Early Postoperative Exercises
These exercises are important for increasing circulation to your legs and feet to prevent blood clots. They are also important to strengthen muscles and to improve your hip movement.
1. Ankle Pumps - Slowly push your foot up and down. Do this exercise several times as often as every 5 or 10 minutes. This exercise can begin immediately after surgery, and continue until you are fully recovered
2. Ankle Rotations - Move your ankle inward toward your other foot and then outward away from your other foot. Repeat 5 times in each direction, 3 or 4 times a day.
Exercise Program and Physical Therapy 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.
Your overall progress, amount of pain, and condition of the incision will determine when you will start going to physical therapy. If no problems arise, your doctor will have you start one to two days after surgery. 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 stairs.
4. Independent in your home exercise program.
5. Able to bend your knee 90 degrees.
6. Able to straighten your knee.
Your doctor 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. 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: Quadriceps Setting
The quadriceps are a set of four muscles located on the front of the thigh and are 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 the straightening of your leg. Hold for 5 seconds, relax for 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. 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.
Heel slides with assist
Lie on your back with your brace off and slowly slide your foot toward your hips, as far as possible. You may use your other foot to push for greater motion. At this point it is normal to feel pressure in the front of the knee. Hold this for 5-10 sec. Now slide the foot back until the knee is fully extended. Repeat 15-25 times, 3 times per day.
Knee Flexion
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. In addition, your doctor may add other exercises as he deems necessary for your rehabilitation.
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 (i.e, sandbags) at the ankle to further strengthen the muscles. The amount of weight is increased in one-pound increments.
Prone knee flexion Lie prone (on stomach), contract your abdominal muscles to prevent the low back from arching, bring the heel of your surgical leg towards your gluts, hold 20-30 seconds and repeat 3-4 times. Use your other leg or hand to provide the bending pressure.
Guidelines at Home What happens after I go home?
Medication
• You will continue to take medications as prescribed by your doctor.
• You will be sent home on prescribed medications to control pain. Plan to take your pain medication 30 minutes before exercises. Preventing pain is easier than chasing pain. If pain control continues to be a problem, call your doctor.
Activity • Continue to walk with crutches/walker.
• Bear weight and walk on the leg as much as is comfortable.
• Walking is one of the better kinds of physical therapy and for muscle strengthening.
• However, walking does not replace the exercise program which you are taught in the hospital. The success of the operation depends to a great extent on how well you do the exercises and strengthen weakened muscles.
• If excess muscle aching occurs, you should cut back on your exercises.
Walking and Early Activity Soon
after surgery, you will begin to walk short distances in your hospital room and perform light everyday activities. This early activity helps your recovery by helping your hip muscles regain strength and movement.
Walking with Walker — Full Weight Bearing – Stand comfortably and erect with your weight evenly balanced on your walker or crutches. Move your walker or crutches forward a short distance. Then move forward, lifting your operated leg so that the heel of your foot will touch the floor first. As you move, your knee and ankle will bend, and your entire foot will rest evenly on the floor. As you complete the step, allow your toe to lift off the floor. Move the walker again, and your knee and hip will again reach forward for your next step. Remember, touch your heel first, then flatten your foot, then lift your toes off the floor. Try to walk as smoothly as you can. Don’t hurry. As your muscle strength and endurance improve, you may spend more time walking. Gradually, you will put more and more weight on your leg.
Walking with a Cane or Crutch - A walker is often used for the first several weeks to help your balance and to avoid falls. A cane or a crutch is then used for several more weeks until your full strength and balance skills have returned. Use the cane or crutch in the hand of the same side as the operated knee. You are ready to use a cane or single crutch when you can stand and balance without your walker, when your weight is placed fully on both feet, and when you are no longer leaning on your hands while using your walker.
How long will I be on a walker?
You will be on crutches or a walker for 3- 4 weeks. At that time, you will be permitted to advance to a cane. Once you are comfortable with the cane, have regained your confidence and balance, you may discontinue its use.
Other Considerations
• You can usually return to work within 1-2 months.
• You should not drive a car until you consult your doctor.
• No shower or bath until after stitches/staples are removed.
Your Incision
Upon returning home, be alert for certain warning signs. If any swelling, increased pain, drainage from the incision site, redness around the incision, or fever is noticed, report this immediately to the doctor. Generally, the stitches/staples are removed in 10 to 12 days
How Your New Knee is Different
You may feel some numbness in the skin around your incision. You also may feel some stiffness, particularly with excessive bending activities. Improvement of knee motion is a goal of total knee replacement, but restoration of full motion is uncommon. The motion of your knee replacement after surgery is predicted by the motion of your knee prior to surgery. Most patients can expect to nearly fully straighten the replaced knee and to bend the knee sufficiently to go up and down stairs and get in and out of a car. Kneeling is usually uncomfortable, but it is not harmful.
Occasionally, you may feel some soft clicking of the metal and plastic with knee bending or walking. These differences often diminish with time, and most patients find that these are minor compared to the pain and limited function they experienced prior to surgery.
Your new knee may activate metal detectors required for security in airports and some buildings. Tell the security agent about your knee replacement if the alarm is activated.
Prevention of Infection
If at any time (even years after the surgery) an infection develops, such as a sore throat or pneumonia, notify your physician. Antibiotics should be administered promptly to prevent the occasional complication of distant infection localizing in the knee area. This also applies if any teeth are pulled or dental work is performed. Inform the general physician or dentist that you have had a joint replacement.
Warning signs of a possible knee replacement infection are:
• Persistent fever (higher than 100 degrees orally).
• Shaking chills.
• Increasing redness, tenderness, or swelling of the knee wound.
• Drainage from the knee wound.
• Increasing knee pain with both activity and rest, not relieved with
analgesics.
Notify your doctor immediately if you develop any of these signs !!
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