A knee replacement is a procedure that resurfaces the femur and tibia, replacing the natural knee joint with a prosthesis. The procedure is primarily used to repair joint damage from osteoarthritis, but other causes of trauma to the bone or joint may require a knee replacement. Most people participate in physical therapy for one to three months following the procedure, but full recovery can take 6 to 12 months.
In the Hospital
During the hospital stay, a physical therapist will begin therapy procedures as early as the day of surgery. Initially, they will start ankle movement in order to increase blood flow and help prevent swelling and blood clots. The surgeon may use a continuous passive motion exercise machine that will slowly bend and straighten the knee to help with range of motion. The therapist teaches the patient to use an assistive device such as a walker or crutches so walking can begin as quickly as possible. Early mobilization after a knee replacement decreases the chances of developing a blood clot, so it is important to get up and get moving quickly. A hospital stay of one to three nights is normal after this procedure if there are no complications.
Sub-Acute Care
Since hospital stays are getting shorter, it may be necessary to spend a few nights in a rehabilitation center before returning home. Although many people prefer to go directly home, the hospital staff will recommend what setting is best upon discharge. Going to a rehab center provides the extra support and daily services needed for a few days between the hospital stay and returning home. In this setting, therapy procedures will concentrate on getting in and out of bed, increasing endurance, navigating stairs, dressing, and self care. This is when the patient can begin to work on stretching knee range of motion and increasing muscular strength.
Transition to Home
The patient has to be able to safely get into the house and navigate self-care in order to be able to return home. If the patient is discharged from the hospital or rehabilitation center, but is still having a difficult time getting in and out of the house, then home therapy services may be required. At home, therapy will concentrate on getting the patient mobile and independent in the house and continue to work on strength and range of motion.
Outpatient
Outpatient therapy will address all of the impairments and functional limitations that the patient has. Therapy will work on muscle strength for the lower extremities, concentrating on any area with increased weakness. Normal range of motion will be obtained through home exercises and the therapist manually stretching the joint. The patient will work on walking, both endurance and quality, and decrease the need for an assistive device until it is no longer needed to help with walking.
Beyond Physical Therapy
With insurance and financial limitations, it is not always possible to stay in therapy until a full recovery is achieved. Therapy will give the patient the knowledge of how to take care of the new knee and an extensive home exercise program to continue the rehabilitation process.
