Every year, about 3.6 million people worldwide undergo a total knee replacement surgery. You might be one of them, or perhaps you’re wondering if it’s finally time to do something about that persistent knee ache. Even though it sounds like a common type of surgery, it still has a lasting effect on your knee, and the recovery process shouldn’t be underestimated. Our team knows that you are not just a statistic and that each person’s healing and recovery will be different.
As the name suggests, the surgery is supposed to replace your knee joint. So, many people hope to find complete relief from the disabling knee joint pain that they had before the replacement surgery. Yet, pain, swelling, and stiffness are common symptoms to struggle with after a complete knee replacement. If your knee still doesn’t feel ‘right’ or you brace yourself before climbing stairs, you are not alone. Whether you had surgery weeks, months, or years ago, don’t let your pain prevent you from getting back to the things you love.
Core background structures
What is a knee replacement?
A knee replacement involves replacing the damaged parts of your knee with metal and polyethylene plastic.
Total knee replacement
In a total knee replacement the bottom part of your femur (thigh bone) and top part of your tibia (shin bone) will be removed. Afterwards the doctor will insert metal prostheses in the place of the bone that was removed. Most surgeons use joint cement to reinforce these structures, but in some cases the knee replacement will be uncemented. With an uncemented knee replacement the surgeon will use bone growth
A polyethylene plastic piece will be placed inside the “new” knee as a shock absorber. What happens to the other structures around your knee will depend on your surgeon. Your patella (knee cap) may be replaced or resurfaced and your cruciate ligaments (the ligaments inside your joint that help you with stability) may be removed or preserved.
The surgery usually lasts 1-2 hours and afterwards you are transferred to an intensive- or high care unit, depending on the doctor. Nurses in this unit monitor your vital signs (heart rate, blood pressure etc) and you move to a general ward once the surgeon is satisfied that you don’t need constant monitoring.
Partial knee replacement
In this operation only one part of your knee is replaced – either your knee cap, the inner part or outer part of your knee. The benefits of a partial knee replacement are that your recovery is faster and you won’t lose as much movement after the operation. However, if more than one part of your knee is damaged this option will not be effective.
When is a knee replacement indicated?
Your knee joint is made up of many different structures – bone, ligaments, cartilage, joint capsule and muscles attached on all sides. The synovial fluid inside your knee is like the oil in your car’s engine that allows everything to move smoothly. All these elements need to work for you to get up out of a chair, walk, jump, climb steps and everything else that involves bending and straightening your knee.
After a bad fall, with knee osteoarthritis, rheumatoid arthritis or sometimes after a knee infection there can be damage to the cartilage and bony parts of your knee joint. Osteophytes (bony spurs) start forming inside the joint and the synovial fluid becomes more sticky and syrupy. This is your body’s way of improving stability around your knee to make up for the damage to the cartilage and bone. However, like an engine with rusty parts and too little oil, this means that your knee doesn’t move smoothly like it should, causing extra strain on your ligaments, muscles and already damaged cartilage.
From there on it becomes an uphill battle with stiffness, pain and instability. However, a total knee replacement doesn’t have to be your first option. Even though cartilage doesn’t heal, it’s quite common to have damaged cartilage without pain. Prostheses don’t last forever, so ideally a knee replacement should be a last resort. Your body is stronger and more resilient than you think, so call us to find out how we can help you with a non-surgical option for your painful knee. The key is to start physiotherapy before you hit that point of no return where you need more aggressive management i.e. a complete knee replacement.
What have you lost?
What is this structure’s Main function/Then, is it independent on: (Isolated function)
- Stability, Protective, Move, Hold, Static Stability, Mobilizer, Brace, Guard
- How should it usually work if everything is okay? (Use an example to say what kind of movement it involves)
- Movements, stability, power, force transfer, absorption, transmit, protect, it is going to help out with and discuss it in a practical way.
- Keep it short and sweet, this section is background information for the patient to understand what they lose or have lost.
- Strength – weakness, Stability – unstable “It’s not there anymore”
- Good place to underpin the relationship working in harmony with surrounding structures to produce, stabilize, absorb, and generate force.
- Please don’t use the word ‘function’. For example, as mechanics, we use our skills and knowledge to help your car function normally. As mechanics, we use our skills and knowledge to keep your car on the road. ~The second line is much more relatable.
Please don’t use the word ‘function’, if there’s no other way to say it – don’t say it.
