Physical Therapy for Total Knee Replacement Patient Information
- This information includes the physical therapist management of adults with knee osteoarthritis undergoing primary total knee arthroplasty total knee arthroplasty (TKA).
- Chronic knee pain is the most common cause of activity limitations and disability in the United States.
- This often leads to TKA, also known as total knee replacement, which is one of the most commonly performed orthopedic surgeries.
- The most common reason for knee replacement surgery is to relieve severe pain caused by osteoarthritis.
- If nonsurgical treatments like medications and using walking supports are no longer helpful, you may want to consider total knee replacement surgery. This is a decision that should be made along with your orthopedic surgeon and physical therapist.
- Total knee replacement can help relieve pain and restore function in severely diseased knee joints.
- During total knee replacement surgery, the damaged part of your knee is removed and replaced with a man-made implant.
- The success of your knee replacement surgery is enhanced with physical therapy before and after surgery.
- You, your surgeon and physical therapist are an essential team for producing the best result from your knee replacement. Starting physical therapy care early and following your program through to the end will assure the maximum benefit and quickest recovery time.
- The better physical shape you are in before surgery, the better your results will be.
- Doing an exercise program prescribed by a physical therapist that includes strengthening and flexibility exercises is associated with better function after surgery.
- Before your surgery, your physical therapist and care team should explain to you what to expect before, during and after the surgery. This may include:
- Exercises to prepare for surgery
- What to expect after surgery
- What to bring with you to the surgery center
- What equipment you will need after surgery
- Planning discharge from the hospital to a rehabilitation facility or back to your home
- The rehabilitation program that includes regaining a normal range of knee motion, strengthening, walking, fall prevention, and maintaining balance
- Encouraging healing during the first week after surgery
- Techniques to help you safely move around as you recover
- Use of assistive devices such as walkers and canes
- Precautions and things you can do to your home to reduce the chance of accidental falls
- Some ways you can prepare your home before surgery include:
- Safety bars or a secure handrail in your shower or bath
- Secure handrails along your stairways
- A stable chair for your early recovery with a firm seat cushion (and a height of 18 to 20 inches), a firm back, two arms, and a footstool for intermittent leg elevation
- A toilet seat riser with arms, if you have a low toilet
- A stable shower bench or chair for bathing
- Removing all loose carpets and cords
- A temporary living space on the same floor because walking up or down stairs will be more difficult during your early recovery
- The main goal of the first 2 weeks is to manage pain, decrease swelling, heal the incision, restore walking and initiate physical therapy management.
- Preventing blood clots, infections and other general wound care should also be prioritized.
- If your surgeon orders a continuous passive movement device (CPM) for mobilization of your knee you should question the use. CPMs are not necessary for most people after an uncomplicated TKA and may increase the amount of time of bed rest.
- The speed and quality of your recovery depends on multiple factors, many of which you can improve.
- While your doctor may prescribe you medication to manage your pain, there are also non-pharmacological options to help reduce pain. The use of ice packs and similar types of cooling devices can also help reduce pain and swelling after your surgery.
- Physical activity is an important aspect in recovery. Your physical therapist should develop a plan for early mobility and progression of your physical activity following your surgery. Moving around soon after surgery and following your physical therapists advice on physical activity and the progression of your program are important aspects in recovery.
- In addition to physical activities, motor function training, range of motion exercises and neuromuscular electrical stimulation (NMES) can help your recovery following surgery.
- Incorrect knee positioning after surgery can result in unnecessary blood loss and swelling or severe tightness. It is important talk with your physical therapist about how to position your knee for the first week after surgery. The recommended position for the first week is between 30 & 90 degrees of flexion to reduce blood loss. After that, extension of the knee is a common practice.
Table 1. Recovery Factors
|Other factors that improve and hasten recovery:|
|Factors that increase the risk of complications and a less satisfactory recovery:|
What To Look For In A Physical Therapist
- Look for a physical therapist who is experienced in treating people with orthopedic or musculoskeletal problems.
- When you contact a clinic for an appointment, ask about specific experience with patients undergoing total knee replacement.
- You can also find a physical therapist by visiting APTA.org/FindaPT
Diane U Jette, Stephen J Hunter, Lynn Burkett, Bud Langham, David S Logerstedt, Nicolas S Piuzzi, Noreen M Poirier, Linda J L Radach, Jennifer E Ritter, David A Scalzitti, Jennifer E Stevens-Lapsley, James Tompkins, Joseph Zeni Jr, for the American Physical Therapy Association, Physical Therapist Management of Total Knee Arthroplasty, Physical Therapy, , pzaa099, https://doi.org/10.1093/ptj/pzaa099