Physical Therapy After Knee Replacement Surgery

Knee prosthesis surgery (total knee arthroplasty) may be recommended if the person has started to have difficulty in movements such as walking and climbing stairs as a result of various arthritis or traumas , especially calcification in which the knee joint is damaged, if the knee continues to hurt even when resting, and if methods such as physical therapy are ineffective.

The knees are the largest and most complex joints in the body. They carry body weight and enable movement. On the articular surfaces of the bones, there is a cartilage layer that facilitates movement. In addition, the intra-articular fluid called synovial fluid reduces friction. Due to reasons such as osteoarthritis, trauma, rheumatoid arthritis , there may be deteriorations in the joint that make normal movement difficult and cause pain.

How is Knee Replacement Surgery Performed?

The damaged cartilage on the sides of the thigh (femur) and tibia (tibia) bones facing the knee joint and a small part of the bone underneath are removed. Instead, metal components are placed to regenerate the joint surface. The lower edge of the kneecap is cut and replaced with a plastic surface. In some surgeries, the kneecap is not touched. A plastic spacer is placed between the metal components for ease of movement . The length of stay in the orthopedic service is as short as 1-3 days. However, the physical therapy process continues.

Who Can Have Knee Replacement Surgery?

  • Those with knee pain and stiffness that limit daily activities such as climbing stairs, sitting, walking
  • Moderate or severe knee pain at rest and even at night
  • Chronic knee inflammation and edema that does not go away with rest or medication
  • Severe deformity of the knee (leg bent inward or outward)
  • Losing weight, not benefiting from treatments such as exercise, physical therapy , painkillers, intra-articular injections ( cortisone , viscosupplementation, etc.)
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Surgery is recommended according to the patient’s level of pain and limitation. Age alone is not the determining factor. Most knee replacement surgeries are done between the ages of 50 and 80. However, younger or older people can also be operated on.

With knee replacement surgery, the success rate is over 90% in terms of pain reduction and comfortable daily activities. However, it may be necessary to avoid activities that expose the knees to high stress, such as running, jumping, tennis, and skiing, for life. It may be possible to do activities that do not strain the knees, such as walking, swimming, cycling, and light dancing.

Possible Complications

There is also the risk of undesirable consequences such as infection, intravascular clot formation, loosening of the prosthesis, vascular or nerve injuries, fracture, loosening of the kneecap, and persistent pain. The rate of serious complications is less than 2%.

Physiotheraphy

In order to return to daily life as early as possible after the surgery and to reduce the risk of complications, physical therapy should be started in the early period. Often the exercises begin the same day after surgery. Movements such as ankle pumping, isometric quadriceps and gluteus maximus exercises, heel slide are performed. Shallow breathing after anesthesia may cause partial collapse (atelectasis) in the lung. To prevent this, deep breathing exercises and exercises with a spirometer are done. Knee range of motion exercises can be performed manually or with a continuous passive motion (CPM) device. The physiotherapist instructs the patient to sit up and walk. In the first days, the use of a walker or crutches during walking may be recommended.

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Generally, the person can return to his normal daily life within 3-6 weeks after the surgery. It is normal for mild pain to persist for several weeks during movement. The walking distance is increased day by day. Special exercises are applied to strengthen the leg and bring the movements back to normal.

At the end of the second week, it is desirable that the knee can be bent 90 degrees. By the end of the sixth week, the bending angle should reach 100-105 degrees. The exercise bike can be used, the height of the seat should be positioned correctly in relation to the patient.

Electrical stimulation to strengthen the muscle, massage and mobilization to soften the scar tissue can be applied. You can work with small weights and exercise bands to strengthen the muscles. 7-8. Weight is given to balance, position sense and strengthening exercises to increase functional capacity in weeks.

Most people who have had knee joint replacement surgery can do their exercises at home, but some patients may need physical therapy in an outpatient or inpatient physical therapy center.

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