Rehabilitation after knee replacement

The osteochondral structures of the knee, which move the knee joint and are responsible for the supportability of the limbs, are the most vulnerable anatomical components that are affected by arthrosis. Endoprosthetics is an effective way to restore the musculoskeletal system, which has undergone serious degenerative-dystrophic aggression against the background of chronic arthrosis.

Dynamics of destruction of the cartilage surface.

However, rehabilitation after knee replacement in Russia is not organized at the level that the patient can fully recover.

Model of a knee joint implant.

Patients often undergo rehabilitation after knee replacement at home, following the medical recommendations received upon discharge. They are forced to look for all the necessary information on the Internet. According to established clinical standards, after such an intervention, which carries risks of developing dangerous complications, competent assistance is required for quite a long time - an average of 3 months.

When recovering on your own, it is good to use a tourniquet or small weights.

Planning physical exercises and performing exercises strictly under the supervision of a competent instructor are fundamental factors in the complete restoration of the biomechanics of the operated limb. The success of the operation, the restoration and usefulness of motor-support abilities, and the quality of future life depend on the rehabilitation of the knee joint after endoprosthetics.

Knee replacement in the Czech Republic: guarantees, prices, rehabilitation, reviews and statistics.

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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.

Physiotherapeutic procedures

You will be prescribed physiotherapeutic procedures:

laser treatment;
electromyostimulation;
UHF treatment;
extracorporeal shockwave therapy (shock wave therapy);
ion-galvanization;
magnetic therapy;
hot paraffin treatment (only in the later stages!).

Electrical stimulation is one of the options for physiotherapy.

Exercise therapy and physiotherapy will help:

relieving spasms from tense muscle structures and increasing the tone of weakened and atrophied muscles;
activation of microcirculation and blood flow in the lower limb;
stimulating metabolism in joint structures;
relief of painful manifestations and swelling.

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.

Recommendations for patients undergoing knee replacement

If your knee joint is significantly affected by arthritis or injury, this may limit your physical activity, such as walking or walking up stairs. You may even experience pain at rest.

If medications, decreased physical activity, and use of additional support when walking no longer help, total knee replacement may be considered. As a result of this operation, pain may go away, the deformity of the limb will be corrected, and normal physical activity will return.

One of the most significant advances in orthopedics of the 20th century, total knee replacement was first performed in 1968. Improvements in surgical materials and techniques have since greatly increased the effectiveness of this operation. In the United States, approximately 300,000 such operations are performed annually.

What will change after total knee replacement?

When deciding whether to undergo surgery, it is important to understand what awaits you without surgery and what surgical treatment can give you.

More than 90 percent of those who undergo this operation expect complete disappearance of pain and a significant increase in mobility for the possibility of a normal, active life. However, total knee replacement cannot do more than you could before you developed arthritis.

After surgery, you should be careful about certain movements and sports, including running and contact sports.

Even with normal use of the endoprosthesis, its components, especially the polymer spacer, will wear out. If you experience increased stress on the joint or are overweight, the wear and tear process may accelerate and cause instability of the prosthesis and renewed pain. If used properly, a knee replacement can last for many years.

Hazardous activities after surgery: running, jumping, contact sports, aerobics.

Activity that exceeds the usual recommendations after surgery: too long or tiring walks, tennis, lifting weights over 25 kg.

Allowed activities after surgery: non-tiring walks, swimming, golf, driving, “non-extreme” tourism, ballroom dancing, climbing short stairs.

RECOMMENDATIONS FOR THE HOME

The following are some recommendations that will make your return home easier during the rehabilitation process.

Firmly fixed grab bars in the bathroom or shower.
Strong handrails along all stairs.
A stable chair with a durable, high seat, a strong back, two armrests, and a footrest.
High toilet seat.
A stable bench in the shower or a chair in the bathroom.
Removing loose carpets and electrical wires from areas where you walk.

OPERATION

You will arrive at the clinic some time before the operation. Next, you will be examined by an anesthesiologist. The most common types of pain relief for total arthroplasty are endotracheal anesthesia (you will sleep during the operation and the ventilator will breathe for you), spinal or epidural anesthesia (in which you will be able to breathe on your own, but your legs will not feel anything. Anesthesiologist will discuss with you the advantages and disadvantages of these methods and help you choose the most suitable type of anesthesia.

The operation lasts on average about two hours. The surgeon will remove the damaged cartilage and some bone and then install new metal and polymer joint surfaces to restore the axis of the limb and the function of the knee joint.

