We hope you find the exercise program after knee replacement helpful, but each person’s situation varies and the surgeon’s opinion must be respected.
Precautions.
Total knee replacement is one of the larger types of knee surgery, and there may be discomfort such as fever and pain after surgery. However, good function comes to a large extent from timely and correct rehabilitation functional exercises. Therefore, under the guidance of the surgeon, you should overcome fear, inertia and other negative emotions and perform functional exercises as early as possible after surgery.
1.The methods and data provided in this plan are formulated in accordance with the general routine, and the specific implementation should be completed under the guidance of doctors depending on their own conditions and surgery.
2.A certain degree of pain is unavoidable during the functional exercises. If the pain can subside to the original level within half an hour after the exercise stops, it will not cause damage to the tissue and should be tolerated.
3, muscle strength exercises should be concentrated until the muscle has a sense of soreness and fatigue, and then proceed to the next group after sufficient rest. The number of exercises, time, load depending on their own situation, and should be practiced at the same time the healthy side. Good muscle strength is a key factor in joint stability and a guarantee of good knee function and must be practiced carefully.
4.In addition to the proper braking protection of the operated limb, the rest of the body parts (such as the upper limb, waist and abdomen, and the healthy side of the leg) should be practiced as much as possible to ensure physical quality, improve the overall level of circulation and metabolism, and promote the recovery of the operated local.
5.Joint mobility (flexion and extension) exercises strive to improve the angle each time. If the flexion angle does not progress for a long time (>2 weeks), there is a possibility of joint adhesions, so great importance should be attached to it and insist on completing the exercises.
6.Ice packs are usually given for 15-20 minutes immediately after the mobility exercises. If you usually feel the joint swelling, pain and fever is obvious, you can apply ice again, 2-3 times a day.
7.The side with shadow in the appendix is the affected side.
8.The swelling of the joint will accompany the whole exercise process, and it is normal that the swelling does not increase with the angle exercise and activity, until the angle and muscle strength basically return to normal. Sudden increase of swelling should adjust the exercise and reduce the amount of activity, and in case of seriousness, timely follow-up should be made.
Early stage
On the day of surgery.
1.After surgery, the affected limb should be placed in the straight position and pillow should be placed under the calf and heel to elevate the affected limb to prevent swelling.
2. After the anesthesia subsides, start to move the toes and ankle joint, and if possible, start ankle flexion and extension activities (ankle pump exercises). The ankle pump exercise – hard, slow, full range of flexion and extension of the ankle joint to promote blood and lymphatic reflux through the squeezing effect of calf muscle contraction and diastole. 5 minutes / group, 1 group / hour.
3. Start “external counterpulsation” therapy according to the situation to further promote blood circulation in the affected limb.
1 day after surgery.
1.Ankle pump exercises for 10-15 minutes/group, 1 group/hour.
2. Isometric contraction exercises for the quadriceps and the N cord muscles (should be done as much as possible without increasing pain.)
3.Stretching exercises: padding at the heel, light load added to the knee joint, 30 minutes/set, >2 times/day.
2 days after surgery: continue and strengthen the above exercises
3 days after surgery: drainage removal (according to the drainage situation)
1.Straight leg elevation exercise: straight leg elevation after knee extension to heel 15M from bed, keep it until exhaustion.
2.Sit frequently and do not lie in bed for a long time to avoid the occurrence of postural hypotension.
3.Stand on the ground under protection, bear weight within the range of slight pain in the affected leg, walk short distances under the protection of a walker (only for activities necessary for life such as going to the toilet). Do not walk for too long. Hold off the exercise if the patient is obviously weak.
Postoperative day 4.
1.Strengthen stretching exercises
2.Weight-bearing and balance exercises (standing weight shift exercises)
Weight-bearing and balancing: Separate both feet under protection and move the center of gravity alternately from side to side within the range of slight pain. 5 minutes/time, 3 times/day. Separate both feet back and forth and move the center of gravity. 5 minutes/time, 3 times/day.
3. Walk on the ground with the help of a walker.
5 days after surgery.
1.Continue and strengthen the above exercises.
2.Walking exercises (using a walker, with the help of protection), and gradually extend the walking distance.
3.Practice using crutches
4.Position transfer exercises: such as getting in and out of bed, chair sitting exercises, etc.
1 week after surgery.
1.Strengthen weight-bearing and standing exercises
2.Passive exercises can be carried out by the rehabilitation doctor according to the situation if the flexion angle is obviously limited. Or under the guidance of sitting leg hanging: sitting on the edge of the bed, below the knee hanging outside the bed. Relax the thigh muscles under protection and allow the lower leg to drop naturally to the limit for 10 minutes. If necessary, add load to the ankle joint. 1-2 times/day, aiming for daily progress in flexion angle. If necessary, the rehabilitation doctor will help you to complete the exercise.
3. Active knee flexion and extension exercises (AROM): Sitting position, with the foot not leaving the bed. Slowly and forcefully, flex the knee to the maximum, hold for 10 seconds and then slowly straighten. 10-20 times/group, 1-2 groups/day.
Mid-term
2 weeks postoperatively.
1. patellar release (performed after stitch removal): push and hold the edge of the patella by hand and push the patella slowly and forcefully in the up and down and left and right directions to the limit position. 20 times in each direction, 2-3 times/day. You can practice by yourself after being taught by a rehabilitation doctor.
