In total knee replacement( TKR) surgery the knee is replaced with components. The thigh bone (femur) is capped by a metal component. The shin bone (tibia) is covered with a metal component. The two metal components have a plastic (polyethylene) inset which allows the smooth hinged movement of the knee metal components.When a knee replacement is performed, the bone and cartilage on the end of the femur and top of the tibia are removed. This is performed using precise instruments to create surfaces that can accommodate the implant perfectly. The knee replacement implant is then placed in to function as a new knee joint. Depending on the condition of the cartilage underneath the knee cap, the kneecap surface may also be replaced.

Total knee replacements are one of the most successful procedures in all of medicine. Most patients are satisfied and happy with the surgery. It allows them to mobilise more and have less pain.

Exercise is a critical component of recovery, particularly during the first few weeks after surgery. Physiotherapy starts on the first day after your surgery whilst you are still in hospital. Most patients stay in hospital for approx 4-5 days before they are safe and independent enough to good home.

You should be able to resume most normal activities of daily living within 4 to 6 weeks following surgery. Some pain with activity and at night is common for several weeks after surgery.

There are a number of risks associated with surgery

– Infection

– Blood clots in the leg, vein or lungs

– Excessive Stiffness

– Bleeding (if excessive, may require a BLOOD TRANSFUSION)

– Damage to blood vessels or nerves

TOTAL KNEE REPLACEMENT

Instructions for AFTER the surgery

  • You may put full weight through your leg when walking.
  • Patient must use a walking aid eg walking frame.
  • Try not to limp.
  • Stop using the walking aid when able to walk comfortably WITHOUT a limp.
  • All wounds are closed with steri-strips (NO stitches) AND covered with a WATERPROOF dressing.
  • Leave bulky dressing undisturbed for 48 hours.
  • Remove bulky dressing after 48 hours and replace with elastic bandage (Tubigrip) supplied.
  • NO soaking, baths OR swimming yet.
  • Physiotherapist will provide you with information/instructions of exercises to do.
  • Swelling. This is to be expected. Try to rest with the leg fully straight. A pillow under the heel will help with this. DO NOT REST WITH A PILLOW UNDER THE KNEE. Elevate the leg on a pillow or cushion while sitting. An ice pack can be used.
  • Pain. You will receive a prescription for pain medication on discharge. These tablets work best when taken regularly. esp during the first week or two after surgery
  • Possible temporary numbness and/or tingling around the wound site.
  • Excessive persistent pain
  • Pus discharge from wound
  • Fever
  • Excessive pain AND tenderness AND swelling in the calf.

Should any of these symptoms persist contact Dr Sim’s rooms or after hours emergency.

Total Knee Replacement Rehab Protocol

Acute Recovery

0-2 WEEKS

Goals

  • Pain relief and wound care
  • Swelling reduction
  • DVT prophylaxis
  • Early mobilization from day one

Pain Relief

  • Ice, elevation, analgesia, wound dressing
  • Take prescribed medication REGULARLY

Dressing and Wound Care

  • Leave bulky dressing undisturbed for 48 hours
  • Remove bulky dressing after 48 hours. Leave waterproof dressing in place
  • NO soaking, baths OR swimming yet. Leave bulky dressing clean and dry

DVT Prophylaxis

  • Take prescribed medication as per Dr Sim

Mobility

  • Mobilise full weight bearing as tolerated progressing form a frame to walking stick as comfort/confidence allows

Exercises

  • Range of motion exercises and muscle activation exercises as instructed by physiotherapist

Range of Motion

2-6 WEEKS

Goals

  • Continuation of pain relief, wound care, swelling reduction and DVT prophylaxis
  • Continuation of mobilization and range of motion exercises

Exercises

  • Progression of exercises to improve range of motion
  • Gradual introduction of strengthening exercises
  • Gait retraining from walking stick to no aid
  • Can commence hydrotherapy after 2 weeks once wound is healed

Strengthening

6 WEEKS – 3 MONTHS

Goals

  • Wean off pain medication
  • Ongoing swelling reduction
  • Continuation of exercises and progression to more functional activities
  • Consider driving a motor vehicle once comfortable

Exercises

  • Progression of walking program aiming to build endurance

3 – 6 MONTHS

Goals

  • Ongoing swelling reduction
  • Ongoing strengthening and endurance training aiming to achieve a 45 minute brisk walk by 6 months

Living with your new knee

6 MONTHS – 1 YEAR

Goals

  • Walk good distances comfortably without pain and eventually “forget” that you’ve even had knee surgery

Review with surgeon at one year post operatively with xray’s

Total Knee Replacement