Rehabilitation after knee replacement

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.

Preoperative preparation for rehabilitation

Preparation for postoperative rehabilitation begins not after the end of the operation, but even before the start of surgical procedures. The need for this is due to the fact that this operation has risks of complications. To mitigate these risks, it is necessary to take certain preventive measures.

Impact on problem muscle areas must begin before the operation. The need for this is due to the fact that after the operation the already weak muscles will become even weaker. This nuance is the reason for the high risk of complications in the form of contractures, atrophy, thromboembolism, vein thrombosis, etc. Elimination of hypotonicity and increased blood supply allow us to count on the absence of these problems. In addition, the implant can function normally only if the muscle-ligamentous structures are elastic and sufficiently elastic.

Developing the muscles before installing the knee joint also helps to simplify and speed up the recovery process. The patient will be able to endure the early stage of rehabilitation more easily if he learns in advance to walk correctly on crutches, do basic physical therapy exercises, etc.

Postoperative stage

When answering the question of how rehabilitation proceeds after knee replacement, it should be noted that its success depends on how the patient complies with the rehabilitation regulations. Therefore, he needs to be determined to work hard for several months. There should be no room for despair during recovery. The patient must set himself the task of achieving his goal at any cost. Motivation plays one of the most important roles during the rehabilitation period.

To achieve the expected result, the patient must:

• perform chest and diaphragmatic breathing exercises;
• take prescribed antibiotics, vitamin-mineral complexes, painkillers, anti-inflammatory and other medications;
• treat the knee joint with antiseptic compounds, bandage it, and drain the wound;
• apply cold bags to the kneecap area, which will reduce pain and reduce the degree of swelling.

Therapeutic exercise at the postoperative stage

When asked what kind of rehabilitation after knee replacement is necessary for a patient, it is worth saying that during recovery after this operation one cannot do without physical therapy. In the first 2 weeks after endoprosthetics, the patient will have to perform the following exercises:

• Pulling the socks towards yourself and then pushing away from yourself. This exercise must be repeated every 10 minutes at least 10 times.
• Raise your leg 30 degrees and hold it in this position for 8 seconds. This exercise has a beneficial effect on the quadriceps femoris muscle. It must be performed 10 times.
• Contraction and relaxation of the gluteal, posterior and anterior thigh muscles. This exercise helps strengthen tissue fibers and achieve the necessary tone.

Rehabilitation after knee replacement

Recovery after knee replacement takes place in several stages, with a consistent increase in the load on the joint and muscles of the leg, which leads to their strengthening and gradual engraftment of the graft.

Stage 0. Informing

Immediately before the operation, the doctor tells the patient in detail about the timing and rehabilitation program, and demonstrates in advance the correct technique for moving on crutches to prevent falling and re-injury. General recommendations for recovery after knee replacement include:

• Before the operation, remove from the floor of the house all things that you can trip on: carpets, wires;
• immediately after replacing the knee joint, do not bend the leg at the knee more than 90 degrees (the increase in the angle of flexion will be controlled by a specialist);
• in agreement with the doctor, wear compression stockings (up to three months after surgery) to prevent venous vessel disease (thrombophlebitis);
• for the first six weeks after surgery, you should avoid taking a hot bath and wash in a warm shower, at first - with safety net;
• walk in low heels;
• avoid prolonged stress on the operated limb;
• Sexual activity is possible no earlier than 4 to 6 weeks after surgery, provided that recovery is going well;
• You should start driving a car no earlier than 3 months after surgery.

At the same stage, in a comfortable environment, the patient is taught how to competently perform physical exercises, which will be useful in the initial stages of recovery after surgery. The exercises are aimed at preventing atrophy of the hip stabilizer muscles and core muscles.

Stage 1. Recovery

1-4 weeks:

• Reduced pain and swelling;
• prevention of postoperative muscle atrophy;
• a gradual increase in the range of motion in the joint until the leg is fully extended at the knee;
• independent movement.

Within a few hours after the operation, the patient is taught to smoothly transfer weight to the new joint: get out of bed, walk using a walker or crutches. Performing a series of gentle movement exercises is aimed at preventing the scar tissue that forms from restricting the movement of the new knee (arthrofibrosis). To get rid of swelling and improve nutrition of adjacent tissues, manual massage is performed. Gradually, the patient returns to his usual routine. Under the supervision of a specialist, crutches are replaced with a cane, and then they learn to cope without it. At this point, the ability to walk up stairs returns.

When you go to home?

The patient can return home if he is able to freely perform a number of routine procedures: get out of bed, walk up to 25 meters on crutches or a walker, use the bathroom, go up and down the stairs. However, it is most effective to undergo the initial stages of rehabilitation in a specialized rehabilitation center, under the supervision of a therapist.

Rehabilitation in a specialized clinic allows you to create an individual rehabilitation program, which includes:

Mechanotherapy (device ARTHROMOT ACTIVE-K).

Exercises on a treatment device, which can be started within a few hours after surgery, under the supervision of a rehabilitation specialist. Work with the device is aimed at early painless restoration of knee mobility and has a positive effect on coordination of movements and helps increase muscle volume.

Individually selected set of exercises.

