Knee replacement surgery is a complex procedure, and physical knee rehabilitation is crucial to a full recovery. In order for you to meet the goals of total knee surgery, you must take ownership of the rehabilitation process and work diligently on your own, as well as with your physical therapist, to achieve optimal clinical and functional results. The knee rehabilitation process following total knee replacement surgery can be quite painful at times.
Your knee rehabilitation program begins in the hospital after surgery. Early goals of knee rehabilitation in the hospital are to reduce knee stiffness, maximize post-operative range of motion, and get you ready for discharge.
When muscles are not used, they become weak and do not perform well in supporting and moving the body. Your leg muscles are probably weak because you haven't used them much due to your knee problems. The surgery can correct the knee problem, but the muscles will remain weak and will only be strengthened through regular exercise. You will be assisted and advised how to do this, but the responsibility for exercising is yours.
Your overall progress, amount of pain, and condition of the incision will determine when you will start going to physical therapy.You will work with physical therapy until you meet the following goals:
1. Independent in getting in and out of bed.
2. Independent in walking with crutches or walker on a level surface.
3. Independent in walking up and down 3 stairs.
4. Independent in your home exercise program.
Your doctor and therapist may modify these goals somewhat to fit your particular condition.
In your physical therapy sessions you will walk, using crutches or a walker, bearing as much weight as indicated by your doctor or physical therapist. You will also work on an exercise program designed to strengthen your leg and increase the motion of your knee.
Your exercise program will include the following exercises:
The quadriceps is a set of four muscles located on the front of the thigh and is important in stabilizing and moving your knee. These muscles must be strong if you are to walk after surgery. A "quad set" is one of the simplest exercises that will help strengthen them.
Lie on your back with legs straight, together, and flat on the bed, arms by your side. Perform this exercise one leg at a time. Tighten the muscles on the top of one of your thighs. At the same time, push the back of your knee downward into the bed. The result should be straightening of your leg. Hold for 5 seconds, relax 5 seconds; repeat 10 times for each leg.
You may start doing this exercise with both legs the day after surgery before you go to
physical therapy. The amount of pain will determine how many you can do, but you should
strive to do several every hour. The more you can do, the faster your progress will be. Your
nurses can assist you to get started. The following diagram can be used for review.
Terminal Knee Extension
This exercise helps strengthen the quadriceps muscle. It is done by straightening your knee joint.
Lie on your back with a blanket roll under your involved knee so that the knee bends about
30-40 degrees. Tighten your quadriceps and straighten your knee by lifting your heel off the
bed. Hold 5 seconds, then slowly your heel to the bed. You may repeat 10-20 times.
Each day you will bend your knee. The physical therapist will help you find the best method to increase the bending (flexion) of your knee. Every day you should be able to flex it a little further. Your therapist will measure the amount of bending and send a daily report to your doctor.
In addition, your therapist may add other exercises as he or she deems necessary for your
Straight Leg Raising
This exercise helps strengthen the quadriceps muscle also.
Bend the uninvolved leg by raising the knee and keeping the foot flat on the bed. Keeping your involved leg straight, raise the straight leg about 6 to 10 inches. Hold for 5 seconds. Lower the leg slowly to the bed and repeat 10-20 times.
Once you can do 20 repetitions without any problems, you can add resistance (ie. sand bags)
at the ankle to further strengthen the muscles. The amount of weight is increased in one
Use of heat and ice
Ice: Ice may be used during your hospital stay and at home to help reduce the pain and swelling in your knee. Pain and swelling will slow your progress with your exercises. A bag of crushed ice may be placed in a towel over your knee for 15-20 minutes. Your sensation may be decreased after surgery, so use extra care.
Heat: If your knee is not swollen, hot or painful, you may use heat before
exercising to assist with gaining range of motion. A moist heating pad or warm damp towels
may be used for 15-20 minutes. Your sensation may be decreased after surgery so use extra
Long-Term Knee Rehabilitation Goals
Once you have completed your knee rehabilitation therapy, you can expect a range of motion from 100-120 degrees of knee flexion, mild or no pain with walking or other functional activities, and independence with all activities of daily living.