Wednesday, 25 April 2012

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.

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.


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