Physiotherapy After A Total Knee Replacement Surgery

Introduction:

Total knee replacements, also known as total knee arthroplasty (TKA), is a procedure for those suffering from severe knee pain, mobility issues and poor quality of life due to conditions like osteoarthritis or rheumatoid arthritis. Surgery involves replacing the damaged parts of the knee joint with metal and plastic artificial implants to allow pain-free movement whilst maintaining joint stability. In 2021-22, 53,000 knee replacements were performed in Australia to treat osteoarthritis (AIHW 2023).

While the surgery itself is a crucial step towards improved quality of life, a detailed and well executed rehabilitation program is integral for a successful recovery. In this blog, we’ll walk you through the phases and key components of post-total knee replacement rehabilitation.


Phase 1: Acute Post-Operative Care (Approximately Days 1-14)

Immediately after surgery, you’ll be closely monitored in the hospital for pain management, wound care, and early mobilisation/movement. The physio team will begin gentle exercises to improve circulation, prevent blood clots, regain knee range of motion, and improve muscle activation. These exercises may include ankle pumps, quad setting, and gentle knee bending. Depending on your level of function, you’ll likely use assistive devices like a walker or crutches to aid in walking and balance in the early stages. As you improve, the level of support needed will be gradually reduced.


Phase 2: Early Rehabilitation (Weeks 2-6)

As you transition home from the hospital, we can really start to increase the intensity of your rehab. We still aim to achieve full extension and flexion of the knee, whilst also increasing the demand of strengthening exercises. Exercises for the quadriceps, hamstrings, glutes and calf muscles are introduced to improve stability and support around the knee joint. Some example exercises include hip/glute bridges, chair squats, heel raises, and hamstring curls. Depending on your rehab goals, we may also incorporate low-impact cardiovascular exercises like stationary biking or aquatic therapy to improve overall fitness without aggravating the knee.

Functional retraining is also addressed during this phase of rehabilitation, improving your performance and confidence with tasks such as stair ambulation and simple single leg balance tasks. There may still be residual pain and/or swelling during this phase, which is managed in conjunction with exercise therapy.

Phase 3: Intermediate Rehabilitation (Weeks 6-12)

Once we have established a good base level of strength, range of motion and mobility, the focus shifts progressing strength and functional retraining. Exercises become more challenging, incorporating balance and proprioception training to help you continue to regain confidence in walking and performing daily activities. We may also introduce resistance training using resistance bands, weight machines and free weights such as dumbbells and barbells to further strengthen the muscles around the knee.

Phase 4: Advanced Rehabilitation (Months 3-6)

By this stage, you should notice significant improvements in knee strength, range of motion, and overall function. Advanced rehabilitation aims to fine-tune these gains and prepare you for more demanding activities. If relevant, your rehab program may include plyometric exercises, agility drills, and functional training tailored to your specific needs and goals. You’ll gradually transition to higher-impact activities like jogging, hiking, or recreational sports under our close supervision. It’s important to note that all rehab programs will differ based on the patient, and that goals are always tailored to the individual!

Phase 5: Maintenance and Long-Term Management

Rehabilitation doesn’t end after the initial recovery period. To maintain the benefits of your total knee replacement, it’s crucial to incorporate ongoing exercise and lifestyle modifications. We will work with you to develop a personalised ongoing program focusing on strength, flexibility, and cardiovascular fitness. As you transition to a more independent management plan, occasional follow-up appointments aren’t uncommon, as this will allow for assessment of progress and adjustment of the rehabilitation plan as needed!


Conclusion:

Rehabilitation following total knee replacement surgery is a lengthy process that requires commitment, dedication, and professional guidance. By following a structured rehabilitation program and adopting a proactive approach to recovery, you can maximise the benefits of your surgery and enjoy an active, pain-free lifestyle. Remember, each milestone achieved is a step closer to reclaiming your mobility and independence. Keep moving forward, and never underestimate the power of rehabilitation in restoring your quality of life.

Morrie Toum – BeFit Training Physio Coogee

Morrie Toum – BeFit Training Physio Coogee

Morrie completed a Doctor of Physiotherapy at Macquarie University after completing his undergraduate degree and Honours thesis in Sport and Exercise Science at University of Technology Sydney.

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