath until after staples are removed.
When using heat or ice, remember to not get your incision wet before your staples are removed.
Indications for Total Knee Arthoplasty
Disabling knee pain with functional impairment
Radiographic proof of significant arthritic involvement
Failed conservative measures including ambulatory aids (canes), NSAIDS, and lifestyle modification. Contraindications for Total Knee Replacement
Absolute
Joint infection
Sepsis or systemic infection
Neuropathic arthropathy
Painful solid knee fusion (usually because of RSD. RSD is not helped by additional surgery)
Relative
Severe osteoporosis
Debilitated poor health
Nonfunctioning extensor mechanism
Significant peripheral vascular disease
Goals of Total Knee Replacement Rehabilitation
Prevent hazards of bed rest like DVT, pulmonary embolism, pressure ulcers.
Assist with adequate and functional flexibility.
Strengthen the knee musculature.
Assist patient in achieving functional independent activities of everyday living.
Independent ambulation with an assistive device.
Perioperative considerations for Total Knee Replacement Rehabilitation
Component design, fixation method, operative technique (osteotomy, extensor mechanism technique), bone quality will all affect perioperative rehabilitation. Implant could be posterior cruciate ligament (PCL) retaining, PCL sacrificing, or PCL sacrificing with substitution.
Rehabilitation of Patients with Hybrid Ingrowth Implant versus individuals with Cemented knee Implant
Ability for standing and walking as tolerated (WBAT) with walker from 1 day postoperative.
Hybrid or Ingrowth Total Knee Arthroplasty
Arrive weight bearing (TDWB) only with walker for first 6 weeks. Next 6 weeks, begin crutch walking with standing and walking as tolerated. Surgeon's preferences might be different.
Preoperative Physical Therapy
Review bed to chair transfers, bathroom transfers, tub transfers with tub chair at home.
Teach postoperative knee exercises and provide patient handout.
Teach ambulation with assistive devices TDWB or WBAT in the discretion of the surgeon.
Review precautions.
Inpatient Total Knee Replacement Rehabilitation Goals
0-90 degree ROM within the first 2 weeks before discharge from an inpatient setting.
Rapid return of quadriceps control and strength make it possible for patient to ambulate without knee immobiliser.
Rapid mobilisation to reduce risk of bed rest.
Day 1
Ankle pump
Initiate isometric exercises.
Quads sets Lie lying on your back with legs straight, together, and flat around the bed, arms with you. Perform this exercise one leg at any given time. Tighten the muscles on top of one of your thighs. Simultaneously, push the back of your knee downward in to the bed. The result ought to be straightening of your leg. Hold for 5 seconds, relax 5 seconds; repeat Ten times for each leg.
SLR This exercise helps strengthen the quadriceps muscle also. Bend the uninvolved leg by raising the knee and keeping the foot flat around the bed. Keeping your involved leg straight, enhance the straight leg about 6 to 10 inches. Hold for 5 seconds. Lower the lower limb slowly to the bed and repeat 10-20 times.
When you can do 20 repetitions with no problems, you can add resistance (i.e. sand bags) in the ankle to further strengthen the muscles. The quantity of weight is increased in a single pound increments.
Ambulate twice daily with knee immobilizer, assistance, and walker.
Cemented prosthesis: Standing and walking as tolerated (WBAT) with walker.
No cemented prosthesis: TDWB with walker.
Transfer up out of bed and into the chair twice daily with leg entirely extension on stool or any other chair.
CPM machine- Do not allow a lot more than 40 degrees of flexion on settings until after 3 days. Usually 1 cycle each minute. Progress 5-10 degrees each day as tolerated.
Initiate active ROM and active assisted ROM exercises.
During sleep place a pillow underneath the ankle to help passive knee extension.
Ice: Ice can be utilized during your hospital stay and also at home to help reduce the pain and swelling inside your knee. Pain and swelling will slow how well you're progressing with your exercises. A bag of crushed ice might be placed in a towel over your knee for 15-20 minutes. Your sensation might be decreased after surgery, so use extra care.
Day 2-2 weeks
Continue isometric exercises throughout Total Knee Replacement Rehabilitation.
Perform vastus medialis oblique (VMO) strengthening by terminal knee extension-Lie lying on your back with a blanket roll beneath your involved knee so the knee bends about 30-40 degrees. Tighten your quadriceps and straighten your knee by lifting your heel from the bed. Hold 5 seconds, then slowly your heel towards the bed. You may repeat 10-20 times.
Begin gentle passive ROM exercises for knee- knee extension, knee flexion, heel slides, wall slides.
Begin patellar mobilization techniques when incision stable to prevent contracture.
Perform active hip abduction and adduction exercises.
Continue active and active assisted knee ROM exercises.
Continue and progress these exercises until 6 weeks after surgery. Give home exercises with outpatient physiotherapist following patient 2-3 times each week.
Plan discharge when ROM of involved knee comes from 0-90 degrees and patient can independently execute transfers and ambulation.
2-3 weeks
Continue previous exercises.
Continue walking with walker until otherwise instructed by surgeon.
Prescribe prophylactic antibiotics for possible eventual dental or urological procedures.
Driving isn't allowed for 4-6 weeks.
Orient family to patient's needs, abilities, and limitations.
Review tub transfers as a whole Knee Replacement Rehabilitation
Many patients lack sufficient strength, ROM, or agility to step over tub for showering.
Place tub chair as long ago in tub as you possibly can, facing the faucets. Patient supports to the tub, sits around the chair, and then lifts the lower limb over.
Tub mats and nonslip stickers for tub floor traction are also recommended.
6 weeks onwards as a whole Knee Replacement Rehabilitation
Begin standing and walking as tolerated with ambulatory aid, if the has not already begun.
Perform wall slides and lunges.
Perform step ups.
Begin closed chain knee exercises on total gym and progress over 4-5 weeks for bilateral lower extremities.
Perform cone walking with progression.
Progress to stationary bicycling.
Other Considerations For the following 4-6 weeks after surgery
Avoid sexual activity. Sexual activity can usually be resumed after your 6-week follow-up appointment.
You usually can return to work within 2 to 3 months, or as instructed because of your doctor.
You should not drive a car until following the 6-week follow-up appointment.
Continue to wear elastic stockings (TEDS) until your return appointment.
No shower or tub bath until after staples are removed.
When using heat or ice, remember to not get your incision wet before your staples are removed.
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