Examination
The Stone Clinic physical therapist will see you before surgery to instruct you in exercises and a hospital therapist will see you on the day of or the day following surgery. Your physical therapists may assess the following:

• How your operated knee is moving.
• The presence of pain.
• The range of motion in your new knee.
• How you are able to move while in your hospital bed.
• Your safety when getting up and sitting on the edge of the bed.
• How well you remember and are practicing your breathing.
• The type of walking aid you will begin to use and if you are putting the right amount of weight through your foot.

Interventions/Treatment Plan
Initially ice may be used to help reduce the pain and swelling. Ice makes the blood vessels become narrower, called vasoconstriction, which helps control inflammation. Elastic stockings may also help to prevent vein problems in the lower leg. Foot cradles or soft heel cups may also be used to prevent sores from developing on the heels.

Your knee may also be placed in a machine that allows continuous passive movement of bending and straightening of your knee.

Precautions
Your therapist will discuss the knee precautions for you to follow after surgery which include:

• Do not twist your knee.
• Turn your entire body to avoid stress on the knee.
• Do not impose any jarring forces on your knee.

Exercises
Exercises should be done at the direction of your physical therapist. Exercises are used to help control pain and help with movement in the knee, hip, and ankle. You may be given gentle passive movements of your knee and lower leg as well as active movements of your knee, hip, ankle, and foot. Some of the following exercises may be incorporated in your treatment plan.

The goals prior to discharge from the hospital will often be to have close to full straightening and approximately 90° of bending of your new knee, the necessary range for stair climbing.

Gently bending and straightening of your ankle – This helps keep your calf muscle flexible while "pumping" the muscles to help circulation.

Exercises for the knee and thigh muscles may include setting or isometric exercises for the buttocks, the quadriceps (the muscles in the front of your thigh), and the abductors (the muscles on the outer side of your hip). Gentle sliding of your heel toward your buttock and straightening it back out and pushing your leg straight out to the side and bringing it back may be initiated. With a roll under your knee, you may begin exercises to straighten the knee.

This exercise may be progressed to straightening your knee out while sitting in a chair. You may also perform straight leg raises of approximately 6-10 inches on your operative side. In standing you may also be taught to bend the knee back, to gently push the leg back, and to hike your hip.

Arm exercises may also be included in your post-operative physical therapy program to assure you have adequate strength in your arms for moving around in bed, for standing up from a chair, and for walking when using your walking aid.

Breathing exercises are incorporated into your post-operative program to help prevent pneumonia from developing. Deep breathing is the simplest form of breathing exercise. In addition, you may be given an incentive spirometer: a device  requiring you to take in as deep a breath as you can, hold it for a few seconds, and then blow it out. An indicator on the incentive spirometer will enable you to track your deep breathing progress as you attempt to take in deeper and deeper breaths each time you use the device.

Trunk strengthening exercises are included in your postoperative program to keep your trunk muscles strong, which may help avoid back problems that may arise from the initial uneven weight bearing. Your therapist will instruct you in the type and number of exercises, the amount each exercise is to be done, and how often they should be done.

Position Changes
You will be given instructions and assistance on how to move and change positions in bed as well as getting yourself to the seated position. Your physical therapist will also assist you to the standing position and will teach you how to transfer safely from the bed to a chair and toilet. Proper body mechanics will be stressed during all activities.

Walking and Stairs
Full weight bearing is encouraged after joint replacement. Your physical therapist will provide you with detailed instructions as to how to achieve that amount of weight bearing. You may use a walker, a cane, or other assistive devices.

Instructions will be given to you in the hospital for stair climbing. The general rule is you go up the stairs holding onto the handrail with one hand and with your walking aid in the other hand. The non-operative leg goes up first and then the operative leg and walking aid are brought up together to that same step. Going down the stairs is the opposite; the operative leg and walking aid go down the step first, followed by the non-operative leg to the same step.

Other Interventions
Your physical therapist will indicate which activities you should avoid and which activities put a strain on the surgical area. You do not want to twist your knee, and you will be instructed in turning your entire body to avoid stress on the knee. In addition, you should not impose any jarring forces on your knee. During your activities, pain acts as your guide. If you feel pain with any activity, stop and consult with your physical therapist to determine if what you are doing is straining or irritating the knee.

While you are in the hospital, your physical therapist may see you for therapy up to two times each day, and you will progress from doing activities bedside to doing them in the therapy department. You may expect to stay in the hospital several days after your knee replacement surgery.