I have a … How did it happen?
What was the event, or buildup, that led to this __________ (condition)?
Choose one mechanism of injury and take the patient through a slow-motion event that describes the pathology.
- The circumstances that led up to the point of failure, the order of dominoes that must fail one after the other to end up with this.
- Slow motion description of how the structures fail under pressure, force, tension, and angular force.
- The condition of the tissue, pre-event and as it deteriorates into this condition state.
- You are responsible for highlighting the secondary fallout that they might not even consider.
- Examples are the physiological breakdown of the structures, failure of one system, and then the next.
- Why the tissue damage takes place: Rotational force, Pressure force, sudden twisting, e.g. Sideways pressure along the length of the bone is like stomping on a toothpick; the bone will crack, splinter, and shatter, shearing into surrounding ligaments and muscles.
- Muscle tension is to the max, then tears. The passive structures are the backup system (ligaments) that takes up the slack but then rips through it, splits the ligament, and prys through any resistance. This all occurs in a split second, in the blink of an eye.
- Pathophysiology
EXPLAIN on a cellular level what goes wrong – Friction, Pressure, Bleeding, Forces, Tension - Explain the defect & bring it back to function.
- Backwards, regression of a chemical irritant, nociception leading into chaos, damage, destruction, loss of function, loss of _____
This is not a bullet section. This is the explanation part – the “causes section” is for listing the bullet points
Causes of
This is the primary factor that determines the likelihood of developing ….
Predisposing factors that lead to this problem can be linked directly or indirectly.
Look at your patient Demographics and see if there’s any correlation in research.
Meaning the activities, movements, and positions, systemic underlying conditions that directly flare up, worsen and keep on causing the problem to get worse
This is the core message I want you to understand, think about after you’ve read this article
Stating something is in a bad state is Information.
Explaining the influence of a bad state is Knowledge.
Symptoms of
Symptoms are the words your patient will use – in a subjective assessment.
Try to resonate with the exact words used by your patients to describe it to you. Then reread your symptoms and imagine a patient reading it to you… (Does it fit into the Title Diagnosis?) Can you describe it even better (signs they haven’t even noticed yet)
Remember – Symptoms are the patient’s subjective feelings. Use the words you expect a fractured fibula patient will say… Clicking, Stinging pain, Wabble, – Not “Abnormal movement of your lower leg”. Rather, please describe what you expect to hear them say.
In this section, more vague includes more scenarios than specifics.
Use emotions to describe what they might feel:
- Hesitant to even open a door
- Scared to lie on that side, climb over a step
- Difficult to work on your computer
- Uncertain if you can train
- Use words like:
- Time: persistent, sudden, lingering, Constant, Worse at night
- Characteristic: Sharp sting, Annoying, Intense
- Location: Area, around, particular spot
- Visible: Puffiness, Blue, bruising,
- Restriction in ADL: Hesitant to …, Cannot …., Avoid …., Unable to
- Load (High vs Low): at rest, during ….,
Tests that you can do to see if you have a …
Self-test your … at home with these modified tests and see if you might have a ….
Use your key phrases abundantly here, if you need a few more.
- Load progression in your tests.
- Do not use “try to..” – keep to clear instructions. It’s an ‘must do’ instruction. These are tests, must be clear and simple, and avoid words like: “attempt” “try”
“attempt to cross your painful leg”, “attempt to bend”, “try and twist”.
Describe at least:
- Weight-bearing
- Loaded
- Unloaded
- Stretch/ End of Range
How severe is my….?
Possible complications after your knee replacement
Deep vein thrombosis (blood clots)
After any surgery there is a risk of developing blood clots. This is because of the inflammation and damage done to your body during the operation. Another reason for this increased risk is that you will try to stay as still as possible due to pain. However, staying still means that there will be less blood flow to your arms and legs. It’s important to get moving again after your knee replacement to improve your blood circulation and decrease your risk of developing blood clots.
Wound infection
The wound over your knee will take time to heal and close, so during this time there will be a risk that bacteria can get into the wound. This bacteria can cause an infection either in the skin around your wound or inside the new joint. Your physiotherapist is trained to recognize signs of infection, so be sure to let them know if you notice a sudden change in your pain or swelling.
Nerve damage
All the nerves going to the skin and muscles in your lower leg have to pass through or around your knee, so with any major surgery to your knee there will be a risk of injury to a nerve. If this happens you will notice numbness or tingling and even weakness of the muscles that move your foot and ankle.
