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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See what others are saying

Comment from: DOT, 65-74 Female (Patient) Published: April 14

After being diagnosed with osteonecrosis I had a total knee replacement on 19th January 2016. I am getting so frustrated because I can't bend my knee. I do my physiotherapy regularly and also walk for 40 minutes daily. I am in so much pain after exercises that the next day I am suffering. I had a mishap at physical therapy 7 weeks after operation. I was in tears because I could not get the pedals round. After rocking back and forward the pedals were forced round and my knee bent and caused me excruciating pain. My knee swelled so much more than it had been and looked like a massive blister with the skin so thin that it looked about to burst. Physiotherapist told me not to exercise for two weeks and I am sure I did some damage. I feel like I am fighting against the tide, exercising and getting nowhere. I cannot see how you can get your knee to bend if it is very swollen and tight. I am due to see my surgeon in 3 weeks and terrified that he will suggest a manipulation under anesthesia. I can't understand why I am not improving when I do everything physiotherapist tells me; ice, exercise, ice, elevation and more ice. Twelve weeks after operation I am in so much pain that I fear I will have a permanent limp. Exercising just makes more pain and I am in agony the next day I am unable to exercise. I am at my wits' end.

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Comment from: granny62, 55-64 Female (Patient) Published: April 27

I had my total knee replacement on March 17, 2016. I am now almost 6 weeks out. I was doing very well the first 3 weeks while at home with my in-home physiotherapy (PT). I started hospital PT on April 12, 2016. The nightmare started that day. Prior to that day I had a bend of 102 degrees and almost straight. The therapist I was given told me to get on a bike and ride it for 15 minutes and make full rotations. I tried but the pain was unbearable. I actually only made it around backwards once. Since that day I have had swelling to the point I think my skin is going to burst. I ice and ice some more. Nothing works to take the swelling down. When I said something to him, he actually blamed me for overworking my knee! I no longer see him but I am unable to do very much because the swelling is so bad. I am getting so depressed and wish I never had this done. I still go to PT 3 times a week but have lost my range down to only 90 degrees. I am losing ground every day. The more I try the more pain I am in. I will never do the other knee which is starting to go bad. The pain I was in prior to surgery was very bad, but this is worse by far.

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