Rehabilitation After Knee Replacement

Total knee replacement is now a routine operation for knee pain and disability. The end result should be a painless and movable knee which you can use quite normally in daily life.

Due to the pain and stiffness after the operation, you will have to work hard to regain muscle power, mobility and knee bend. Co-operation with your physiotherapist is vital for you to achieve the best start with your new joint, and to set the programme for the following months.

It may take three months for all the pain and swelling to settle down and you will have to keep your knee working during this time. Work hard with your physio and you will do well.

Getting up after knee replacement

You are likely to get up on the first day after your operation, or perhaps the second, depending on the surgeon’s wishes and your medical condition. This is usually done by a physiotherapist with an assistant.

You will use crutches or a frame for a period as designated by the physiotherapist or surgeon. In most cases you can put your weight through your knee as able, and progress to using sticks as advised.

• In some cases, such as revisions and uncemented replacements, weight-bearing may be restricted and the time using crutches longer than the routine amount.

• You should be able to sit out in a chair as you feel able, with your leg up on a support.

• Try to eat the regular meals provided so the body can heal quickly.

• Drink plenty of fluids to prevent dehydration and urinary problems.

• Do your knee exercises hourly for a few minutes, as directed by your physiotherapist. Rest your leg between these times.

• Your physiotherapist will tell you when you are safe to get on and off the bed and walk on your own.

• The wound is usually left covered for the first 48 hours, then checked and re-covered.

Stairs

You will be taught to manage the stairs by the physiotherapist or a helper. Always use a bannister or rail if there is one, and hold the stick or crutch in the other hand.

Going up - leave the walking aid on the level you are starting from and lead with the unoperated leg first, followed by the operated leg and then the walking aid.

Going down - put the walking aid on the step below first, step down with the operated leg, following with the unoperated leg.

It is not practical or safe to attempt stairs with a walking frame. Anybody who is frail or very heavy may find it safer to avoid stairs until they can weight bear normally on the limb.

Range of motion

It is useful, but not essential, to get a 90 degree bend before you leave hospital. Your knee should continue to increase in range of motion over a long period.

To lead a ‘normal’ life and do stairs, a 110 degree knee bend is useful, but your knee may bend even further than this in some cases. However, many people are very happy with their new knee even though it bends much less than the maximum possible.

If your knee bend is poor even after your best efforts it may be necessary to manipulate the knee under anaesthetic. The surgeon will bend your knee in theatre while you are unconscious for a short period. After this you will need to work hard to maintain the extra movement gained.