To understand total knee arthroplasty, you must first be familiar with the structure of the knee. The knee is a complex joint that consists of three bones: the femur (thigh bone), the tibia (lower leg bone), and the patella (kneecap). When you flex or straighten your knee, the distal end of the femur rotates against the proximal end of the tibia and the patella slides to the front of the femur.
In a healthy knee, the smooth, weight-bearing surface allows the joint to move painlessly. The muscles and ligaments provide lateral stability. The cartilage acts as a cushion between the femur and tibia, and the synovial fluid acts as a lubricant. The knee joint allows your leg to: straighten (knee extension), bend (knee flexion)
In an arthritic knee, the cartilage padding is worn down. The bones rub directly against each other and gradually become rough. The resulting inflammation and pain lead to reduced mobility and difficulty walking.
Knee pain often occurs when the cartilage is destroyed, the bones are worn away, the surface becomes irregular, the muscles are weak and the joint is stiff, and fluid accumulates in the joint. The femur wraps around the end of the thigh bone, the tibia wraps around the top of the calf bone, and the patella wraps around the medial aspect of the kneecap.
Functional Training: Please work with your doctor, nurse, nurse practitioner, and rehabilitation physical therapist, to arrange and complete your care.
Exercise: Gentle exercises will improve your joint mobility, thus preventing circulation problems, and will also build muscle strength. Your rehabilitation physiotherapist will guide and monitor your exercise program for a period of time after surgery.
Deep breathing: It is very important to practice deep breathing after surgery. Deep breathing removes mucus from your airways and lungs. Generally, you will take several deep breaths almost every hour, often without even realizing it, including sighing and yawning. When you are in pain or feel drowsy from narcotics or pain medication, your breathing can become shallow. To ensure that you practice deep breathing every day, your caregiver will give you a device called an evoked spirometer and will also teach you how to use it.
Pain management: Recovery from any surgery is bound to be painful and uncomfortable. By managing pain, the medical team can help reduce your discomfort and therefore speed up your recovery. However, pain management requires your right to cooperate. Although there are no objective tests to measure how you feel, you must try to describe your pain to your doctor in detail, pinpoint the location of the pain, determine its intensity, and report changes in the pain, which may be constant or intermittent, and may be sharp, burning, stabbing, or aching. The pain score helps you and your doctor assess the level of pain and the effectiveness of treatment.
Our plan is for you to gradually transition to oral medications. Usually oral pain medications are opioids or narcotics, and anti-inflammatory medications are used when necessary. This transition is usually very smooth and allows you to gradually begin your activities with minimal discomfort.
Every patient feels differently. So, if you need pain medication, tell the nurse as soon as the pain starts. Remember, pain medication is better when taken before the pain becomes severe. If necessary, pain medication can be taken every 3-4 hours.
Ice therapy: The application of freezing has been shown to reduce edema and pain due to the inflammatory response in the postoperative area. Ice packs or cold pads should be used consistently as daily therapy for the first few weeks after surgery for 15 minutes at a time, with intervals of 3-4 hours.
Starting to walk: The physical therapist or nurse will assist you to sit on the edge of the bed. You can then use a walker and stand up with the help of your physiotherapist. Soon you will be able to put full weight on your post-surgical leg and start walking. Over time, you will need to gradually increase the distance and frequency of walking. The vast majority of patients progress to walking with a straight cane within a few days after surgery.
Stair climbing: You will practice climbing stairs several times before discharge, using the exercise stairs in the physical therapy room. Remember, the results are up to you!
Active participation in the physical therapy program is essential to speed up recovery and ensure successful long-term rehabilitation, as well as to prepare for discharge home. Active participation in the physical therapy program is essential to the success of the procedure. The harder and more enthusiastic you are, the faster your progress will be. Shortly after surgery, we will prepare a rehabilitation program to improve joint mobility and strengthen the muscles in your legs.
Functional training considerations after total knee arthroplasty:
Below are some precautions that must be followed after total knee replacement. The hospital staff will be able to provide you with guidance if there are other conditions that require attention. Position your knee comfortably for daily activities. Walk and exercise your joint mobility daily. If your knee joint becomes swollen, apply cold packs to it. If you have swelling in your knee, calf, or ankle, elevate your knee for one hour twice a day. When at home, use a grab bar or bathing stool for extra safety, comfort, support and stability.
Twisting your knee joint cannot be done. Instead, turn your entire body instead. Bouncing or other activities that cause sudden, intense stress on the knee joint. Do not place a pillow or towel roll directly under your knee. Always keep the knee joint straight when lying down.
Prevention of blood clots,After total knee replacement, blood clots, known as deep vein thrombosis, may form in the veins of the lower extremities. In rare cases, these lower extremity clots can travel with the bloodstream to the lungs and cause other symptoms. To prevent and reduce the formation of blood clots, the nurse will use a mechanical device (a pump in the foot or calf) to squeeze the muscles of your leg during your hospital stay to keep the blood flowing through the vein. In addition, medications such as warfarin, low molecular heparin or aspirin will be used to reduce the formation of blood clots.
Swelling of the leg. After total knee replacement, most patients will experience swelling of the affected limb. Although the degree of swelling varies from person to person, edema itself is very common, whether it occurs in the leg, knee, ankle or foot. And it is usually accompanied by bruising of the skin, which usually takes several weeks to gradually subside.
