Total Knee Replacement: A Patient's Guide.

Rehabilitation

Physical therapy

Following hospital discharge (or discharge from inpatient rehabilitation), patients who undergo total knee replacement will participate in either home physical therapy or outpatient physical therapy at a location close to home.

The length of physical therapy varies based upon patient age, fitness, and level of motivation, but usually lasts for about six to eight weeks. Two to three therapy sessions per week are average for this procedure.

At first, physical therapy includes range-of-motion exercises and gait training (supervised walking with an assistive device, like a cane, crutches or walker). As those things become second nature, strengthening exercises and transition to normal walking without assistive devices are encouraged.

Can rehabilitation be done at home?

All patients are given a set of home exercises to do between supervised physical therapy sessions, and the home exercises make up an important part of the recovery process. However, supervised therapy--which is best done in an outpatient physical therapy studio--is extremely helpful, and those patients who are able to attend outpatient therapy are encouraged to do so.

For patients who are unable to attend outpatient physical therapy, home physical therapy is arranged.

Usual response

No two patients are alike, and recovery varies somewhat based on the complexity of the knee reconstruction, and the patient’s health, fitness, and level of motivation.

Most people walk using crutches or a walker for 3-4 weeks, then use a cane for about 2-3 more weeks; sometime between one and two months post-operatively, most patients are able to walk without assistive devices.

Most patients obtain and keep at least 90 degrees of motion (bending the knee to a right angle) by the second week after surgery, and most patients ultimately get more than 110 degrees of knee motion.

Most patients can return to sedentary (desk) jobs by about 4-6 weeks; return to more physical types of employment must be addressed on a case-by-case basis.

Most patients are back to full activities--without the pain they had before surgery--by about three months after the operation.

Risks

Long-term patient limitations

The goal of total knee replacement is to return patients to a high level of function without knee pain. The large majority of patients are able to achieve this goal. However, since the joint replacement components have no capacity to heal damage from injury sustained after surgery, we offer some common-sense guidelines for athletic, leisure, and workplace activities:

Recommended:

• Swimming
• Water aerobics
• Cross-country skiing or Nordic Track
• Cycling or stationary bike
• Golf
• Dancing
• Sedentary occupations (desk work)

Permitted:

• Hiking
• Gentle doubles tennis
• Gentle downhill skiing
• Light labor (jobs that involve driving, walking or standing but not heavy lifting)

Not recommended:

• Jogging or running
• Impact exercises
• Sports that require twisting/pivoting (aggressive tennis, basketball, racquetball)
• Contact sports
• Heavy labor

Since the joint replacement includes a bearing surface, which potentially can wear, walking or running for fitness are not recommended. Some patients feel well enough to do this, and so need to exercise judgment in order to prolong the life-span of the implant materials. Swimming, water exercises, cycling and cross country skiing (and machines simulating it, like Nordic Track) can provide a high level of cardiovascular and muscular fitness without excessive wear on the prosthetic joint materials.

Surgery for Severe arthritis of the knee at the University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, Washington

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