2. Try to put full weight on the affected leg.
3.Passive flexion (PROM) >100 degrees.
4.Active flexion (AROM) up to 90 degrees.
Heel lift exercise: Under protection, stand with feet about 10 cm apart and distribute the supporting weight equally between the legs. Lift the heel (i.e., heel off the ground and stand on your toes.) To the limit, hold for 10 seconds, 30 reps/set, 2-4 sets/day, 30 seconds rest between sets.
3 weeks after surgery.
1. Thigh adductor and abductor exercises: start lateral leg raise exercises. 30 reps/group, 2-4 groups/day, 30 seconds rest between groups.
2. Bedside anti-gravity knee extension exercises: sit on the edge of the bed with the knee joint hanging naturally below the bed, forcefully and slowly extend the knee until it is as straight as possible, hold for 10 seconds and slowly lower it in a controlled manner. 10-20 times/group, 2-3 groups/day.
4 weeks post-op.
1. 0-30 internal flexion/extension exercises in standing position.
Under protection, stand with feet apart, shoulder-width apart, supporting weight equally distributed between the legs. Flex both knees simultaneously to approximately 30 degrees, then slowly extend.
30 times / group, 2-4 groups / day.
2, prone position “leg hook exercise”, should be static exercises, bend the knee to a pain-free angle to maintain 10-15 seconds. 30 times / group, 4 groups / day.
Use sandbag as the load, within the pain-free range of motion, and apply ice immediately after the exercise. If the healthy side of the leg is painless, you can choose the standing position “hook leg” exercise.
3.Static squatting exercise. Back against the wall, feet shoulder-width apart, toes and knees are forward, not
”inside and outside the eight”, with increasing strength gradually increase the angle of the squat (less than 90 °), 2 minutes / time, interval of 5 seconds, 5-10 consecutive / group. 2-3 groups / day.
4, VMO exercises (the last 15 degrees of knee extension anti-gravity exercises).
Sitting position, a rigid pillow under the affected knee, so that the knee joint is in a position of 15 degrees of flexion, slowly and forcefully straighten the knee joint and hold it in the straightest possible position for 5 seconds, 30 reps/group, 2-4 groups/day, 30 seconds rest between groups.
5. stationary bicycle exercises, no load to light load. 30 min/set, 2 sets/day.
Postoperative period
2 months after surgery: (as much as possible to reach the mobility allowed by the prosthesis within 2-3 months)
1.Intensive muscle strength and joint mobility exercises.
2.Start knee exercises with the affected leg in a 45° position with semi-squat flexion and extension. The affected leg stands on one leg with the upper body straight, slowly squats to 45° of flexion
and then slowly pedal until completely straight. 20-30 times/group, 30 seconds interval between groups, 2-4 times/day.
3. ADL exercises (going up and down stairs, etc.).
STEP10cm-15cm: that is, choose 10cm high steps as shown for forward and lateral stepping up and down exercises. Note that when completing the movement, use the affected leg to support the weight, slowly exert force, and experience the muscle sensation and control the stability of the joint. 30 times/group, 2-4 groups/day, 30 seconds rest between groups.
3 months post-operatively: return to full activity as determined by review.
Remarks.
Methods of exercises for one flexion.
Choose any one of the following methods. Once a day, aim for a slight increase in angle is sufficient. If there is any special discomfort during or after the exercise, promptly inform the doctor. Exercise process shall not be straightened rest, repeated flexion and extension, otherwise it will affect the effect, and very easy to cause swelling.
1.Sitting (or supine) position hanging leg.
Sitting on the edge of the bed lying down, below the knee hanging outside the bed. Relax the thigh muscles under protection, so that the calf drops naturally, to the limit of protection for 10 minutes. If necessary, add load at the ankle joint.
2.Supine leg hanging:.
Supine on the bed, thighs perpendicular to the bed, under the protection of the relaxed thigh muscles, so that the calf drops naturally, the requirements as above. See Appendix 1 – Figure 9.
3, sitting position “top wall”:.
Sitting on the chair, the affected side of the toe top wall or fixed, slowly move the body forward to increase the bending knee angle, feel the pain and keep still, a few minutes after the pain disappears or lower, and then move forward to the limit. The whole process is controlled within 30 minutes.
4.Active flexion and extension exercises: (performed after passive flexion)
Sitting position, the foot does not leave the bed. Slowly and forcefully, flex the knee to the maximum, hold for 10 seconds and then slowly straighten. 10-20 times/group, 1-2 groups/day.
Exercises for second extension and flexion.
Stretching exercises in the muscles and the posterior joints of the pulling sensation and slight pain is normal, not to contract the muscles against, should be completely relaxed, otherwise it will affect the effect. The weight of the load used in the exercise should not be too large, should make the affected knee dare to relax, and last up to 30 minutes, there is a clear pulling sensation is appropriate. No breaks should be taken in the middle of the exercise, otherwise the effect will be affected.
1. Seated knee extension.
Sitting position, foot cushioned and weighted above the knee joint. Relax the muscles completely and hold for 30 minutes. 30 minutes / time, 1-2 times / day.
2. Prone suspension.
Prone, hanging below the knee outside the bed, weighted at the ankle joint. Requirements as above.
3.Active stretching.
Hold at the limit for 10 seconds, relax for 5 seconds. 20-30 times/group, 1-2 groups/day.