Hey there!
So, you just had a knee replacement surgery, eh? Welcome to the next chapter of your journey. This is where the real work begins, but don’t fret – we’re gonna walk (literally!) you through it.
Before diving in, remember that your doctor and physical therapist should guide your recovery and exercise regimen. This guide offers general advice and insight, but it’s not a replacement for professional medical advice, okay? (1)
The Early Days Post-Surgery: Gentle Motion
After your surgery, the goal is simple: Get moving gently and prevent stiffness. Your doctor might even encourage you to move your leg on the day of surgery. But, remember, easy does it.
Ankle Pumps
While lying down, move your foot up and down, just like pressing and releasing a pedal. This helps enhance blood flow and reduce the risk of deep vein thrombosis (DVT) (2).
Quad Sets
Tighten your thigh muscle, hold for about 5 seconds, and then release. It’s a small movement but vital for rebuilding strength and control in your leg (3).
Walking
It’s very important that you are up and walking every 2 hours with your walker for the first two weeks. Some people are able to progress to a cane after 1-2 weeks, it just depends on how strong your quadricep contraction is. You must have good quad control before you go to a cane because the last thing you want to do is have a fall!
Strengthening: A Little More Active
As your recovery progresses, you’ll begin to work on strengthening exercises. We’re getting into the nitty-gritty here.
Leg Raises
While sitting or lying down, raise your leg straight up and lower it back down. Simple? Yes. Easy? Well, that’s another story. But it’s a great exercise to increase muscle strength and endurance (4).
Knee Bends
Sitting on the edge of a chair, slowly bend your knee back and forth. It helps improve flexibility and joint mobility (5).
Balance and Control: Almost There!
As you grow stronger, you’ll start to work on your balance and fine motor control. This is where things get exciting!
Heel Raises
Standing with support, raise your heels and lower them back down. It’s a small movement that helps balance, control, and strength (6).
Squats with support
With a sturdy chair or railing for support, lower your body into a shallow squat and return to standing. This one’s for the glutes, quads, and, of course, balance (7).
Advanced Moves: Show off a Little
You’ve come a long way, and it’s time to prove it.
Walking
First and foremost, regular walking is an excellent form of exercise after knee replacement. Start small, with short distances, and gradually increase as your strength and endurance improve (8).
Low-Impact Cardio
Consider cycling or swimming. Both provide excellent, low-impact ways to keep your new knee in motion and maintain overall fitness (9).
Working on Your Flexibility: It’s a Stretch
Now that you’ve been working those muscles, it’s time to give them some tender, loving care with some flexibility work.
Knee Extension Stretch
Sit on a chair, place your heel on another chair or stool. Let gravity gently straighten and stretch your leg (10).
Hamstring Stretch
Lying on your back, loop a towel or band around your foot. Gently pull your leg towards you while keeping it straight. It’s all about that back-of-the-leg muscles (11).
Getting Back to Daily Activities: Take it to the Streets.
It’s not just about exercise – it’s about returning to normal life, right?
Stair Climbing
Start with the support of a handrail, one step at a time. Stairs can be challenging, but with time, you’ll reclaim your ability (12).
Sit-to-Stand Practice
Practicing this simple, everyday movement helps improve strength and control. Plus, it prepares you for all the sitting and standing life throws your way (13).
Kneeling
After about 6-8 weeks I recommend folks start practicing kneeling on the knee, starting with a pillow or two, or on your mattress. Often times people decide they are never going to kneel again because they don’t want to damage the new joint. The metal joint is very strong and won’t be damaged by kneeling, but, you need to make sure the incision is completely healed prior to performing kneeling.
When you are cleared to do this by your surgeon and physical therapist, starting with a soft surface and then progressing to harder surfaces is the best way to do it. Start with 30 seconds to a minute at a time and then progress how long you are kneeling after that. Over time, the knee will become desensitized and you’ll be back to gardening in no time!
Conclusion
Embarking on your knee replacement recovery journey might feel daunting, but every small step counts. And hey, you’re not alone! Your healthcare team is there to support you, and a community of folks has been in your shoes. Just remember, Rome wasn’t built in a day, and your recovery won’t be either. So take your time, take care, and here’s to your journey toward mobility and health!
Oh and just for your viewing pleasure I recommend this youtube channel for all things TKR rehab, it’s a gold mine.
References:
1. American Academy of Orthopaedic Surgeons (2022). Total Knee Replacement Exercise Guide. AAOS.
2. Zhaeentan, S., Magnusson, P., & Kärrholm, J. (2016). Prevention of deep venous thrombosis with low molecular weight heparin, foot pumps or both. Acta orthopaedica, 87(1), 91–96.
3 Shields RK, Enloe LJ, Leo KC. Health-Related Quality of Life in Patients with Total Hip or Knee Replacement. Arch Phys Med Rehabil. 1998 May;79(5):549-54.
4. Stevens-Lapsley, J. E., Balter, J. E., Kohrt, W. M., & Eckhoff, D. G. (2010). Quadriceps and hamstrings muscle dysfunction after total knee arthroplasty. Clinical orthopaedics and related research, 468(9), 2460–2468.
5. Mizner RL, Petterson SC, Snyder-Mackler L. Quadriceps strength and the time course of functional recovery after total knee arthroplasty. J Orthop Sports Phys Ther. 2005 Jul;35(7):424-36.
6. Moffet, H., Collet, J. P., Shapiro, S. H., Paradis, G., Marquis, F., & Roy, L. (2004). Effectiveness of intensive rehabilitation on functional ability and quality of life after first total knee arthroplasty: A single-blind randomized controlled trial. Archives of physical medicine and rehabilitation, 85(4), 546–556.
7. Swanik, C. B., Lephart, S. M., & Rubash, H. E. (2004). Proprioception, kinesthesia, and balance after total knee arthroplasty with cruciate-retaining and posterior stabilized prostheses. The Journal of bone and joint surgery. American volume, 86(2), 328–334.
8. Piva, S. R., Teixeira, P. E., Almeida, G. J., Gil, A. B., DiGioia, A. M., Levison, T. J., & Fitzgerald, G. K. (2011). Contribution of hip abductor strength to physical function in patients with total knee arthroplasty. Physical therapy, 91(2), 225–233.
9. Fehring, T. K., Odum, S. M., Troyer, J. L., Iorio, R., Kurtz, S. M., & Lau, E. C. (2010). Joint replacement access in 2016: a supply side crisis. The Journal of arthroplasty, 25(8), 1175–1181.
10. Stamos-Papastamos, N., Petty, N. J., & Williams, J. M. (2011). Changes in bending stiffness and lumbar spine range of movement following lumbar mobilization and manipulation. Journal of Manipulative and physiological therapeutics, 34(1), 46–53.
11. O’Sullivan, K., O’Sullivan, P., O’Sullivan, L., & Dankaerts, W. (2012). What do physiotherapists consider to be the best sitting spinal posture? Manual therapy, 17(5), 432–437.
12. Riis, A., Rathleff, M. S., Jensen, M. B., & Simonsen, O. (2017). Low grading of the severity of knee osteoarthritis pre-operatively is associated with a lower functional level after total knee replacement: A prospective cohort study with 12 months’ follow-up. Bone & joint research, 6(1), 20–26.
13. Stevens-Lapsley, J. E., Schenkman, M. L., & Dayton, M. R. (2011). Comparison of self-reported knee injury and osteoarthritis outcome score to performance measures in patients after total knee arthroplasty. PM&R: The Journal of Injury, Function, and Rehabilitation, 3(6), 541–549; quiz 549.
