A Guide to Rehabilitation Exercises After a Total Knee Replacement

Embracing a total knee replacement surgery is akin to granting your knee a fresh lease on life. Whether you have recently undergone this procedure or are gearing up for it, this comprehensive guide will illuminate the intricacies of the replacement surgery and shed light on what awaits you during your post-operative rehabilitation journey.

Understanding Total Knee Replacement Surgery and Its Candidates

Total knee replacement surgery, also known as total knee arthroplasty or TKR/TKA, is a surgical marvel that involves replacing a damaged or deteriorated knee joint with an artificial joint or prosthesis. Typically, this surgery is recommended for individuals grappling with debilitating knee pain due to conditions such as osteoarthritis, rheumatoid arthritis, or traumatic injuries to the knee joint. So, how do you know if a knee replacement is the right course of action for you? Orthopedic surgeons often suggest that when the time is right for a replacement, you'll instinctively know it. Before jumping to the surgical option, most orthopedists advocate exploring physical therapy as an initial measure to see if surgery can be avoided. If a total knee replacement is still the recommended course of action even after pursuing physical therapy, take comfort in the knowledge that your dedication to PT has not been in vain. Research reveals that individuals who undergo pre-surgery physical therapy tend to achieve more favorable post-operative results!

A Glimpse into the Surgical Procedure

After you've had a thorough evaluation with your orthopedic surgeon and both you and your doctor determined surgery is your best bet, here is what you can expect. The surgery is typically conducted under either general anesthesia, where the patient is unconscious, or spinal/epidural anesthesia, where the patient remains awake but is numbed from the waist down. Here are the next steps:

1. The surgeon carefully moves aside the muscles and other tissues surrounding the knee joint.
2. The damaged portions of the thigh bone (femur) and shinbone (tibia) are removed and these bone surfaces are then reshaped to accommodate the artificial components of the knee prosthesis.
3. The artificial knee joint, consisting of metal and plastic components, is securely implanted. The femoral component replaces the end of the thigh bone, the tibial component replaces the top of the shinbone, and a plastic spacer is inserted between them to allow smooth movement.
4. If needed, the undersurface of the kneecap (patella) may be resurfaced with a plastic component.
5. With the artificial joint securely in place and the knee's movement and alignment thoroughly checked, the surgeon closes the incision, marking the start of your rehabilitation journey.

Initiating Your Rehabilitation Journey

Following the surgery, you are relocated to the recovery room, where you may spend several days. It is there in the hospital where you will typically have your first physical therapy session. During this initial session, you can expect a set of knee exercises, along with your physical therapist helping as you take your first steps on your new knee!

After you get home from the hospital, a physical therapist will often make home visits. Once the physical therapists thinks you are safe to leave the home, they will recommend you go to outpatient physical therapy, or physical therapy in an office. At this point, the rehabilitation process typically unfolds in about four phases, which can vary based on your personal goals and your pre-surgery level of function.

As you read through the general goals and recommendations of each phase, remember the importance of consulting an expert physical therapist. Each person experiences unique strengths and challenges during this process. It's crucial to have a physical therapist conduct a thorough evaluation and create a personalized plan of care tailored to your strengths, weaknesses, and goals. What works wonders for someone else might not be suitable for you.

Phase 1 - Immediate Post-Surgical Phase (Days 0-3)

The primary objectives during this phase are:

1. Managing swelling
2. Easing stiffness
3. Enhancing muscle control

Occasionally, your surgeon may suggest strategies for managing knee swelling, such as icing or compression. Your physical therapist will guide you in mitigating stiffness and bolstering muscle control. Here are a couple of exercises that your physical therapist may introduce during this initial phase:

1. Quad Set: This exercise enhances both quadriceps muscle control and your ability to fully extend your knee.

   

   
   Contract your thigh muscle as you push your knee down towards the ground. Hold for 3-5 seconds.  Relax and repeat 20x.
2. Seated Knee Bending: After knee replacement, bending your knee can be one of the biggest challenges. This exercise is designed to improve your knee's flexion range of motion.

