After your knee replacement surgery,
you may be sent home, moved to a rehabilitation facility,
or moved to a long-term care facility.
Ambulation and Elevation Activities: By
watching you walk, the physical therapist will analyze
your walking pattern and check your assistive device
to ensure you are using it correctly and safely. The
amount of weight you bear on your leg will also be checked.
Balance and Coordination: Your
balance and coordination may be assessed to see if any
activities in these areas need to be incorporated into
this phase of your physical therapy program.
Functional Activities: You
may be given a questionnaire that helps you describe
day-to-day problems you may be having with functional
activities (e.g., putting on socks and shoes, dressing
or self-care activities, managing your home, etc.) as
a result of the surgery.
Girth: Using
a tape measure, your therapist may compare the circumference
of your knee, thigh, and calf with the non-operative side.
These measures may indicate if any swelling is still present
or whether your muscles may have lost size (atrophied)
as a result of a lack of use or from pain.
Leg Length: The
lengths of both of your legs will be assessed to see if
a lift may be necessary in your shoe.
Pain: You may
also be asked to rate your pain on a scale from 1-10. This
measure helps your physical therapist gauge how much pain
you may be experiencing and how much your pain and symptoms
may change with the physical therapy interventions/treatment.
Posture: Your
physical therapist will check your overall posture, including
the alignment of your head, back, pelvis, hips, knees,
and ankles.
Range of Motion (ROM): Your
therapist will check the ROM in your new knee. These measurements
will indicate how far you can move your knee in different
directions. Measurements may include forward and back
(flexion/extension) motions.
Skin Status: Palpation
or feeling of the soft tissues around the scar area may
be done to check the skin for changes in temperature, to
determine if any swelling is present, and to see if there
are tender points or spasms in the muscles around the knee
joint. The scar will also be assessed for healing.
Strength: The strength
of your muscles will also be tested. The muscles around
the knee, the hip, and the ankle will be assessed.
These measurements will be initially assessed on
your non-operative side and then compared with
the operative side. Weakness in key muscles will
be addressed with a strengthening program.
Once your examination is complete a post-operative, outpatient
interventions/treatment plan will be established.
Once the physical therapist has completed the examination, an intervention/treatment
plan will be established. This plan will list the goals you and your therapist
think will be helpful in getting you back to your daily activities. Finally,
it will include a prognosis, or how much time and how many visits your therapist
feels will be needed.
The therapist may choose from one or more of the following
interventions to facilitate your recuperative process.
Exercises: Exercises will be prescribed
by your physical therapist for many different reasons.
- To improve your flexibility
- To increase your strength
- To enhance your endurance
- To increase your balance and coordination
- To make the performance of your daily activities easier
- To improve your walking and stair climbing ability
Improving Flexibility: To improve flexibility,
your physical therapist may use graded exercises including
active movements and stretching exercises. These exercises
help restore movement.
Strengthening and Stability Exercises: Strengthening
and stability exercises will progress during this phase
to regain the strength in the muscles around the knee
and lower leg, especially the muscles in the front and
back of your thigh, the muscles around your thigh, and
your calf muscles. In addition, you will continue to
strengthen the trunk, non-operative leg, and arms.
Endurance Exercises: Endurance
exercises will also be progressed so your muscles may function
effectively over longer periods of time. They may include
walking, bicycling (stationary or recumbent), swimming,
upper body exerciser, and any other activity, which enhances
your endurance while protecting the knee.
Weight Bearing Exercises: Weight
bearing exercises may increase during this time.
You may be asked to shift weight from side to side
and front to back, to walk for increasing distances,
to go up and down ramps and curbs, and to climb increasing
number of stairs. You may also be asked to rise up
on your toes or perform modified squats.
Postural Exercises: Postural
exercises will be incorporated into the program to keep
your back and head well aligned and preclude unnecessary
stresses on your back as a result of the surgery.
Balance and Coordination Exercises: Balance
and coordination exercises may be incorporated at this
time. You may be asked to balance on one leg with your
eyes open and closed, walk on uneven or softer surfaces,
and do side-to-side walking.
If you have a pool available and are cleared by your
surgeon for immersion in water, aquatic exercises may be
incorporated into your overall program.
Exercises should never be overdone. If you find you are
swelling late in the day, it may be a sign you are doing
too much too quickly. Pain should also be avoided. Pain
is an indicator something is or was too much. A small amount
of muscle discomfort with increasing exercise may occur,
but it should be reasonable discomfort, not pain.
Gait Training
Once you are able to bear full weight on your operated
leg, your physical therapist will work with you to fine
tune your gait. Retraining may be needed if you developed
a limp as a result of pain prior to the surgery, apprehension,
or simply a habit developed over time. The goal is to develop
a normal walking pattern where your steps are equal in
width and length and to learn to appropriately shift your
weight.
Functional Activities
Exercises may be included in your program simulating day-to-day
activities like stair climbing and partial squatting. You
will review all of your self-care and home management activities,
as well as all activities related to your job and leisure
life. This is done to ensure you are able to do them safely
and effectively. You may continue to use the elevated toilet
seat until adequate knee range of motion is present.
Modalities
Ice may be used if there is pain or swelling. Heat may
also be used for pain management and for relaxation. Special
care must be taken to make sure your skin does not overheat
and burn.
Other Activities
If the surgery was on the right side, you may be given
permission by your surgeon to drive approximately six weeks
following the surgery. In any case you must be able to
move the leg easily from gas pedal to brake. If you have
a manual shift car and the surgery was on the left side,
driving permission may also be given at approximately 6-8
weeks following surgery.
Home Program
As your condition continually improves, you will be given
advanced exercises to do at home, in a pool, or in a gym
setting. You may be scheduled to recheck with your physical
therapist at regular intervals to make sure you are doing
these exercises routinely and safely. During these rechecks,
you may be given additional exercises to work on over the
next few weeks. Eventually, you will be progressed to a
final home program. Once you have been released to full
activity, you may be instructed to follow up with a few
visits over the next few months to make sure you reach
your peak level of performance.
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