Endoprosthetics is a surgical treatment aimed at restoring a joint damaged by degenerative-dystrophic processes. Rehabilitation measures after knee replacement are sometimes more important for the patient’s health than the operation itself. The success of surgical intervention, the usefulness of the motor abilities of the joint and the quality of future life depend on rehabilitation. To speed up the process of restoring joint mobility, it is important that the attending doctor or exercise therapy instructor has knowledge of the principles of biomechanics and ontogenesis, according to which the human body is a single mechanism, and with regular systematic influence on certain points or organs, the condition of a previously damaged and operated knee improves, the patient learning new movements.
Types of endoprosthetics
Knee replacement surgery is the main way to avoid being in a wheelchair. Surgical intervention is performed when complex pathology can no longer be eliminated. Depending on the extent of damage, the following types of endoprosthetics are distinguished:
- Total – complete replacement of the knee joint with a prosthesis. The operation is performed in case of tissue damage of 70%.
- Partial – replacement of a specific area with an implant. A gentle technique is used if the joint is less than 50% damaged.
Damage to the knee joint can be caused by a jump from a height, chronic arthrosis, arthritis, gonarthrosis, or a blow to the knee. Bone and cartilage tissue is destroyed due to impaired blood flow and trophism.
Preoperative preparation
The main complications of endoprosthetics are the development of contractures, muscle atrophy, vein thrombosis or synovitis (accumulation of excess fluid in the joint capsule). The reason for their appearance is considered to be a lack of preparation for surgery. The fact is that knee replacement surgery is most often performed on elderly people whose health has been compromised by chronic diseases.
To prevent the development of complications during the rehabilitation period, you need to prepare for surgery. The patient must undergo a course of physiotherapy, exercise therapy and massage. They will improve blood circulation in the knee joint and increase muscle tone. As a result, rehabilitation after surgery will be more successful. In addition, it is necessary to improve the performance of the hands, since they will take on the main load after the operation. The following types of physical activity are recommended:
- swimming;
- aqua gymnastics;
- Nordic walking;
- cycling or exercising on an exercise bike.
Stages and principles of physical rehabilitation
Rehabilitation helps patients fully recover after surgery and avoid complications. Its key tasks:
– restore knee function; – restore a person’s ability to move independently; - give him the opportunity to work and lead a socially active lifestyle.
To solve these problems, it must comply with certain principles:
- Rehabilitation should begin as early as possible - already on the first day after surgery, and continue until a lasting, positive result. It distinguishes the first stage (the patient undergoes it in a hospital setting) and the second stage (the patient undergoes it after discharge from the department in a specialized institution).
— An important difference between competent rehabilitation and ineffective and even dangerous programs is phasing. That is, the degree of load must strictly correspond to the patient’s capabilities. It should not be excessive or too light. Otherwise, it will lead to complications or will not produce results.
— It should include a variety of methods: exercises, massage, physiotherapy, etc. This will provide a comprehensive effect and at the same time not bore the patient. The full recovery process takes several months, so it is important that he does not lose interest in it.
These principles of rehabilitation are the same for all operations - both knee replacement and any other.
The recovery program after installation of an endoprosthesis has one goal - to restore mobility to the knee joint so that the patient can live a full life. You can find a lot of exercises and other tips for this in the public domain.
But the initial condition of the joint, the extent of the operation and other features can make adjustments to the program - which methods are optimal for a given patient, with what intensity he should exercise, how often, etc.
Many patients are mistaken that they can go through the second stage without the participation of specialists. They perform sets of exercises that they have chosen for themselves. But they cannot adequately assess how suitable these exercises are for them, as well as the correctness of their implementation. Therefore, attempts at self-recovery often end in complications.
“Quality of Life” is a rehabilitation medicine clinic where you can undergo the second stage of rehabilitation. After assessing the patient’s condition, our specialists will create an individual program for him, which, in addition to exercises, includes other effective methods.
