The physical therapist is an integral part of the team of health care professionals who help people receiving a total knee replacement regain movement and function and return to daily activities. Your physical therapist can help you prepare for and recover from surgery and develop an individualized treatment program to get you moving again most safely and effectively possible.
Physiotherapy treatment may start within a day of your surgery. If you're not in too much pain, you may start the day of the surgery. The goal of physical therapy as post surgical rehabilitation is to promote the healing process and help patients regain functioning. This is accomplished through several therapeutic physiotherapy treatment protocols with personalized patient assessments.
Your new knee will continue to recover for up to 2 years after your operation. During this time, scar tissue will heal and muscles can be restored by exercise.
Despite individualized care, everyone gains the same health benefits after following physical therapy in knee replacement surgery.
Some of them are,
Easing your pain
Reducing inflammation
Maintaining circulation
Restoring joint strength and mobility
Strengthening supporting muscles
Eliminating joint and muscle stiffness
Improving your balance
Regaining your normal gait
Returning to normal movement and activities
Some of the negative consequences that can potentially occur in patients recovering from knee surgery who don’t continue with physical therapy.
Supporting muscles and soft tissue can begin to atrophy due to nonuse and swelling. The function of your new joint depends on strengthening the surrounding muscles.
Increased strain can be put on the knee from improper movement.
If you don’t move and engage in physical therapy, however, scar tissue develops that restricts movement and your muscles weaken. The range of motion can be diminished.
The healing process can be slowed down due to a lack of blood flow to the area.
A physiotherapist may help,
Immediately Following Surgery
You may stay in the hospital for a few days following surgery, or you may even go home on the same day, depending on your condition. If you have other medical conditions, such as diabetes or heart disease, you might need to stay in the hospital or go to a skilled nursing facility for a few days before returning home. While you are in the hospital, a physical therapist will,
Educate you on applying ice, elevating your leg, and using compression wraps or stockings to control swelling in the knee area and help the incision heal.
Teach you breathing exercises to help you relax and show you how to safely get in and out of bed and a chair.
Show you how to walk with a walker or crutches, and get in and out of a car.
Help you continue to do the flexibility and strengthening exercises that you learned before your surgery.
In the rehabilitation stage
The goal of the first 2 weeks of recovery is to manage pain, decrease swelling, heal the incision, restoring normal walking, and initiate exercise. Following those 2 weeks, your physical therapist will tailor your range of motion exercises, progressive muscle-strengthening exercises, body awareness, and balance training, functional training, and activity-specific training to address your specific goals and get you back to the activities.
Range of motion exercises
Swelling and pain can make you move your knee less. Your physical therapist can teach you safe and effective exercises to restore movement (range of motion) to your knee so that you can perform your daily activities.
Strengthening exercises
Weakness of the muscles of the thigh and lower leg could make you need to still use a cane when walking, even after you no longer need a walker or crutches. Your physical therapist can determine which strengthening exercises are right for you.
Body awareness and balance training
Specialized training exercises help your muscles "learn" to respond to changes in your world, such as uneven sidewalks or rocky ground. When you can put your full weight on your knee without pain, your physical therapist may add agility exercises and activities using a balance board that challenges your balance and knee control. Your program will be based on the physical therapist’s examination of your knee, your goals, and your activity level, and general health.
Functional training
When you can walk freely without pain, your physical therapist may begin to add activities that you were doing before your knee pain started to limit you. These might include community-based actions, such as crossing a busy street or getting on and off an escalator. Your program will be based on the physical therapist's examination of your knee, your goals, and your activity level, and general health.
The timeline for returning to leisure or sports activities varies from person to person; your physical therapist will be able to estimate your unique timeline based on your specific condition.
Activity-specific training
Depending on the requirements of your job or the type of sports you play, you might need additional rehabilitation that is tailored to your job activities (such as climbing a ladder) or sports activities (such as swinging a golf club) and the demands that they place on your knee. Your physical therapist can develop an individualized rehabilitation program for you that takes all of these demands into account.
Physiotherapy advise in the recovery period
DO'S
Move your knee as soon as possible after the operation unless your surgeon or physiotherapist tells you not to.
Use your walking aids but aim to gradually decrease the amount you rely on them as your leg feels stronger.
Keep up your exercises to help prevent stiffness, but do not force your knee. normally in the first three weeks 3 times per day.
Wear supportive shoes outdoors.
Raise your leg when sitting and apply an ice pack (or a bag of frozen peas wrapped in a tea towel ) for 20 minutes every 3 or 4 hours to reduce any swelling.
DON'TS
Do not sit with your legs crossed for the first 6 weeks after your operation.
Do not put a pillow underneath your knee when sleeping as this can result in a permanently bent knee.
Do not twist at your knee.
Do not kneel on your operated knee until the right time comes.
Avoid extreme movements or sports where there's a risk of falling, such as skiing or mountain biking.
Do not drive for 6 -8 weeks. Start driving only when you are fully recovered and pain-free.
Do not stand for long periods as this may cause ankle swelling.
Avoid stretching up or bending down for the first 6 weeks.
Consult your physiotherapist for better and thorough, individualized advice.
References
https://www.nhs.uk/conditions/knee-replacement/recovery/
https://www.choosept.com/symptomsconditionsdetail/physical-therapy-guide-to-total-knee-replacement
Sanjula Senanayake