   

   
   Using your unaffected leg, slide your affected leg backwards to bend your knee. Feel a gentle stretch, hold for 3-5 seconds and repeat 20x.

Phase 2 - Motion Phase (Day 3 - Week 6)

During this phase, you will likely experience improvements in swelling and joint range of motion, although some residual swelling and stiffness will most likely persist for a bit longer. The goals of this stage mirror those of Phase 1:

1. Continuing to work on range of motion
2. Initiating muscle strength training, alongside muscle control
3. Enhancing proprioception (balance and spatial awareness)

Should you still be unable to fully straighten your knee by the end of this phase, it becomes a focal point of your rehabilitation. Here are exercises that may be introduced:

1. Straight Leg Raises (SLR): Ensure you can completely straighten your knee before attempting this exercise, which enhances hip flexor strength and quadriceps muscle control.

   

   
   Keep your knee completely straight as your raise your affected leg upwards to the height of the bent knee and lower back down. Repeat 2-3 sets of 10 repetitions.
2. Supine Knee Flexion: As your rehabilitation progresses, this exercise, done while lying on your back, may help you achieve greater knee flexion than in the seated position.
   

   

   
   Bring your affected leg in towards your chest. To get a deeper stretch, hold onto your shin as you gently pull your shin towards you to get a stretch in the knee. Hold for 3-5 seconds and repeat 20x.
3. Standing balancing: Activities that involve standing and balancing on your operated leg are necessary for a safe and full recovery. Always perform them near a stable surface for safety.
   

   

   
   Stand on your affected leg for as long as you can. Repeat up to 20x.
4. General Strengthening: Initiate comprehensive lower extremity muscle strengthening, targeting the hip abductors and adductors, quadriceps, hamstrings, gluteal muscles, and calves.
5. Stationary bike: Once you can bend your knee beyond 90 degrees, consider using a stationary bike. This is a great exercise to reduce knee stiffness and improve cardiovascular endurance.
6. Gait training: As your leg gets stronger and you start walking more naturally, you can slowly use your cane or walker less. But don't rush to toss them away; make sure you can walk without a limp before giving them the boot.

Phase 3 - Intermediate Phase (Week 7-12)

During this phase, you should aim to regain your full capabilities and start feeling much better! The goals for this phase include:

1. Being able to bend and straighten your knee without stiffness
2. Attaining good strength and muscle control
3. Cultivating strong balance
4. Resuming normal, light activities, such as leisurely walks

You should continue with most of your strengthening exercises from phase 2 and be sure to include these additional exercises if you have not already:

1. Step Ups/Downs: This will help train you to navigate curbs and stair cases with balance, control, and confidence.

   

   
   Hold onto a sturdy surface if needed. Step up using your affected leg and step down leading with your unaffected leg. Repeat 2 -3 sets of 10 repetitions.
2. Monster Walks: This will help with both hip strength, balance and stability.

   

   
   Place a theraband around your shins. Bend your knees as you slightly squat backwards. Step to the side for 10 steps in each direction.
3. Advanced Balancing Exercises
   

   

   
   Stand on your affected leg as you hinge at your hips to allow your trunk to move forwards and your unaffected leg to move backwards. Repeat 2 - 3 sets of 10 repetitions.

Phase 4 - Advanced Strengthening and Higher Level Function (Week 12-16)

This is the fun phase, all about honing your skills! The goals include:

1. Improving your strength, endurance, and balance
2. Achieving a full return to your favorite recreational sports.

Some higher level exercises include:

1. Light Plyometrics: This involves small jumping drills and helps improve your ability for faster movements like jogging.

   

2. Progress all of the exercises in phase 2 and 3

While the journey to recovery after a knee replacement might seem intimidating, remember that you can do hard things, and you are worth it. Try to take each step as it comes, and know you're heading towards a future with less pain and more freedom to move. Feel free to use this blog as a helpful guide, but always stick to your surgeon's advice and work closely with a physical therapist for the best results tailored to your unique journey.

For more guidance and information, don't hesitate to book an appointment with one of our Union Square, NYC physical therapists.

You can reach us at (212) 604-1316 or email us at info@tula.nyc.