Total knee replacement is usually done as a surgical treatment option for advanced osteoarthritis of the knee joint. During the surgery, the knee joint is replaced with artificial material. The knee joint is made up of femur, the tibia, the patella and the cartilage which is usually worn out because of osteoarthritis.
The knee muscles which go across the knee joint are the quadriceps and the hamstrings. The quadriceps muscles are on the front of the knee and the hamstrings are on the back of the knee. The ligaments are usually important in the knee joint because they hold the joint together. You may have heard of people who had ligament tears. In review, the bone supports the knee and provides a rigid structure of the joint, the muscle moves the joint, and the ligament stabilizes the joint.
There are three components to a knee implant replacing three bone surfaces femoral, tibial and patellar implant.
Femoral component in a knee implant the femoral component made of metal Curves up around the end of the femur.
The tibial component:
The tibial component of the knee implant is a flat metal platform with polyethylene insert or spacer.
The patellar component the patellar button is a dome-shaped piece that replicates the cell face all the knee cap.
Indications for total knee replacement:
• Disabling knee pain with functional impairment.
• Radiographic evidence of significantly severe arthritis like osteoarthritis, Rheumatoid arthritis, Gouty arthritis or Lupus arthritis.
• Failed conservative measures including canes, drugs and lifestyle modification.
• There are at least three other issues that we should consider alongside age, Pain, poverty and behavior. They are sex, ethnicity and rural living.
Goals of total knee replacement Rehabilitation:
• Prevent hazards of bed rest like DVT, pulmonary embolism, pressure ulcers assist with Medical and functional range of motion.
• Inpatient total knee replacement Rehabilitation goals (0 to 90 degree ROM in the first 2 weeks)
• Strengthen the knee muscles
• Assist in patient and achieving functional Independence in activities of daily living
• Independent walking without assisted device.
Preoperative physiotherapy in Mississauga
• Review bed to chair transfers, bathroom transfers, tub transfers.
• Teach post operative knee exercises and give patient handout.
• Teach ambulation with assistive devices WBAT
• Review precautions
Post-operative Rehabilitation In Mississauga
For patients to expect a good result from knee replacement surgery, they must be an active rehab participant. Rehabilitation after knee replacement begins immediately.
• Ankle pumps
• Initiate isometric exercises like quad set, straight leg raising.
• Ambulate twice a day with knee immobilizer, assistance and Walker
• Weight bearing as tolerated with Walker
• Transfers out of the bed and into the chair twice a day with leg in full extension on a stool or another chair.
• CPM machine to improve knee flexion and progress 5 to 10 degrees a day as tolerated. The machine then constantly moves the knee through various degrees of range of motion for hours while the patient relaxes. This can help to improve circulation and minimize the risk of scarring and contracture of the tissues around the knee.
• Initiate active ROM and active assisted ROM exercises.
• During sleep place a pillow under the ankle to help passive knee extension.
• Ice may be used during the initial phase to reduce pain and swelling in your knee as pain and swelling in the knee will slow your progress with your exercises. Try placing the ice over your knee for 15 to 20 minutes. Your sensation may be decreased after your surgery so, use extra care.
The exercises after surgery can reduce recovery time and lead to optimal strength and stability. Sports that involve running or contact are avoided. Riding a stationary bicycle can help maintain muscle tone and keep your knees flexible; try to achieve the maximum degree of bending and extension possible. Driving: If your left knee was replaced and you have a an automatic transmission, you may be able to begin driving in a week or so provided you’re not taking any pain medications. If your right knee was replaced avoid driving for 6 weeks or so depending on your symptoms.
Walk as much as you like, but remember that walking is no substitute for the exercises your doctor and physical therapist will prescribe. Acceptable activities include dancing golfing and bicycling on level surfaces.
Avoid activities that put stress on the knee, these activities include tennis, badminton, contact Sports such as football, baseball, squash, jumping, squats, skiing, jogging. Do not do any heavy lifting more than 40 pounds or weightlifting. Swimming is the ideal form of exercise, since the sport improves muscle strength and endurance without exerting any pressure or stress on the replaced joint.
Risks of total knee replacement:
Include blood clot in the legs.
Pulmonary embolism can cause shortness of breath, chest pain, and even shock.
Other risks include urinary tract infection, nausea and vomiting (usually related to pain medication)
Chronic knee pain and stiffness
Bleeding into the knee joint, nerve damage and blood vessel injury
Infection of the knee which can require reoperation.
You can be referred to a team of Mississauga physiotherapists, who can help you giving proper exercises. Call us now @ 905 997 4333 and book your appointment today to get checked and have a Home Exercise Program to continue. Your success with rehabilitation largely depends on your commitment to follow the home exercise program.