Total Knee Replacement Surgery: Pre- and Post-Operative Rehabilitation

Total knee replacement surgery is a common means of treating degeneration and/or osteoarthritis of the knee joint. It requires the two degenerated articulating surfaces to be replaced, making it a highly invasive and traumatic procedure. It is, therefore, important that numerous measures are taken to ensure one is physically ready for surgery.

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In the case of an elderly person, the surgeon may require the patient to have a full medical examination with a physician prior to surgery to ensure the patient is physically strong enough to undergo surgery. In the past, total knee replacement surgery was done using a full anaesthetic. Nowadays, it is becoming more common to use sedation together with an epidural.

If possible, the patient should start a pre-operative programme to strengthen the knee. This will help to strengthen the surrounding muscles that support the knee joint, thus shortening the recovery process. One must also try to maintain or improve one’s general physical fitness, so that the physical state of the individual is adequate prior to surgery in order to improve recovery. Exercise may, however, cause further inflammation and discomfort, so care must be taken at all times. A Biokineticist plays a crucial role in this process.

Below are some guidelines with regards to exercises that can be done prior to a total knee replacement procedure.

Exercise to improve cardiovascular fitness:

Cycling – high saddle

Walking – tolerable to pain

Swimming or water aerobics – minimal impact and strain on the knee

Arm ergometry

Strengthening exercises for the rest of the body:

Arm strengthening exercises – machines or dumbbells – important for holding ones weight on the crutches following surgery

Abdominal and core strengthening exercises – to assist in maintaining good posture

Strengthening exercises for the muscles surrounding the knee:

Quadriceps setting

Straight leg raises

Heel slides

Calf raises

Foot pumps

Ball squeezes (between knees)

Hip raises

Glute squeezes with a theraband

Following surgery, the first step is to regain mobility and range of motion of the knee joint. One must see a physiotherapist regularly to assist in regaining range of motion. Once this has been achieved, one should see a Biokineticist to assist you in starting an exercise programme to again strengthen the surrounding muscles. Initially, the exercises will be similar to those done prior to surgery and they will become progressively harder with time. The exercises should be done at least 3 to 5 times per week. Cardiovascular and upper body strengthening exercises that were done pre-surgery should be restarted as soon as possible to regain general physical fitness.

So, don’t be afraid to start exercising as soon as you feel ready to do so. With the correct guidance and appropriate progression, the rehabilitation can be more successful and the recovery time can be shortened significantly.

Multiple Sclerosis

What is it?

Multiple Sclerosis (MS) is an autoimmune disease that affects the central nervous system, that is, the brain and spinal cord. All nerves are surrounded by a myelin sheath – a protective layer surrounding the nerves. This myelin sheath assists in the conduction of neural signals from the brain to the muscles, innervating the muscles and thereby creating muscular contractions. With MS, demyelination of these sheaths occurs, resulting in the neural conduction along the nerves being adversely affected. Speed of conduction is reduced and the result is a reduction in smooth, rapid and coordinated movement. The effects can range from little or no disability to severe disability.

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Various types of MS exist

The National Multiple Sclerosis Society identifies 4 types of MS: relapsing remitting, secondary progressive, primary progressive and progressive relapsing. The most common form is relapsing remitting MS (RRMS). In this case, one has relapses, where symptoms are present, and then periods of remittance, where symptoms subside or disappear altogether. The more relapses a person has, the more severe the symptoms become. Stress, both physical and emotional, is the main contributing factor causing a relapse.

Causes

MS occurs as a result of the myelin sheath surrounding the nerves being damaged. This can be due to inflammation, when the body’s own immune cells attack the nervous system (autoimmune disease). The reason for this is unknown, but is thought to be due to a virus or genetic defect.

Who is at risk?

MS is more common in women. It is generally diagnosed between the ages of 20 and 40, but can occur at any age.

Symptoms

MS affects numerous body systems, including the eyes, bowel and bladder, sexual function, speech and swallowing and, most noticeably, the muscular system. In this blog, I will discuss the muscular system only. According to ACSM, the physical symptoms include the following:

• Spasticity
• Incoordination
• Impaired balance
• Fatigue
• Muscle weakness, paresis (partial paralysis) and paralysis
• Sensory loss and numbness
• Cardiovascular problems
• Tremors
• Heat sensitivity

The role of exercise in managing MS

The progression or prognosis of MS is not affected by exercise. However, a person with MS will still experience the short-term benefits of partaking in a regular exercise programme, such as improved cardiovascular fitness, increased strength and flexibility, and improved functional ability. People with MS often lose function in their legs, resulting in them being unable to walk. It is important to strengthen and stretch the leg muscles in order to prolong function. One should also focus on balance and stability exercises to reduce the risk of falling.

Important things to remember

People with MS do not have the same ability to regulate their body temperature as those without MS, so it is important to keep the room temperature in which you are exercising cool.

If muscles are overworked or overstretched, this can cause an acute inflammatory response, which may exacerbate symptoms. So, take it easy! Rather use lighter weights and do more repetitions to improve endurance and muscle tone.