Hey Team,

 

Total knee replacements are one of our physical therapy clinic's most common post-surgical procedures. This is also the most dreaded. Out of all the joint replacements, a total knee can be the most difficult… But why? Why is the total knee so challenging for many who come out of surgery looking to rectify their joint pain and return to an active lifestyle? Also, why do so many people have difficulty with joint pain one, three, and five years after surgery? This procedure is a game changer for some individuals, and for others, they wish they never would've had the replacement.

 

In today's entry, we will review why people have difficulty after a total knee replacement, never achieving full range of motion to the knee, and why people continue to have perpetual pain even five years after surgery. 

 

If you are having surgery soon, following these tips today will give you the best chance to have a perfect total joint replacement for the knee.

 

 

How Do You Know You Need Surgery?

 

So, let's dig right in today. An individual who is a candidate for a total joint replacement has a significant level of disability in their daily life. These individuals are miserable in their regular daily chores. For a total knee replacement, walking, ascending, descending stairs, or attempting to squat can be very challenging. These individuals tend to decrease their social life. When an opportunity arises to leave the house, an assortment of questions go through their head. Will there be a place to rest? Will there be too much walking? Will I slow the group down if my joints hurt too much? These individuals often elect to stay home and miss out on key social engagements. If you are starting to decrease your social life because of your joint pain, this is the exact reason why a joint replacement surgery is needed.

 

After Surgery: Your First Step!

 

Beginning your knee range of motion is essential and should be started immediately. The extension is just as important as knee flexion. The extension is how straight you can keep the knee, versus knee flexion is how far you can bend it. A goal of 0° to 125° is optimal. Your goal should be to maintain this range of motion in the first six weeks. 

 

Listed below are other vital steps to follow:

 

Six-week goals After Total Knee Replacement

1. Increase ROM from 0 to 125 degrees 

2. Pain management 

3. Eat calories, preferably proteins 

4. Get a good night's sleep

 

ROM: Flexion (bending): 10 seconds on and 10 seconds off for as hard as you can tolerate. Perform 15 times. Rest for 5 minutes. During rest, you can move the knee, get up and move around, etc. This is considered one set. You will perform 3 sets total in one session. 

(Instructions: 3 sets of 15 reps of 10 sec on/10 off x 3 per day. (Morning, Lunch, Evening) 

 

 

ROM: Extension: You will spend most of the day resting with the knee bent; therefore, keep a rolled towel under the heel while resting. The towel must be thick enough for the thigh not to touch anything. 

Stretching: on a rolled towel. Push down 10 sec/ rest 10 sec. = one repetition. Perform 3 sets of 15 reps x 2 per day. 

(Instructions: 3 sets of 15 reps of 10 sec. on 10 off x 2 per day.) 

 

CPM( Continuous Passive Movement) Machine: The CPM is no good. Well, no good if not done actively. YOU MUST BE AN ACTIVE PARTICIPANT. You cannot lie down and sleep. You have to set a goal on how many degrees you want to achieve per session. The numbers on the machine for degrees of ROM are arbitrary. These numbers do not reflect your actual ROM. DO NOT TRUST THEM. You must increase your tension on the CPM to the point of significant discomfort and leave here for 5 mins. Then increase gradually every 5 minutes. 

 

(Instructions: Perform 1-2 hours in CPM with specific goal degrees increase in mind. Increase the degree of bend every 5-10 minutes.) 

 

Pain management: You cannot push yourself and increase your knee ROM to functional limits if your knee hurts too much. Too much weight-bearing activity will increase tenderness and soreness; therefore, you will not have the energy or WILL to push your ROM. You must use your pain medication as necessary and not perform too much walking or ADL s. 

 

Nutrition: A good caloric diet is necessary to heal the tissue. Calories are needed for healing, but also energy for your exercises. A mild increase in protein is helpful if your stomach can tolerate it. Try to get back on track with eating a nutritious diet. 

 

Sleep: You must rest when not performing specific exercises and get sleep at night to have the energy or mental stamina to continue to push your knee to functional levels. 

 

 

These are the first few things I start with each of our physical therapy clients to help them properly progress with their total knee replacement. The important part is to improve your range of motion to acceptable levels as quickly as possible. Once this is achieved, we start strengthening the leg muscles. An individual's success will be predicated on achieving full range of motion to the knee and achieving full strength to the quadriceps. These two variables will affect all walking abilities, a synonym for descending stairs and squatting.

 

 

In this entry, I will also attach the two handouts we provide to our patients after a total knee replacement. 

1. One is the criteria listed previously

2. The other is our tracking guide: We use this tracking guide for an individual at home  so they can keep track of their stretching program. It is imperative that these individuals follow the guidelines for stretching rigorously to meet the range of motion goals.

 

 

If you are wondering about your total knee replacement and progressing correctly, feel free to respond to this entry or email us. You are also welcome to call the office.

 

We love to see people back and moving again, so do not hesitate to contact me.

 

I sure hope this entry gets you moving well!

 

See you over here!

 

Rob