Rehabilitation after endoprosthetics
The main task of the recovery period after surgery is the gradual return to the patient’s ability to move independently. Rehabilitation after knee replacement consists of three stages: early (3 weeks), late (up to 6 months) and long-term (up to a year). Postoperative recovery is accelerated by physiotherapeutic procedures and physical therapy. The rehabilitation program is developed individually, taking into account the reason for knee replacement, the age and health of the patient.
Rehabilitation after endoprosthetics performs the following tasks:
- relieving pain and swelling;
- improvement of blood circulation and tissue trophism;
- improving the mobility of the prosthesis;
- relief of the inflammatory process;
- muscle strengthening;
- restoration of range of motion.
Knee replacement surgery, rehabilitation, indications
Knee replacement is indicated for the following symptoms and conditions:
- chronic inflammatory process in the joint area, swelling that does not subside even after taking special medications;
- severe pain that limits movement. The need for additional equipment (crutch, cane) for long distance hikes;
- deformity of the knee joint;
- incessant pain at night;
- joint stiffness;
- decreased effectiveness of non-steroidal painkillers. Long-term use of painkillers can cause problems with the gastrointestinal tract, blood clotting, and also cause fairly rapid addiction;
- lack of effect from medication and physiotherapy (taking hormonal drugs, injections of hyaluronic acid, exercise therapy). After knee replacement surgery, your doctor may prescribe a second course of drug therapy.
Orthopedists and traumatologists at the Yusupov Hospital prescribe endoprosthetics after first examining the patient’s medical history. The quality of the endoprostheses used in our clinic meets all European quality standards, and the technical equipment of the operating rooms allows surgical interventions to be performed at the highest level.
CPM therapy in the early postoperative period
From the first day after endoprosthetics, Artromot or Kinetec mechanotherapy devices are used for passive development of the knee joint. They allow you to control the intensity of physical activity: amplitude, speed and frequency are individually selected. The flexion angle is increased by 10° daily until 90° is reached in independent flexion. The electronic remote control allows you to easily set the speed and pauses in stretching the joint. The display shows the achieved extension and flexion value.
The design of CRM simulators is anatomically correct, based on the physiology of the functioning of the knee joint. Constant movement promotes rapid recovery of injured tissue, minimizing the likelihood of contractures and stiffness. During the session, patients note complete muscle relaxation and absence of pain. The advantage of a mechanical apparatus is the ability to work out a joint 3-4 times a day, which cannot be done through physical therapy exercises. Next, the artificial joint is developed using special installations - orthotics. They restore balance and coordination of movements. The complex allows you to assess the functional state of joints and muscles. The Biodex device has the following features:
- passive mode – a change in speed is provided to overcome the stretch reflex and further assist in movement;
- isometric mode – to increase static muscle strength in the presence of pain;
- isotonic mode – for active training of the osteoarticular system.
Using the control panel, you can control or change various parameters: speed, torque, range of motion. The Biodex rehabilitation complex allows you to combine dynamic and static muscle loads.
Features of the knee joint
This is one of the most complex joints in the human body. It is formed by the femur and tibia, the patella and several ligaments.
Normally, the heads of the bones are covered with cartilage, and the tension of the ligaments and surrounding muscles is clearly balanced. This promotes easy, painless sliding of the bones relative to each other. Only with coordinated work of all structures of the knee joint is its normal functioning possible:
– leg bending; – leg extension; – in a bent position, rotation around an axis.
When there is a disease or injury, the cartilage becomes thinner or completely erased, and irregularities and layers appear on it. As a result, movements are accompanied by pain, their volume decreases, up to the complete inability of a person to walk.
In case of serious injuries, when conservative methods are no longer effective, only with the help of endoprosthetics can the patient be relieved of pain and restore normal range of motion.
The joint is formed by many muscles and ligaments that are damaged during surgery. This seriously complicates the process of his postoperative recovery. Patients whose muscles are weakened recover especially poorly.