Many different types of prostheses are currently used in total knee replacement. Almost all of them consist of three components: the femoral component (made of a highly polished, durable metal), the tibial component (consisting of a strong polymer, often located on a metal platform), and the patella (also polymer).

After the operation, once you are fully awake, you will be transferred to your room.

You will be in the clinic for several days. After the operation, you will feel pain in the operated joint. You will receive painkillers to relieve pain.

Walking and gentle exercise of the operated joint are essential for recovery and should begin soon after surgery.

To prevent pulmonary complications, you should breathe deeper and cough more often.

The surgeon will take certain measures to prevent thrombosis and prevent swelling, such as elastic bandages, stockings, and the use of anticoagulants.

Foot and ankle exercises should also be done immediately after surgery and will help increase blood flow to the extremities, reducing swelling and the risk of blood clots. Many patients begin knee exercises the day after surgery. Your physical therapist will teach you specific exercises to strengthen your knee joint and restore the movements needed for walking and normal daily activities shortly after surgery.

POSSIBLE COMPLICATIONS AFTER THE OPERATION

The risk of complications after this operation is low.

Serious complications, such as infection of the operated joint, occur in less than two percent of cases. Such serious complications as myocardial infarction or stroke are even less common. However, chronic diseases can increase the risk of complications. Although they are rare, these complications may prolong your recovery period.

Vein thrombosis of the femur or pelvis is the most common complication of total hip arthroplasty. Your podiatrist will take steps to prevent blood clots from forming in the veins of your legs and pelvis. These measures include special elastic bandages or stockings, exercises and anticoagulants.

Despite the fact that the biocompatibility of implants and surgical techniques are constantly progressing, over time the endoprosthesis may wear out or its fixation in the bone may weaken. In rare cases, important vessels or nerves in the knee joint may be damaged during surgery.

HOMECOMING

The success of the operation largely depends on how well you follow your orthopedist's recommendations at home during the first few weeks after surgery.

Careful attitude to the postoperative wound. Stitches or special staples will be placed along your wound along the front surface of the knee joint, or it will be closed with a subcutaneous suture. The staples or stitches will be removed approximately two weeks after surgery. The subcutaneous suture does not require removal.

You must be careful not to get water on the wound until it is completely sealed. You may want to place a bandage over the wound to prevent clothing or elastic stockings from irritating the wound.

Diet. A slight decrease in appetite often occurs for several weeks after surgery. A balanced diet rich in iron is essential to help promote tissue healing and restore muscle strength. Of course, you need to consume enough liquid.

Activity. Exercise is a crucial component of your home rehabilitation, especially during the first weeks after surgery. You should return to normal activities and daily life within 3 to 6 weeks after surgery. During this time, you will experience slight discomfort during active movements and at night.

Your activation program should include:

Gradually increasing duration of walking, first at home and then on the street.
Training of necessary movements, such as sitting down, getting up from a chair, walking up the stairs.
Return to necessary household chores.
Special exercises a few minutes a day to develop movements in the knee joint.
Special exercises a few minutes a day to strengthen the knee joint.
It is possible to carry out physiotherapeutic activities at home.

Driving a car is possible when you develop movements in the operated joint so that you can get into the car without difficulty and when your muscles can provide an adequate reaction when pressing the pedals. This most often occurs 4 to 6 weeks after surgery.

PREVENTION OF COMPLICATIONS AFTER OPERATION.

Prevention of thrombosis. Follow your doctor's instructions carefully to reduce the potential risk of blood clots. These problems may especially occur in the first few weeks after surgery.

The following signs indicate the formation of blood clots:

Pain in the leg, in the calf muscles, not associated with the incision.
Pain, swelling, redness along the back of the leg.
Swelling of the thigh, leg, ankle, or foot.

Indications for thromboembolism:

Sudden difficulty breathing.
Sudden pain in the chest, aggravated by deep breathing and coughing.

Contact your doctor immediately if these signs occur!

Prevention of infection.

The most common routes of infection after endoprosthetics are the introduction of bacteria into the bloodstream during dental procedures, urinary tract infections, and skin infections. These bacteria can infect the area around the denture.

For two years after surgery, you may need to take prophylactic antibiotics before dental procedures, including enamel cleaning, or other surgical procedures that may introduce bacteria into the bloodstream.

Be alert for the following signs of an early infection:

Continued fever (temperature above 37°).
Fever or chills
Increasing redness, swelling, pain in the area of the postoperative wound.
Discharge from a wound.
Increased pain with exercise and at rest.