Dislocation
A dislocation is when the joint surfaces (thigh bone and shin bone) move away from each other. This is not a common complication after a knee replacement and will usually be due to a fall or hard impact on your leg. Under normal circumstances (before a knee replacement) the muscles and ligaments around your knee will keep the thigh bone and shin bone from moving too far apart. However, while your knee replacement is still healing, the muscles around the joint aren’t strong enough to protect your knee from sudden strong forces.
Ongoing pain
Post-surgical (after the operation) pain is normal and can last for weeks or months, but should gradually improve over time. As your knee heals the inflammation caused by the operation will gradually resolve. You will notice that the pain improves a lot as your knee gets stronger and you get your mobility back.
Swelling
The swelling after a total knee replacement can be quite prominent and may take weeks to go away. If any fever or redness develops with the swelling you should contact your surgeon as soon as possible as this could be a sign of infection.
Stiffness
In the first weeks after your knee replacement most of your knee stiffness will be due to swelling. Just keep doing your exercises and follow the advice of your physiotherapist and doctor. If you don’t do your exercises and move your knee in the first weeks after the operation you will risk developing scar tissue inside the joint. This scar tissue can cause permanent stiffness and keep you from regaining full movement in your knee.
Choose 4/6 of the below signs and DISCUSS why you (as a professional) use to identify and classify the … into: Severe vs Not severe
EXPLAIN WHY it is a serious type of injury ~ This describes the scope of … to a patient in order to understand if it’s worse or better than another person with …
Meaning: Imagine there’s a group of 20 patients, all with … and you must rank them from ‘less severe’ to ‘more severe’ ~ What markers/ signs will you look for to make your hierarchy and group them?
- Frequency – Intermittent/Constant/recurring
- Movement or static positions (rest) flare pain.
- Duration – Days, Weeks, Sudden, Short burst, change position of your … eases the pain.
- Size – Radiate – Shoulder, Upper back, Head…
- Intensity (pain) – bearable, pain doesn’t stop you, hesitant to
- Colour: Bruising, Blue, Red,
- Loading: Contraction, Low load required to bring on pain, High load (jump)
- ROM: Limitation? Less than 10 degrees limitation (not a problem) vs completely locked up.
- Stiffness
- Swelling
- Intensity: Discomfort – Painful – Sharp sting
On a scale from 0-10 describe a picture of Regression.
- Ligament tear Gr 1 – 3
- Muscle strain, micro tear – complete separation split in fibers
- Tendon phase of degeneration
- Cartilage erosion, plugging, tears
Diagnosis
Physiotherapy diagnosis
Describe a sentence to give the patient confidence that we’re the equipped/best at diagnosing this problem.
“We can handle it” vs “Our knowledgable expert physiotherapists are well versed, confident, and experienced in their approach to diagnosing your…”
We follow a structured plan to diagnose, classify the severity, and determine the hierarchy of priority that your knee needs. We stress, screen and scan all the possibilities that could be causing your pain. Identify any other injuries to surrounding structures. If there is an injury to the ligaments, meniscus, muscles or nerve, or cartilage we will find it.
We understand the physiological healing stages you’ll go through, and custom-fit your treatment program. By knowing the extent of the tissue damage we can guide you through a structured program to recover faster and safely return to the things you love doing. That’s why our physiotherapists are the best at diagnosing this type of problem.
Why is it crucial to get/understand a diagnosis? Does it mean anything? Or is it a death sentence? or will you treat it differently if you know what you’re dealing with?
X-rays
Muscles cannot be seen on an x-ray, so it will not be effective to diagnose a muscle spasm. X-rays will however show the integrity and alignment of joints in your spine. This will enable us to see if something is wrong with the structure of the bones in your spine or if there is a loss of disc space.
What are you looking for on an X-ray? Cortical stress lines, Displacement measurements, What Classification is done via X-ray?
Your physiotherapist can refer you to get x-rays taken if necessary.
Diagnostic ultrasound
Diagnostic ultrasound can be used to show the presence of a muscle tear (muscle strains), inflammation, swelling or simply increased contraction of a muscle (muscle spasms).
If you need an ultrasound, your physio will refer you.
MRI
An MRI scan can image all of the structures in your lower back, including soft tissue, discs, nerves and bones. However, for a muscle spasm an image like this is unnecessary and very expensive. If your physiotherapist suspects anything more than just a muscle spasm, you will be referred to the right specialist.
