A knee replacement procedure is performed to repair a joint that has been damaged by trauma or a disease process such as arthritis. Under anesthesia, a surgeon removes the damaged portions of the joint and replaces them with prosthetic components that move smoothly on each other. The replacement pieces are made of metal and plastic and are shaped to allow natural movement and function. After several days in the hospital, many patients are transferred to a sub-acute rehabilitation facility for physical therapy. Therapy continues after a patient returns home, usually in an outpatient clinic. Most people are able to return to their normal employment and leisure activities after successful rehabilitation of the knee.
Range of Motion
The focus of rehabilitation immediately after a knee replacement is on regaining normal range of motion, or ROM. According to F. P. Kendall and E. K. McCreary in their book "Muscles: Testing and Function," an average range for a knee is from 0 degrees of extension to 140 degrees of flexion. Due to the surgical approach for the knee replacement procedure, the post-operative swelling of the joint and the pain experienced in the early stages of healing, regaining ROM is often a slow process but is absolutely necessary to regain function. Moving the knee from full flexion to complete extension frequently throughout the day and providing gentle, steady pressure at the end of the available range will continuously improve the ROM of the joint.
Muscle Strength
After the surgery, a physical therapist provides instructions on the proper exercise routine to regain normal muscle strength. A home exercise program is prescribed so that the muscles are worked several times each day. The program should also include the musculature of the hip and ankle because the knee works in conjunction with these other joints for functional activities, suggest C. Kisner and L. A. Colby in their book "Therapeutic Exercise: Foundations and Techniques." Following the therapist's instructions and attending all therapy appointments builds the muscle strength necessary to return to work and recreational pursuits.
Pain and Edema
Pain and edema, or swelling, of the knee is normal after knee replacement surgery. The surgeon will prescribe medication that helps to reduce these side effects. An ice pack can be placed on the knee for 20 minutes at a time, three to five times a day to help control both the pain and edema. Good pain and edema management allow for better participation in therapy and a quicker overall recovery.
Blood Clots
A blood clot, or thrombosis, is a potential complication following joint replacement surgery. A clot that loosens and begins to travel in the blood stream is potentially life-threatening, as it could cause a heart attack or stroke. Surgeons prescribe medication to thin the blood in the early stages of recovery to avoid this prospective problem. Some also order special stockings that provide gentle pressure to the legs to improve circulation. Both doctors and therapists encourage frequent walking to promote good blood flow.
Adequate Sleep
While exercise is an important part of the rehabilitation process, so is getting a good night's sleep. The body does its best restorative work when it is sleeping. Getting enough rest should be part of healing from any illness, injury or surgical procedure. Patients should consult their physician if normal sleep patterns are not resumed in the first one to two weeks following surgery.
Healthy Diet
Nutritious, well-balanced diets provide the building blocks for healing. Normally, the appetite is somewhat reduced following surgery but should rebound to normal levels fairly quickly. The quality of each meal, regardless of how much food is consumed, is the key to repairing the body after surgery. A diet high in protein, fruits and vegetables, while low in fat and empty calories helps to speed regeneration of bone and muscle. Adequate water intake is also important to avoid dehydration and constipation.
Doctor Appointments
The surgeon must perform periodic check-ups to ensure the knee is healing well. These appointments are necessary to make sure the joint is on track in the rehabilitation process as well as to catch any problems while they are in the early stages and still treatable. The physician also closely manages any other diseases to allow for full recovery from the knee replacement surgery.
References
- "Muscles: Testing and Function, 4th Edition"; F. P. Kendall, E. K. McCreary; 1993
- "Therapeutic Exercise: Foundations and Techniques, 5th Edition"; C. Kisner, L. A. Colby; 2007