Teaching the patient a set of gentle exercises to perform both within the clinic and for regular exercise at home. These simple workouts are aimed at preventing complications after surgery (stiffness, swelling, tissue malnutrition), strengthening muscles and improving knee mobility. For example, it may include the following physical therapy exercises:

• Quadriceps muscle tension. Tighten your thigh muscles and try to straighten your knee. Hold for 5 to 10 seconds. Repeat 10 times for two minutes, rest for one minute, then repeat again. Continue until the hip feels tired.
• Straight leg raise. While lying down or sitting, tighten your thigh muscles so that your knee is fully extended on the bed. Raise your leg a few tens of centimeters. Hold for 5 to 10 seconds. Lower slowly. Repeat until the hip feels tired.
• Bend the knee while lying down. Pull your foot toward your buttock, keeping your heel on the bed and bending your knee. Keep your knee bent as much as possible for 5-10 seconds, then straighten. Repeat several times until your leg feels tired or until you can fully bend your knee.

The complexity and intensity of the exercises will increase gradually as the muscles strengthen and the joint develops.

Neuromuscular electrical stimulation.

Electrical impulses are sent through the patient's skin, stimulating nerve endings to transmit signals to a specific muscle group. The muscles respond to the impulse by vibrating or contracting - just as during normal muscle activity, such as walking or working out in the gym. This allows you to optimize muscle strength and tone and relieve pain.

Kinesiological taping.

Applying special elastic cotton tapes on an acrylic adhesive base to the skin around the joint. Tapes stabilize the joint and muscles, increasing their range of motion and providing an anti-edematous effect.

Stage 2. Return to daily activities

4-12 weeks:

• Increased range of motion;
• development of muscle strength and endurance;
• improving the sense of body position in space.

By the beginning of the second stage, patients who strictly adhere to the rehabilitation exercise schedule observe significant improvements in knee mobility and stability. The angle of passive knee flexion will reach 90 degrees, the angle required for comfortable walking and climbing stairs. There is a gradual increase in physical activity, and modern exercise equipment (exercise bike, elliptical trainer, treadmill, strength training equipment) are added to the methods used at stage 1. Exercises on balancing platforms are added to strength and mobilization exercises.

At 7-9 weeks of rehabilitation, patients can:

• Walk a kilometer or more without any assistive devices;
• engage in basic activities that require physical effort, including driving, housekeeping and shopping.

By week 12, the range of motion in the knee joint is fully restored and the joint is strengthened enough for the patient to be able to easily do housework, go to work, and drive a car. However, if after knee replacement there is a desire not to stop there, to lead an active lifestyle and return to sports, then the rehabilitation course must be continued.

Exercise therapy from 3 to 13 weeks

The answer to the question of how long rehabilitation after knee replacement will last depends on the patient’s diligence during the 3-13th week of recovery. At this stage of rehabilitation, in addition to the above-described exercises, a number of other tasks are added to facilitate the rapid development of the limb that has undergone endoprosthetics.

The opportunity to work out more diligently arises due to the disappearance of painful sensations characteristic of the first two weeks of rehabilitation. At the same time, patients should not overdo it with the load.

At this stage of recovery, patients after knee replacement should:

• bend and straighten the knee while standing or lying on your stomach (there must be support);
• lift the injured leg onto the steps (given possible problems with maintaining balance, it is necessary to hold on to the railing);
• stretch the operated leg;
• transfer weight from one limb to another (you will need the support of a healthcare worker or relative);
• perform amplitude flexion and extension of the limbs;
• roll from heel to toe.

Exercise therapy also provides for the possibility of using various equipment: step platforms, simulators for developing joints, etc.

For patients wearing a cast

At this stage, it is recommended to perform gymnastics to generally strengthen the upper shoulder girdle. Lying straight in bed, the patient can straighten and bend the uninjured leg, perform abductions and lifts, and also strain the muscles in a static manner. Weak movements can also be performed with healthy parts of the injured leg, for example, with the fingers, thus avoiding blood stagnation and severe swelling.

Already two or three days after a cast is applied to the leg, doctors advise performing the following simple set of exercises:

1. Slowly pull your chin towards your chest and then move it back;
2. Place your hands behind your head and grab the headboard. Pull your body up in the back, then return to the starting position;
3. Raise and lower your arms vertically in front of you. Over time, you can take dumbbells or regular bottles filled with water;
4. The healthy leg can be pulled towards you and then straightened. It is important not to lift your foot off the bed while performing the exercise.

Possible complications of the postoperative period

Having figured out how long rehabilitation lasts after knee replacement, it is necessary to talk about the problems that may arise during this process. After knee replacement, there is a risk that the prosthesis will become dislodged or blood clots will form in the veins. During rehabilitation, joint mobility is also sometimes limited. This problem occurs because scar tissue forms. In addition, inflammatory processes develop at this stage. Moreover, sometimes they can arise as a result of infection.

Why develop a knee

Muscles and ligaments become noticeably weaker as a result of prolonged immobilization. Some people complain that the leg does not bend completely after a fracture, or that pain is felt while walking. This is why a proper recovery period is very important.

When wearing a cast, significant changes occur in the joint. There, blood circulation can slow down significantly, and metabolic processes can worsen.

Such symptoms provoke a risk of tendon and muscle atrophy, which is the cause of incomplete extension of the legs.

Life after recovery

After the rehabilitation period is over, the life of the patient with a new knee joint will change. It will have several restrictions. Firstly, such a patient is prohibited from lifting loads exceeding 15 kg. Secondly, he will not be able to squat or kneel. Thirdly, this patient needs to avoid dislocations, bruises, impacts, falls and other situations that can lead to injury to the knee joint. It is also prohibited to play team sports, skiing, rollerblading, skating, etc. Physical activity should be as moderate as possible.