Is an MRI necessary for this diagnosis – if not when could it become a necessity?
Why is the pain not going away?
Why will this condition NOT resolve or recover on it’s own
What happens after a knee replacement?
Your total knee replacement is only the beginning – the correct exercises and rehabilitation are crucial for long-term results. After a knee replacement there is a lot of tissue damage and swelling around the joint. The body’s natural reaction to all this damage is to keep the joint as still as possible to help the healing process. However, staying still means that your knee will heal in that one position. Think of the hinge on a door that hasn’t been opened in a while – it becomes rusty and stuck in that position. As your knee heals it forms scar tissue inside the joint. This new connective tissue needs to be moved and stretched to adapt to all the movements your knee should be able to do.
Another important part of rehabilitation is getting your knee strong again. Pain and swelling after your operation will inhibit the muscles around your knee. So spending time and effort on just getting your knee moving won’t be enough. If your muscles aren’t strong enough to move and protect your knee, the stiffness in your knee will always come back no matter how much you stretch.
Discuss 3 Problems that are OUT of the patient’s control but can, with guidance, be leveraged to accelerate and control healing or limit setbacks or regression.
A prompt to ask Gemini: Search medical journals published to Rank the risks of complications and secondary fallout caused by with a… treated using non-surgical rehabilitation not limited to, but including predictable compensation patterns, joint stiffness, specific muscle weakness, physiological complications due to anatomical structure, swelling, non-union, malunion, rupture, tendonitis, arthritis, accelerated joint erosion. Also, indicate the percentage likelihood of the development of these complications.
Expected compensation, adaptation
- This section assumes that NO intervention/ treatment/ personal care/medical attention is applied….
- A patient who leaves his … untreated, undiagnosed, what will happen next…
- Pathology:
- If you don’t take the warning signs seriously, you risk more critical and possibly irreversible damage.
- Discuss physiology that slows down your recovery (severed nerves, swelling impede arterial bloodflow & nutrients, venous clearing of debris
- Discuss – Non-union, Malunion, Prolonged healing, Abnormal Callus formation, etc.
- You become stuck in a cycle of pain, not knowing if it is safe to move or not.
- Without intervention or treatment, why is the tissue state not improving?
Why is my swelling not going away?
Having a total knee replacement causes a lot a damage to your knee. A large cut is made through your skin to get to the joint, most of the joint is removed and artificial parts are inserted. All this damage triggers an inflammatory response in your body which starts the healing process. Part of this response is swelling around the “injury”.
The function of swelling is to help with stability and to keep your knee still while it heals. As the new joint gets stronger and your stability improves, the swelling isn’t necessary anymore. So why do you still have swelling around your knee weeks or months after your operation?
Your muscles act like the shock absorbers in a car – they should keep most of the stress away from your joints when you use your knee like during walking, twisting or squatting. If there’s too much stress on your knee joint, your body will “help” by allowing swelling around your knee. That’s why you might get up without a swollen knee and notice it gets puffier as the day goes on. Strengthening exercises for the muscles around your knee will improve its stability, thereby reducing the stress on the joint when you move around and use your knee. We can help you with the right exercises at the right time to get rid of the swelling around your knee.
Problems we see when patients come to us with …
Problems we see after a total knee replacement
Not realizing how important it is to see a physio after your knee replacement
The physiotherapist will give you basic bed exercises to start with in hospital after your knee replacement. These exercises are mostly for circulation and to start getting some movement and muscle activation around your knee. However, these exercises won’t be enough to get you fully mobile again. Some patients don’t follow up with a physiotherapist after leaving the hospital because they think that these exercises will get the job done. As your knee heals, though, the initial exercises will become too easy and your knee muscles won’t get back to the level of your unoperated leg. To complete rehabilitation and get optimal, long-term results after your knee replacement, your exercise program needs to change as you get stronger. Physiotherapists can evaluate the progress of your knee and change your exercises to match the stage of healing.
Stiffness and pain after a knee replacement
You may have heard that it’s normal to have pain, discomfort and stiffness for weeks or months after your knee replacement. A total knee replacement removes the damaged parts of your knee and you get a brand new, artificial knee. So there’s no reason for you to have permanent pain and discomfort. Physiotherapists are experts when it comes to stretching, strengthening and correcting movements after a knee replacement. If all the parts in and around your new knee are doing what they’re supposed to do, you should be able to do the things you enjoy without struggling with a painful knee afterwards.
