What You Need To Know
Total knee replacements are a common surgical procedure, which improves the quality of life. Even with its commonality, many people delay and even put off having surgery due to their fear of the rehabilitation that follows. Patients hear stories of poor outcomes and problems that can persist after a total knee replacement surgery. There can be a lot of anxiety felt by patients that are behind or not doing as well, as fast as they should be. This blog will help calm any fears and explain what you need to know before a total knee replacement.
The rehabilitation process begins before the surgery, known as prehab. Multiple research articles cite the benefits of prehab. Prehabilitation reduces the time required for rehabilitation after the surgery. Four to eight weeks of simple strengthening and range of motion exercises before surgery increase the patient’s ability to reach their goals sooner. This reduces the amount of pain and improves lower extremity strength post-surgery.
Total Knee Replacement Surgery Expectations
Total knee replacement surgeries require one day in the hospital. You will demonstrate you can transfer out of a chair, walk, and do stairs safely before being allowed to leave the hospital. Often patients will state it is painful because of the surgical pain, but it is much better than the pain that they experience pre-surgery. How much assistance the patient needs will determine when they can return home. For some, they will need home therapy or go to a skilled nursing facility. The main objective during this phase of rehab is to make sure their range of motion allows the patient to be safe and require minimal assistance.
Once the patient is deemed safe, then outpatient rehabilitation can begin. The normal rehab process takes, on average, 8-12 weeks in outpatient therapy. The first month of outpatient therapy is focused on reducing swelling and range of motion. Increased swelling after a total knee replacement surgery attracts cells that produce scar tissue. The increased scar tissue can eventually limit the joint motion. Limited mobility can cause increased pain. It is important to get the knee joint moving quickly early on in therapy to reduce the chances of scar tissue.
Goals After A Total Knee Replacement
The goal for knee range of motion is 0 degrees extension (knee straight). With knee flexion (bending) 120 degrees. If the patient lacks knee extension, this affects the patient’s walking pattern. Without proper knee extension, the patient will not be able to take a full step, creating a noticeable limp. The patient’s poor walking mechanics can lead to pain not only at the knee but also at the ankle/foot, hip, and lower back. The patient that lacks knee flexion will have difficulty sitting in tighter seats and squatting down. With a focused approach during therapy and the home exercise program, these limitations can be eliminated before they become problematic.
The other important goal with therapy is to ensure good quadriceps strength before discharge from therapy. Unlike the range of motion, gaining strength is a more gradual process. The post-operative swelling will affect the nerve that controls the quadriceps, which can lead to weakness. Patients often are worried because they will not be able to lift their leg even onto the bed in the early stages of rehab. The physical therapist helps to restore the strength through exercise, however, occasionally using electric stim to stimulate the nerve and the muscle to work properly.
As the quadriceps gets stronger the therapist will guide the patient with more challenging exercises to regain their strength. The goal for strength is to be discharged from therapy at 80% of normal. We aim for 90% at our clinics to reduce the chances of returning to therapy in the future. Regaining strength is vital to therapy to make sure there aren’t compensations in mobility.
Total knee replacements are one of the most successful surgical procedures.
Pain After A Total Knee Replacement Surgery
According to the AAOS, nine out of ten patients will have some immediate pain relief after having a total knee replacement. In addition, less than 5% will need a revision within ten years. Total knees replacement rehabilitation will have some pain, but should not be feared. An experienced physical therapist will guide you through the rehabilitation process to help you meet your goals.
Let our experienced physical therapists get you back to doing what you love after a total knee replacement. Schedule your appointment today.