The knee is the joint in the body that is most frequently replaced. You should visit your orthopedic surgeon and physical therapist before deciding to have knee replacement surgery. Total knee replacement surgery is typically performed when a person suffers from one of the following conditions:
- Osteoarthritis, rheumatoid arthritis, other bone diseases, or a fracture that has not responded to more conservative treatment options
- Knee pain or leg alignment issues that make walking or performing daily activities difficult, despite more conservative treatment options
Physical therapists are movement experts who use hands-on care, patient education, and prescribed movement to improve people's quality of life. For an evaluation, you can contact a physical therapist directly.
What is a Total Knee Replacement (TKR)?
The arthritic parts of the bones at the knee joint (the tibia, also known as the shin bone; the femur, or thigh bone; and the patella, or kneecap) are removed and replaced with artificial parts in a total knee replacement (TKR), also known as total knee arthroplasty. These components include a metal cap at the femur's end and a cemented metal piece in the tibia with a plastic cap to allow the surfaces to move freely. The back part of the kneecap can also be replaced with a smooth plastic surface if necessary.
How Can a Physical Therapist Help?
The physical therapist is an important member of the healthcare team that assists people who have had a total knee replacement in regaining movement and function and returning to daily activities. Your physical therapist can assist you in preparing for and recovering from surgery, as well as developing an individualized treatment plan to get you moving again safely and effectively.
The better your physical condition is before TKR surgery, the better your outcomes will be (especially in the short term). According to a recent study, even one visit with a physical therapist before surgery can help to reduce the need for post-surgery short-term care, such as a stay in a skilled nursing facility or a home health physical therapy program.
Your physical therapist may suggest the following before surgery:
- Teach you exercises to strengthen and stretch the knee joint and its surrounding muscles.
- Demonstrate how you'll walk with assistance after your operation, and get ready to use a walker or other assistive device.
- Remove loose accent rugs that could cause you to “catch” your leg when maneuvering with an assistive device, or strategically place a chair so that you can sit instead of squatting to get something out of a low cabinet. Before you have TKR surgery, it is always easier to make these changes.
Before surgery, you should make the following long-term adjustments:
- Smoking cessation. As you schedule and plan for your surgery, ask your doctor for help or advice on quitting smoking. Being tobacco-free will help you heal more quickly after surgery.
- I'm trying to lose weight. Losing weight can help you recover faster, improve your function, and improve your overall results after surgery.
Immediately Following Surgery
Depending on your condition, you may need to stay in the hospital for a few days after surgery or even go home the same day. If you have other medical problems, such as diabetes or heart disease, you may need to spend a few days in the hospital or a skilled nursing facility before returning home. A physical therapist will do the following while you are in the hospital:
- Educate you on how to control swelling in the knee area and help the incision heal by using ice, elevating your leg, and wearing compression wraps or stockings.
- Teach you relaxation breathing exercises and demonstrate how to get in and out of bed and a chair safely.
- Show you how to use a walker or crutches to walk and how to get into and out of a car.
- Assist you in continuing to perform the flexibility and strengthening exercises you learned before surgery.
As You Begin to Recover
The first two weeks of recovery are spent managing pain, reducing swelling, healing the incision, resuming normal walking, and beginning exercise. Your physical therapist will tailor your range-of-motion exercises, progressive muscle-strengthening exercises, body awareness, and balance training, functional training, and activity-specific training after those two weeks to address your specific goals and get you back to the activities you enjoy!
Range-of-motion exercises. Swelling and pain can make it difficult to move your knee. Your physical therapist can teach you safe and effective exercises to help you regain the range of motion in your knee so you can get back to doing the things you love.
Strengthening exercises. Even if you don't need a walker or crutches anymore, weakness in the thigh and lower leg muscles may require you to walk with a cane. Your physical therapist can help you choose the right strengthening exercises for you.
Body awareness and balance training. Specialized training exercises enable your muscles to "learn" how to respond to changes in your environment, such as uneven sidewalks or rocky terrain. Your physical therapist may add agility exercises (such as turning and changing direction while walking, or making quick stops and starts) and balance board activities that challenge your balance and knee control once you can put your full weight on your knee without pain. Your treatment plan will be determined by the physical therapist's examination of your knee, your goals, and your level of activity, and overall health.
Functional training. Your physical therapist may begin to add activities that you were doing before your knee pain started to limit you once you can walk freely without pain. These could include actions performed in the community, such as crossing a busy street or boarding and disembarking from an escalator. Your treatment plan will be determined by the physical therapist's examination of your knee, your goals, and your level of activity, and overall health.
Returning to leisure or sports activities takes a different amount of time for each person; your physical therapist will be able to give you an estimate based on your specific condition.
Activity-specific training. Depending on the demands placed on your knee by your job or the sports you participate in, you may require additional rehabilitation that is tailored to your job activities (such as climbing a ladder) or sports activities (such as swinging a golf club). Your physical therapist can create an individualized rehabilitation plan for you that takes into account all of these factors.
Can This Injury or Condition Be Prevented?
If you have knee pain, working with a physical therapist to improve the strength and flexibility of the muscles that support and move the knee may help you avoid surgery. This training may even enable you to avoid surgery entirely. Participating in a physical therapist-designed exercise program can be one of your best defenses against knee injury. Additionally, staying physically active in moderately intense physical activities and maintaining a healthy weight through proper nutrition may help to reduce the risk of osteoarthritis of the knee worsening.
What Kind of Physical Therapist Do I Need?
Although all physical therapists are trained and experienced to treat people who have a TKR, you may want to consider:
- A physical therapist who has worked with people who have orthopedic, or musculoskeletal, issues.
- A physical therapist who is a board-certified clinical specialist or has completed a residency or fellowship in orthopedic physical therapy, giving them advanced knowledge, experience, and skills that may apply to your condition.
When looking for a physical therapist, keep the following in mind:
- Seek advice from family and friends, as well as other healthcare professionals.
- When making an appointment with a physical therapy clinic, inquire about the physical therapist's experience with TKR patients.
Prepare to describe your symptoms in as much detail as possible during your first visit with the physical therapist, as well as what makes them worse.