Discuss 3 Problems that are WITHIN the patient’s control with guidance, which can be leveraged to accelerate and control healing or limit setbacks or regression.
Complications (guaranteed, or high probability of developing with this problem/diagnosis/condition.
- One concept per paragraph. Explain what resistance or problems you can encounter during the treatment process. Stay to the core message.
- These are not bullet points —they are only to guide your thoughts. Choose a few (not all) and explain why.
- Themes range from: Ignoring… , Accurate Diagnosis, Immobilisation, Too much rest, Too little rest, Medication use,
- Speak to your patient as if each of these is happening to them.
- Without treatment, a “wait and see” approach. – What’s wrong with it, and what problems will they face?
- Explain why it’s a problem. Not only state “it’s a problem” but explain why.
- Reasons that delay recovery time
Pain medication (how long is normal/ acceptable)
Misconceptions about treatment
Physiotherapy treatment
Physiotherapists are experts in rehabilitation and supporting the healing process. After your knee replacement we can answer any questions you may have and guide you through the process. We can help you to get the confidence you need when you’re using your new knee and check on your progress. It’s important to do the right level of exercises at the right time as your knee heals. When you’re going on a journey you can’t just jump to the end all at once, you have to take the first step in order to get to the second and third. Your physiotherapist can also treat your knee pain and help you to regain knee movements. When you’ve completed the process with us you should be able to hop, skip and jump without any fear or discomfort.
We will show you what to do every step of the way.
What about physiotherapy before my knee replacement?
Coming in to see a physio before your knee replacement will definitely be worthwhile. We can answer any questions or concerns you may have to prepare you for the road ahead – you will know what to expect and how long your rehabilitation and recovery will take after surgery.
After the operation your knee will be swollen and painful, so getting used to the physio exercises the day after your knee replacement can be challenging. If you make an appointment with us before surgery we can start teaching you the initial exercises and also start strengthening your core muscles and the other leg. These muscles will be working extra hard in the weeks after your knee replacement to take some of the off of your healing knee.
Phases of rehabilitation
Keep your focus on the primary problem structure.
As long as I can see progression & functional expectations changing, Example:
- crutches
- 20% Weight (limited ROM)
- 50% weight (FROM)
- 100% weight with concentric & eccentric contractions
- Speed & Power (Jump)
Please work the PEACE & LOVE protocol into the Plan of Action (Not all in the first phase)
- Balance on one leg
- Perform a lunge
- Squat to 90 degrees
- Balance reactions (stepping out sideways, forwards & backwards)
- Jump & Land from a step
- Do a Single leg jump
- Sit in a crouched position & get up
- Jump over a hurdle
1st Phase: What you want to achieve (Week 0 – 1)
Rehabilitation begins almost immediately after you wake up after your operation. Your physiotherapist will teach you to walk with your crutches or walking frame and usually start with a short walk to the bathroom. On the first day after your operation a physio will help you with exercises to improve blood circulation and start activating the muscles around your knee.
Before you are discharge you will be able to:
- Bend your knee to at least 90°
- Walk to and from the toilet
- Climb up and down steps using your crutches or walking frame
- Safely walk with crutches or a walking frame for up to 50 meters
- Get into and out of bed, sit and stand without help
To progress to the next stage you should be able to …
2nd Phase:
Regain range of movement and initial strengthening
By now you should be at home and moving around using less support from your crutches or walking frame. You will still have pain and stiffness, but from this phase on your pain will improve day by day.
Goals during this phase will be to regain your knee range of movement – especially full extension (straightening) of your knee. If your knee can’t straighten and lock you will walk with a permanent limp after your knee replacement. We will also work on bending the knee and start with muscle strengthening. For every extra bit of movement we gain, your muscles should get stronger to maintain the improvement. If your muscles can’t control the range the stiffness will just go back to where we started.
At the end of this phase you should be able to straighten your knee completely while you walk. You should also have enough flexion (bending) to use both knees when getting up from a chair.
3rd Phase:
Phase 3: Retraining walking pattern
At this stage of rehabilitation you should have full extension of your knee, so we can start retraining your walking pattern. We will also work to get rid of any compensatory (cheating) patterns you might have learnt before your knee replacement. After your knee replacement (and often even before the operation) your healthy leg would have taken most of your weight during walking. This means that you will be walking with a limp. During this phase the goal will be to get your new knee to take its share of the load. We will also add strengthening exercises for your hips, core and calf muscles. If the muscles above and below your knee are strong it helps with shock absorption around your knee and stability of both legs during walking.