For the first month after surgery, continued sitting with the affected limb underground or down can aggravate the edema. You should limit continuous sitting to 30-45 minutes at a time. Walk and elevate the affected limb in the prone position alternately. When elevating the affected limb, be careful to keep the ankle above the level of the heart. Lying flat for 1 hour in the morning or afternoon may also reduce edema.
How to prevent or reduce leg and ankle edema: Elevate the leg after surgery. Sit for no more than 30-45 minutes at a time. Move your ankle joint more often. Ice your knee several times a day for 20 minutes at a time (before and after your workout).
Final phase: functional training at home focusing on the surgical area
1. Until the skin staples or sutures are removed from the incision, the incision will be covered with sterile excipient material.
2.After the sutures or skin staples are removed, please expose the incision directly unless the doctor requests a dressing.
3. Please inform your doctor if you notice any redness in the incision or exudate home aggravated.
Painkillers:
1.Please take painkillers according to the prescription.
2.For better pain control, please take painkillers before the pain worsens.
3.If painkillers do not work well, or if you experience uncomfortable side effects after taking them, please contact your doctor immediately.
4.Do not drink alcoholic beverages while taking painkillers.
5.One important point is that if you need extra painkillers, please contact your doctor before you run out of painkillers. For insurance purposes, please contact your doctor one week in advance.
If you experience discomfort during your rehabilitation, take your pain medication at least 45 minutes prior to your treatment. This will allow the pain medication to take full effect.
Preventing infection (prophylactic antibiotics)
It is very important to protect your artificial joint from infection. Some patients have an increased risk of infection after total joint surgery because the infection can spread from other parts of the body to the new joint with blood flow (in medical terms, this becomes blood-borne transmission). So tell your doctor about your history of artificial joint replacement, then they will give you antibiotics before treatment is needed. This is especially important before dental procedures or invasive urologic procedures. If you do not know which procedures are invasive, it is safe to consult your surgeon who will give you additional instructions.
Rehabilitation Exercise Program:
It is very important to complete these exercises after surgery. Your goal is to build strength in the affected limb, reduce swelling and achieve full joint mobility. Therefore, it is critical that you continue to exercise the knee in flexion and extension on a daily basis. Please repeat the following rehabilitation exercises as appropriate under the guidance of your rehabilitation therapist.
The following are exercises that you should do at home. You should set up at least 2-3 sets of exercises per day, each set lasting 15-20 minutes. It is normal to experience discomfort during the exercises. To make the exercises easier, please take a painkiller before the exercises.
Ankle pump: keep the lower limbs straight and flat, then move both ankles up and down
Gluteus exercises: lie flat with your legs straight and clench your gluteus muscles
Quadriceps exercises: Lie flat and apply pressure to bring your knees down as far as possible while tensing your thigh muscles. Do not lift your heels off the bed.
Active joint movement: Sit on a stool and place your foot flat on the floor with a tissue or a pillow under your foot to make it easier to slide your foot. Use muscle strength to flex the post-surgical knee joint as much as possible.
Active-assisted joint movement: Sit in a chair with your legs dangling or place your foot flat on the floor as in exercise 4. Use muscle strength to flex the post-surgical knee as far as possible. Then cross the non-operated leg in front of the affected limb and gently apply a backward force. Keep your pelvis level and do not lift your hips during the exercise.
Active knee extension: Sit on a chair or bed with your thighs on the chair/bed surface. Tense the thigh muscles to straighten the knee joint and lift the toes upward. Try to fully straighten the post-operative leg. The thighs should remain tight against the chair/bed.
Step Stretch: Place the post-surgical leg on step 2, or step 1 if you are unable to reach it. Hold the step or wall with both hands. Lean your body forward and flex your post-surgical leg. Do not spring up suddenly.
Passive stretching: Lie flat on your back and place a towel roll over your ankle so that your knee is lightly hyperextended.
Place an ice pack on the knee joint.
Remember, the outcome is up to you!
It is important that you understand that active participation in the physical therapy program is a crucial point that affects the speed of post-operative recovery and long term recovery.
Ice therapy during rehabilitation:The use of cryotherapy after total knee arthroplasty is an important factor in post-operative recovery. Cryotherapy can reduce pain by decreasing edema and inflammation. Postoperative swelling of the knee is very common. It becomes important to reduce the adverse effects of swelling and thus promote recovery. If you increase your activity too quickly or too much, your knee or leg may become more swollen after surgery. The more swollen your knee/leg is, the more painful it will be, the more difficult it will be to flex, straighten or even lift your leg, and the more likely you will feel discomfort when bearing weight. Please monitor the level of swelling and elevate your leg if it is severe. Also, keep moving your ankle joint while lying down. If you have any concerns about post-operative swelling, please contact your doctor or rehabilitation physiotherapist.
Ice can be a bag of crushed ice or towels, a cold ice pack, or a cold compression sleeve. You can apply ice while straightening your leg as described in exercise 9.
Bathing/dressing, generally no bathing for 10-14 days after surgery until the skin staples or sutures are removed. Please follow your doctor’s instructions for details. Bathing in the tub/shower
It may be difficult to get in and out of the tub at the beginning of the postoperative period. However, you should be careful about getting in and out of the tub/shower for both the short and long term. For safety reasons, you should add safety grab bars or non-slip mats to the tub/shower. If possible, please complete these arrangements prior to your procedure.