Contact your doctor immediately if these signs occur!

Prevention of falls.

A fall during the first weeks after surgery can damage the endoprosthesis and lead to the need for another operation. You need to be especially careful when walking on stairs. You should use a cane, crutches, walker, handrails or other assistive devices until the joint becomes stronger and the mobility or strength of the muscles in it is restored.

Your surgeon or physical therapist will advise you on what assistive devices you need after surgery and when you can safely stop using these devices.

WHAT ARE THE FEATURES OF YOUR NEW KNEE JOINT.

After surgery, you may feel numbness in the skin around the scar. You may also feel some difficulty bending your knee joint. Restoring movement in the joint is one of the goals of total arthroplasty, but complete restoration is not always possible.

The metal components of the joint may be detected by metal detectors at airports and other facilities. In such cases, inform the security staff that you had an operation with metal implantation. You can ask the surgeon for a certificate stating that you have had an endoprosthesis implanted.

After surgery, be sure to do the following:

Participate in training programs to maintain stability and mobility of the new joint
Follow specific guidelines to prevent falls and injuries. Patients who have suffered a fracture after total joint replacement may require new surgery.
Let your dentist know that you have undergone total endoprosthetics. It is necessary to take antibiotics before dental procedures for two years after surgery, possibly more, depending on the course of the postoperative period. Antibiotic guidelines for the surgeon and dentist are available on the AAOS and ADA websites.
Periodically see the surgeon for examination and x-ray control, even if you do not experience any problems with the joint.

EXERCISES.

For a complete recovery and a gradual return to normal life, regular exercise is necessary to help restore normal joint movements and muscle strength. Your orthopedist and physical therapy doctor may recommend exercising for 20-30 minutes two to three times a day, and also walking for half an hour 2-3 times a day. They may suggest some of the exercises below. The brochure will help you understand how to do these exercises.

Exercises in the early postoperative period.

Begin the following exercises as soon after surgery as possible. You can start them already in the recovery room. You may experience discomfort at first, but they will speed up your recovery.

Contraction of the quadriceps muscle. Contract your quadriceps muscle. At the same time, try to straighten your knee and lift your leg, holding it for 5 - 10 seconds. Repeat this exercise 10 times for 2 times. minute period, rest for a minute, then repeat. Continue until you feel tired in your hip.
You can also raise your leg while sitting. Try to straighten your knee more. Continue this exercise until you can straighten your knee completely.
Flexion - extension of the foot. Slowly bend and straighten your foot at the ankle joint. Do this exercise several times every 5 to 10 minutes. You can start this exercise immediately after surgery and continue until you have fully recovered.
Exercise to straighten the knee. Place a small bolster under your ankle so that your foot does not touch the bed. Contract your quadriceps muscle. Exercise until your knee is straight, then place your leg on the bed. Keep your knee fully extended for 5 to 10 seconds. Repeat until you get tired.
Bending the knee while resting on the bed. Slide your heel toward your buttock, bending your knee as much as possible. Keep your knee bent as much as possible for 5 - 10 seconds, then straighten it. Repeat until you become tired or cannot fully bend your knee.

Walking in the early postoperative period.

Soon after surgery, you will begin to walk short distances within the room and begin to care for yourself. Early activation will strengthen the muscles, restore range of motion in the joint and speed up recovery.

Walking with a walker/walking with full weight bearing on the operated leg. Stand up straight and balance your weight on crutches or a walker. Move your crutches or walker forward a short distance. After this, move forward yourself, raising your operated leg so that you can feel the floor, touching it. As you move, your knee and ankle will be flexed. To rest, lower your leg to the floor. When you take a step, it is permissible to lift your foot off the floor. Move the walker forward again and move your foot forward again for the next step. Remember, first you need to touch the floor with your heel, then straighten your leg, then lift your leg off the floor. You are allowed to walk as much as you can. Do not hurry. As your muscle strength and exercise tolerance increases, you will be able to walk more and more. Gradually you will increase the weight load on the operated leg.

Walking with a stick or crutches. A walker is often used for the first few weeks to help with balance and prevent falls. A cane or crutches are then used until strength and range of motion are fully restored. Hold the cane in the hand opposite the operated joint. You will be ready to transition to a cane or crutches when you can balance and stand without a walker, when you can fully distribute your weight on both legs, and when the walker becomes uncomfortable to hold.