After completing this phase you should be walking comfortably and without a limp. You might still be using your crutches until 6 weeks after your operation (depending on your surgeon’s instructions), but at this stage most of your weight will be on your legs.
4th Phase:
Progressive loading
The goal of this phase is to gradually add extra load to your knee replacement. Load on and through your knee stimulates bone formation. This is important for the stability of your prosthesis. As new bone forms around the artificial parts in your knee it becomes fixed inside your thigh bone and shin bone, respectively. Without this bone formation the prosthesis can “wiggle” around, becoming loose and unstable.
Your physiotherapist will start by using your own weight to add load to your knee joint. As healing progresses and your muscles become stronger we can start adding extra load using weights.
5th Phase:
Further strengthening
In the first 4 weeks after your total knee replacement the main goals of your exercises would have been to regain movement and initial strengthening. From week 4 healing is well under way and your artificial knee is strong enough to cope with extra load. Now your exercises will become more challenging – we’ll start adding more balance exercises, weights or elastic resistance and some faster exercises to get your heart rate up.
At the end of week 6 you should:
- Be able to stand on your operated leg
- Notice less swelling and inflammation around your knee
- Be doing everyday activities
- Be back at work
- Have more than 90° of knee flexion (bending)
- Be able to walk longer distances (about 500m)
6th Phase:
Phase 6: Maintain range of movement and continue functional strengthening
You should reach this phase about 7 weeks after your total knee replacement. By now you should be able to go about your normal day without any problems. The swelling around your knee will start disappearing. You should be able to drive, walk around at work and maneuver steps without any problems. Your physiotherapist will keep on monitoring your progress and modify your exercises as you get stronger and more mobile. Exercises at this stage will include functional exercises like squats, steps, changing direction and adding speed to improve your balance and coordination.
By the end of week 11 you should have:
- Range of movement of about 120°
- Improved mobility and very little stiffness in the morning
- Minimal swelling
- Returned to normal everyday activities including walking and swimming
Phase 7: Long-term maintenance
When you reach 12 weeks after your total knee replacement you should be able to put on your shoes, walk without a limp, get down onto the floor and up again without any trouble. Sitting down and getting up from a low chair or going up and down steps shouldn’t be an issue. You should even be able to jog at this stage.
To maintain your progress we will refer you to a biokineticist to continue with supervised exercises. Remember that your muscles won’t stay strong if you stop all your exercises when you reach this phase. The prosthesis in your knee doesn’t last forever, so it’s important to keep all the muscles around your knee strong to prevent extra stress on your knee replacement. A biokineticist can also help you with exercises you can continue at home to keep you fit and strong.
Healing time
How long will my total knee replacement take to heal?
A total knee replacement will follow the normal phases of wound healing. There is usually some overlap between phases, meaning that the one doesn’t stop completely when the next phase starts.
Inflammatory phase
The first couple of days after your total knee replacement you will notice heat, swelling, redness and pain around your knee joint. Your pain will also be at its worst during this phase, so it’s important to use the medication as prescribed by your doctor. This phase usually peaks after 3 days.
Proliferation phase (+ 3 weeks)
The second phase of healing starts about 48 hours after your operation and lasts about 2-3 weeks. During this phase healing takes place, where scar tissue forms in and around your knee replacement. This may sound like a bad thing, but scar tissue is your body’s way of closing the wound and the start to regaining stability inside your knee joint.
Guidance from your physiotherapist is vital during this stage, because the healing tissue around your operation will still be quite fragile. The goal of the exercises and advice from your physiotherapist at this point after your knee replacement will be to support the healing process. Doing too much too soon can interfere with healing, but doing too little will result in stiffness and can interfere with how much movement you eventually regain in your knee joint. By now you should be able to walk, climb steps and get into/out of a chair with your crutches.
Remodelling phase (+ 6 weeks)
In the last phase of healing the scar tissue formed during the proliferation phase matures. This means that it isn’t as fragile and can tolerate more than during the early phases of healing. If you were seeing your physiotherapist regularly up to this point and completed your exercises, by now the muscles around your knee should already be strong enough to support your total knee replacement during everyday activities.
