Total Knee Replacement - Exercises and Physical-Therapy

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How does the patient continue to improve as an outpatient after discharge from the hospital?

It is important for patients to continue in an outpatient physical-therapy program along with home exercises for optimal outcome of total knee replacement surgery. Patients will be asked to continue exercising the muscles around the replaced joint to prevent scarring (contracture) and maintain muscle strength for the purposes of joint stability. These exercises after surgery can reduce recovery time and lead to optimal strength and stability.

The wound will be monitored by the surgeon and his/her staff for healing. Patients also should watch for warning signs of infection including abnormal redness, increasing warmth, swelling, or unusual pain. It is important to report any injury to the joint to the doctor immediately.

Future activities are generally limited to those that do not risk injuring the replaced joint. Sports that involve running or contact are avoided, in favor of leisure sports, such as golf, and swimming. 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.

Patients with joint replacements should alert their doctors and dentists that they have an artificial joint. These joints are at risk for infection by bacteria introduced by any invasive procedures such as surgery, dental or gum work, urological and endoscopic procedures, as well as from infections elsewhere in the body.

The treating physician will typically prescribe antibiotics before, during, and immediately after any elective procedures in order to prevent infection of the replaced joint.

Though infrequent, patients with total knee replacements can require a second operation years later. The second operation can be necessary because of loosening, fracture, or other complications of the replaced joint. Reoperations are generally not as successful as the original operation and carry higher risks of complications. Future replacement devices and techniques will improve patient outcomes and lead to fewer complications.

Previous contributing editor: Dennis Lee, MD

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Comment from: librarian, 55-64 Female (Patient) Published: June 02

I had a total knee replacement in 2010 after an injury to the knee. When released from the hospital, I went to a rehabilitation facility on a Saturday. This facility does not do therapy on weekends, so I went two days with no therapy. No one bothered to tell me to bend the knee and by Monday, I had only a 90 degree bend and it has stayed that way in spite of 6 months of therapy. The therapist did not attempt to help me bend the knee. I wish he had. Stairs are difficult and there are many things I can no longer do. If you have a knee replacement and go for rehab, make sure the facility does therapy seven days a week and keep bending that knee!

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Comment from: Carlos, 65-74 Male (Patient) Published: January 20

My physical therapy (PT) began in the hospital the afternoon of the surgery for total knee replacement, where they have a small PT facility. Two days later I was at home and the PT person arrived every couple days for the next two weeks. Then I went to the PT clinic two minutes from my house for the next seven weeks. The PT folks stressed flexibility for the first four weeks, over strength building. So I had to bend the knee a lot, like it or not. Surgery was 11/23/15 and now, on 1/17/16 I'm at 121 degrees of flex and virtually no pain, except after about six hours in bed, when I can relieve pain with a pillow under the knee or a couple of Tylenol. I've used virtually every machine in the PT clinic, from elliptical to reclining bike but they have deliberately avoided the treadmill. Also I have returned to the gym between PT appointments and use all of the same equipment as before the surgery except at lower settings. I'd rather take time and build up slowly to where I was prior to surgery rather than risk any injury by pushing too fast. I've seen the doctor twice and he says all looks good. This is the second knee of mine he has replaced and this one was much less painful than the first. Unlike with the first he now has a procedure where they inject painkiller all around the knee, carefully finding the nerves with ultrasound. They showed me what they were going to do. I was knocked out when they did it. I especially appreciated that I could take a lot less of the opioid pain killers this time, since I hate the way they scramble your brains. They also stressed icing the knee three or four times a day to reduce swelling, since swelling reduces flexibility. I have an ice water machine that circulates the cold water in a cuff that's velcroed around the knee but when that's inconvenient I just use ice packs from the freezer, similar to those that they use at the PT clinic. You also have to elevate the knee while icing it. I like this PT guy especially because he has fixed numerical goals to achieve and he's serious about achieving them. I just have to grin and bear the pain.

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