Therefore, before the operation, you need to strengthen your muscles in advance by performing a set of special exercises. Then recovery will be quick and easy.
Physiotherapy
The exercise therapy program is aimed not only at developing the knee, but also at restoring neural connections. The instructor controls the duration and intensity of classes. Fitness balls, dumbbells, expanders and other sports equipment are used. Myofascial release (kinesitherapy) is performed using special rollers. Exercises are performed on slings. They combine simultaneous unloading of some muscles and targeted training of others.
A course of physical therapy for postoperative rehabilitation should alternately affect all areas of the lower limb and include the following exercises:
- Flexion and extension of the ankle joint. First, the sock is pulled towards you, and then in the opposite direction. The exercise is repeated 10 times. It is recommended to do it every 10 minutes throughout the day.
- Taking your leg to the side while lying in bed. The limb is moved to the side, sliding along the surface, then returned to its place. In this case, the toe of the foot should be directed upward.
- Knee flexion to 90° followed by extension. The exercise is performed in a horizontal position. The leg is smoothly pulled towards you until a right angle is reached at the knee. Then the limb is returned to its original position - pulled forward, sliding along the surface. Start with a small amplitude, gradually increasing it.
- Tension of the quadriceps femoris muscle and activation of the limb. In a supine position, the leg is raised up to a level of 30 cm from the surface. She is held in this position for 5-8 seconds. Do 10 approaches with an interval of 2 minutes.
- Alternate contraction of the gluteal, posterior and anterior thigh muscles. This gymnastic technique normalizes tissue trophism and increases muscle tone.
5-6 days after the operation, they begin to master walking on parallel bars, a treadmill or a step machine. A bicycle ergometer is used, equipped with an electronic system to control the progress of the workout. The built-in computer allows you to adjust the speed, time and distance. The number of approaches is determined by the doctor. Gradually increase the time spent on your feet.
To increase the effectiveness of physical therapy, physiotherapeutic procedures are prescribed: shock wave therapy, ultrasound, electrical muscle stimulation, magnetic and laser therapy. The rehabilitation center offers water classes, massage courses, mud therapy and balneotherapy. Physiotherapy improves blood circulation, stimulates metabolic processes, and calms the nervous system. To improve regeneration, manual therapy, classic manual and lymphatic drainage massage are used.
Late period rehabilitation
After discharge, the patient uses crutches for 5-7 weeks, then begins to learn to walk independently. While lying down, you can do the following:
- bend your knees, lying on your stomach;
- lie on your back and do a plank, resting on your healthy foot and shoulder blades.
While sitting, it is recommended to do the following exercises:
- simultaneous flexion and extension of the toes;
- rotation of the feet clockwise and counterclockwise;
- raising your leg without bending your knee;
- swinging limbs in the air for several seconds.
Exercises performed while standing:
- bending the leg forward and backward, leaning on a chair;
- raises on toes;
- “sliding” along the wall;
- half squats with support;
- back lunges;
- rolling from heel to toe.
The intensity of the exercises is increased gradually. The number of repetitions is no more than 15 times. Rehabilitation doctor S. Bubnovsky, who developed a set of exercises, recommends doing everything slowly and avoiding sudden movements. The main condition is that there should be no pain or swelling. 1.5 months after joint replacement surgery, you can begin exercise therapy.
Long-term recovery period
The goal of the final stage of rehabilitation is the complete restoration of movements and preparation for a full life. At a later stage, you are allowed to visit the gym. You can engage in a sport with moderate loads: Nordic walking, swimming, cycling. Rehabilitation at the final stage includes the following daily exercises: “scissors”, “bicycle”, walking on bent legs with the help of support.
Do not lift heavy objects or subject the joint to high physical stress. It is prohibited to play football, basketball or volleyball. If the doctor's recommendations are followed, performance returns 1.5-3 months after surgery.