The process described above takes about 6 weeks, but there will be overlap from one phase to the next. During the first 6 weeks after your total knee replacement you will be seeing your physio about twice a week. By then you should have enough movement and strength in your knee that your exercises will maintain the improvement between sessions. This means that your physiotherapist will start seeing you once every week or two and, as you get stronger, once a month.
At the end of 6 weeks you should be able to start walking without crutches and put your full weight on your affected knee. Getting into and out of a car will still be slow, but you should be able to do this without help from someone else. Your knee might still be swollen at times, but this is normal and can still happen up to 6 months after your operation. You should be able to start driving at this stage, but that will depend on when your doctor gives you the go ahead.
At 12 weeks
Throughout your rehabilitation e will check on your progress, make sure that you don’t develop any muscle imbalances and clear your knee joint when you have completed rehabilitation. This means that you should have full extension (straightening) and almost full flexion (bending) of your knee. You should also be able to stand on the operated leg with your full weight without pain. After a total knee replacement this is generally at 12 weeks after your operation.
If you followed the guidance of your physiotherapist and did your part by sticking to your home exercises, your knee should be strong and flexible enough to do most of your normal day to day activities. This should include brisk walking, climbing stairs, getting up from a chair and strolling around in a shopping center. Even picking up a shoe or dropped pen should be possible. You should be able to do all of this without using a crutch or walking stick.
What about 6 months and onwards after the operation?
As time goes on your knee will keep getting stronger and you will get more confident in your activities. By the time you reach 6 months post-operatively you should be able to drive your car around town comfortably, climb stairs without hesitation and climb up and down a ladder.
At the one year mark you should be able to do things like drive longer distances, kneel in the garden, sit on the floor with your legs crossed and get up again without difficulty.
Full recovery after a total knee replacement can take up to two years after surgery. How long your recovery takes will depend on many different factors including the extent of the damage to your knee, how long you had the problem and how strong you were before the operation. After 18 months you should be back on the tennis court of golf course, hopping off the sidewalk and almost able to forget which knee gave you trouble in the first place.
Other forms of treatment
This section is about other treatments that can help the process services that can help – but we don’t provide.
- Your doctor (GP) will probably
- Pain meds, injections,
- Getting your back or neck ‘aligned’ or ‘clicked’ in the hopes of improving the … will not improve the state of the muscle or change your pain. It could even worsen or trigger a muscle spasm. You need to look at the bigger picture.
- A biokineticist will be able to help you in the final stages of your rehabilitation and get you back to training for your sport.
- Wearing a back brace won’t be the solution to your problem.
- Stretching or foam-rolling might ease your pain temporarily, but
Is surgery an option?
Surgery is necessary when …
Revision knee replacement
Years after your knee replacement your knee may start to feel unstable, painful or stiff, so your doctor may recommend a revision. This is because the parts used during the procedure have a lifetime of 10 to 20 years. In a revision knee replacement the orthopedic surgeon will remove and replace some of the parts of the original knee replacement. If an infection develops after a total knee replacement, the knee won’t heal properly and can become loose and unstable. It could even be necessary to remove the original prosthesis to treat the infection. In this case a revision knee replacement will also be done once the infection has cleared up.
- These surgical checkboxes must be ticked before surgery is even considered.
- What is considered a failure of conservative treatment when surgery must be considered?
- Give the components of clinical measurements that indicate surgery
- Surgery is only the Halfway mark for a successful surgery; the rest is reintegration, strengthening, and adapting your body to the change.
- Why is rehab important after surgery?
What else could it be?
- Quadriceps tendinitis – your pain will mostly at the front of your knee, just above your knee cap.
- Pes anserinus bursitis – this bursa is on the inside of your leg about 5 cm below your knee, so that’s where you will have pain.
- Hamstring tendinitis – if you have a hamstring tendinitis your pain will be on the outer side and just below your knee.
- Patella dislocation – with a patella dislocation you won’t be able to straighten your knee and you will notice that the position of your knee cap is looks different on your other knee.
- Hamstring strain – pain with a muscle strain will be higher up than your knee, in the muscle belly. With a hamstring strain you will have pain at the back of your thigh.
- Quadriceps strain – the quadriceps muscle is on the front of your thigh, so your pain will be on the front of your thigh.
- Knee tendinitis – also known as patellar tendinitis, your pain will be just below your knee cap.
Also known as
Total knee arthroplasty
Complete knee replacement
Full knee replacement
