Have you just had, or are you having a Total Knee Replacement (TKR)?
Have you had a Total Knee Replacement (TKR)?
A total knee replacement is usually done for severe arthritis and primarily used to eradicate the pain involved. In most cases you will regain the full range of movement that you had pre-operatively and sometimes a little more but it may not allow you to sit back on your heels and they are not made for high impact activities such as running and jumping. Although knee replacement surgery is now much more common, it’s still a major operation and it can take time to recover fully.
Some tips when having a TKR
The more mobile and strong the joint is before surgery, the better. This will give you a good platform to start your rehab from afterwards. Although, you may be in some pain, it is worth trying to stay active in the run up to your operation. If exercise on land is too painful, then exercising in the pool is a great alternative.
A TKR is undertaken to relieve arthritis pain, but because of the trauma to the soft tissues surrounding the joint during surgery you may experience some pain after the surgery. Taking the pain medication that has been advised by your consultant; regularly should help minimize this. On discharge from hospital some pain may persist for a further few weeks/ months and you should use this as a guide when increasing your daily activities.
Post-operative swelling is often a limiting factor to progress. Swelling around your knee is normal and this can remain for up to 12 weeks following surgery but you need to try and minimise it as much as possible. Using ice packs at this stage may still help to reduce swelling. Keeping your leg elevated every time the opportunity arises can also help. Raising your leg at night may also help. Place a pillow under your heel to raise your leg. Do not place it under your knee even though this may feel more comfortable it can prevent the knee being able to fully straighten and this can cause more problems.
Things to watch out for
Watch out for your wound becoming very swollen or red/hot, these signs can be related to an infection. Also monitor any new numbness, tingling or discolouration in your foot, which lasts for more than 24 hours. If you notice any of these symptoms, contact your GP or NHS Direct.
You will probably need to use a walking aid (crutches or a walking stick) in the early stages. Don’t be tempted to discard it too quickly; it’s better to walk normally using a walking aid then to limp without one. As you improve walking is a good way to build up and maintain the strength in your leg muscles. Practice walking indoors without an aid before venturing outdoors. You should gradually increase the distance that you walk each day progressing to 30 minutes or two lots of 15 minutes a day. Walking also improves your balance, and heart and lung fitness.
You will be given exercises from a physiotherapist in hospital and for the first three weeks you should do your exercises at least three times throughout the day. A follow-up physiotherapy outpatient appointment should be arranged within one to two weeks after you leave hospital. This is to help you continue to develop your strength, knee movement and walking ability. It will also give you an opportunity to discuss any concerns that have arisen since you left hospital. Participating in a structured rehab programme will help you to recover quicker and in the longer term continuing exercise regularly will help to stabilise and support your new knee.
Hydrotherapy can be a great benefit to recovery after a TKR. As the bodyweight is supported by the buoyancy of the water, you are able to exercise the joint to increase mobility and strengthen the surrounding muscles without putting the stress of the bodyweight through the joint in the process. This means exercise and rehabilitation can start sooner, which avoids a prolonged period of inactivity and therefore speeds up recovery.
Due to the properties of water many of the complications following a TKR: such as pain, swelling and stiffness can be reduced in water. The buoyancy and resistance experienced in water can be harnessed to provide an extra degree of difficulty or as assistance while carrying out exercises.
Buoyancy in water relieves body weight, allowing for easier walking and functional movements after the surgery. The hydrostatic pressure of the water has positive effects on reducing swelling in the knee which in turn helps regain more range of motion and reduces pain.
The sensory input of the water can also increase body position awareness enabling improved balance, co-ordination and confidence.
Through increased confidence and reduced pain, patients are able to move more freely, which often leads them to report reduced fear and anxiety about the recent surgery. This can help behaviours and movements over the early stages of recovery that can greatly determine long term outcomes.