Climbing and descending stairs. The ability to navigate stairs requires a certain range of motion and muscle strength. First, you will need handrails for balance and additional support, and at first you will only be able to step on one step at a time. Always ascend stairs on your healthy leg and descend on your operated leg. Remember “ascent with a healthy person” and “descent with a sick one.” At first, you may need help. Climbing stairs is a very good exercise for training muscles and developing joints. Do not climb steps that are more than 7 inches (18 cm) high and always use handrails.

The following exercises.

Full recovery will take many months. Soreness before surgery and pain after will weaken your muscles. The following exercises will help restore muscle strength.

Standing knee bend. While standing upright with the support of a walker or crutches, lift your hip and bend your knee as much as possible, holding this position for 5 to 10 seconds. Then lower your leg, trying to feel the floor. Repeat several times until you get tired.
Supported knee flexion. Lying on your back, wrap the belt around your shin and, helping yourself with your hands, try to bend your knee as much as possible.
Load-bearing exercises. You can place a small weight on your ankles and perform the above exercises. Loading can be done 4–6 weeks after surgery. At first, use a load of 500 - 1000 g, then gradually increase.

Exercise bike. An exercise bike is an excellent exercise for restoring muscle strength and full range of motion. Adjust the seat height so that when your knee is almost straight, your foot just touches the pedal. First the pedal turns back. Moving forward is possible if the pedal rotates backward comfortably. As your muscle strength increases (over about 4 to 6 weeks), increase the resistance of the machine. Exercise for 10-15 minutes twice a day, gradually increasing to 20-30 minutes three to four times a week.

Pain and swelling after exercise. You may experience pain and swelling in the area of your operated knee after exercising. You can reduce them by holding your leg in an elevated position and applying cold.

Your orthopedic surgeon is a doctor with extensive knowledge in the diagnosis, therapeutic and surgical treatment of injuries and diseases of the musculoskeletal system, including bones, joints, ligaments, tendons, muscles and nerves.

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.

How to arrange a house

To make your home more comfortable and safe when you return from the hospital, there are a number of important changes you should consider before surgery:

Place regularly used items at hand level so that you don’t have to reach or bend over for them.
If you live in a private home, temporarily change the assignment of rooms if necessary to avoid unnecessary stairs.
Rearrange furniture to create enough space for walking with crutches or a walker.
Find a chair that is sturdy and tall enough with secure armrests to make getting out of it easier.
Remove visible, loose electrical cords from walkways and hide rugs or secure corners with double-sided tape to prevent tripping hazards. Think about what you can hold on to when moving around the house, cover the sharp corners of the furniture with soft pads, and ensure normal lighting in all rooms.
A small stool is useful as a support for your operated leg to keep it straight when you sit in a chair.
To avoid the hassle of constantly getting up and walking around, set up a personal corner in your home with a TV, computer, remote controls, sanitary napkins, drinking water, magazines and books, as well as medicines within arm’s reach.
It is better to give pets that can push you or get in your way to family or friends for a few weeks to reduce the risk of falling and damaging the new joint.
Prepare the bathroom. When showering, install a secure seat with anti-slip rubber tips. Attach stable handrails to the wall. Place soap, shampoo and other bath accessories so that you don’t have to turn around or reach for them.

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.

Osteolysis and aseptic loosening of components

Osteolysis is a pathological process that leads to bone destruction at the site of fixation of the endoprosthesis. The main reason for this phenomenon is the prevalence of resorption processes over bone formation processes. Over time, osteolysis causes aseptic (non-infectious) loosening of the endoprosthesis parts.

Pathological mobility of the implant can also be a consequence of the destruction of the cement that was used to fix it. Due to the disruption of the strong connection between the surfaces of the bones and the endoprosthesis, the latter loses support. This leads to its loosening. The patient may experience knee pain, discomfort, and difficulty walking.

There should be no areas of distinct color or outline between the implant and the bone. This may indicate loosening and instability.

Aseptic loosening of the endoprosthesis occurs at a later stage. According to statistics, in the first ten years after surgery it develops in 10-15% of operated people. Instability of the knee joint is an indication for revision arthroplasty late after surgery. The patient is given an implant with longer legs. Such an endoprosthesis provides reconstruction of lost bone tissue and allows for durable fixation.

A number of medications are used to prevent aseptic instability and implant loosening. These include bisphosphonates, calcium supplements and vitamin D. In addition, the patient is recommended to eat a calcium-rich diet. The intake of osteolysis inhibitors, vitamins and minerals into the body slows down the development of osteoporosis. The bones of the lower extremities stop deteriorating. This allows you to avoid pathological loosening of the endoprosthesis or delay the occurrence of unpleasant complications.

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.