Home Life And Exercises After Knee Replacement

It is very important to continue with physical therapy and exercises after any joint replacement procedure. Once patients are out of the hospital, the surgery may be finished but the physical therapy and rehabilitation are just beginning.

This may sound daunting to someone who is contemplating surgery and currently dealing with a painful knee, but in actuality, most patients find that the pain they have after surgery is quite different from the preoperative pain. Patients commonly remark immediately after surgery that they no longer feel the grinding, deep joint pain with weightbearing that they had previously, and that most of the discomfort after surgery is muscular pain in the area of the incision. Perhaps even more importantly, this type of discomfort steadily resolves and actually improves the more patients are up and about using their new knee.

There is little disagreement that there is definitely some pain associated with the postoperative period. Pain medication, early mobilization, and time all help to reduce this period until you are moving around well and getting out of the house on the new knee. Knee replacements do tend to be somewhat tougher in recovery than hip replacements, but over 95% of patients can expect a good outcome after 9 to 12 months after the surgery.

Although many patients are driving and getting around within a month after knee replacement surgery, I often advise my patients that they should expect about a year before the knee reaches maximum strength and range of motion.

Getting Home And Transportation

Most patients are able to go home in a regular car, and within a few days, they can certainly use the car as a passenger to get to the hospital or physician's offices. Generally it works best to use a vehicle that allows you to stretch your legs out in front of you, although this is not as important as it is for hip replacement patients (who need to avoid flexing beyond 90 degrees).

Generally it is best to avoid nonessential travel out of the house for about 7 to 10 days after a total knee replacement. Most patients are able to go for short rides or to a restaurant after about a week. Partial knee replacement patients can expect to mobilize somewhat quicker. Although some younger and more active patients have actually returned to office (desk) jobs for short periods after the first week, it is typically best to do the exercises / physical therapy and otherwise rest in the first few days after surgery.

You should not take any extended car trips for 5 weeks. This is primarily because of the prolonged sitting and the increased risk of blood clots, the same as seen for hip replacement patients.

Driving is usually not recommended until 2 or 3 weeks after discharge, if you have good control of your right leg, and if you do not have any other medical conditions that prevent you from driving. If you have other conditions besides your knee that may impede your driving (such as low blood pressure, vision, or neurologic issues), check with your family physician before driving. Obviously, if you have lightheadedness or are still taking narcotic medications, then you should not drive.

We typically recommend that patients practice driving in an empty parking lot, such as an empty school or church parking lot on a Saturday. It is also a good idea to take a family member or friend with you, and if you BOTH feel comfortable with your ability to drive, then begin driving short distances and gradually work up to longer trips.

It is important to understand that you have to take legal responsibility for determining when you are safe to drive. If you feel you are unsafe, then wait until you feel more confident.

Getting Around On Your OwnTwo Feet

You should be walking at least 4 or 5 times per day, increasing your distance each time. Walking and bending the knee are your most important exercises after a knee replacement. It will increase your stamina and strength, decrease stiffness, help to prevent blood clots and constipation, and you actually will feel much better if you are mobile.

However, when you are not walking, remember your rest periods in bed with leg elevation. These breaks are important to prevent swelling. You should spend most of the first week resting in bed, elevating the legs for as long as there is significant swelling. Keep the legs elevated above the level of the heart. However, while in bed, you certainly can (and should) continue to bend the knees back and forth.

Flex the ankles up and down whenever you think about it, which promotes circulation. You may walk frequently, but in general you should spend two hours, twice a day, in bed with the legs elevated for as long as there is persistent swelling in the leg. If your leg and calf suddenly become much more swollen, warm to the touch, and painful in the calf, it can be a sign of a blood clot and you should call the surgeon's office.

During the first week at home, you should not sit in a chair for more than 3 times a day for 30 minutes each time (usually at mealtime). While sitting up is good for many things, it does increase swelling in the legs, and therefore in the first week try not to sit up in a regular chair for more than 30 minutes at a time. After the first week, this can be relaxed if there is not significant swelling or discomfort. Sitting periods can slowly be increased to a normal routine after the first week.

While sitting in a chair, try to have everything you need (e.g., water, telephone, television remote, etc.) within arm's reach so that you do not twist.

Stairs

You may begin using stairs as soon as you feel comfortable. Some patients with good stamina and muscle strength may practice stairs at the hospital before going home; others will take a few weeks to build up their strength. The most important factor is to be safe, and always use a handrail for balance as you begin using stairs again. If you feel unsteady, then you may use a sitting position to scoot up or down the stairs.

When going up stairs, lead with the unoperated leg, and when coming down, lead with your operated leg. (If both legs have been operated on, then you can use whichever leg is more comfortable.)

Go UP stairs leading with the nonoperated (or stronger) leg.	Go DOWN stairs leading with the operated (or weaker) leg.

Showers and Toilets

Different surgeons may have different guidelines, but in our practice, we generally allow showering 2 days after discharge if the wound is dry. Gently towel the area dry after showering. Do not shower or get the wound wet until 2 days after the wound has become completely dry, and do not allow it to get wet if there is still some drainage.

A shower stool is a good idea for the first 6 weeks after surgery. This can be helpful to avoid slipping and falling.

No tub baths for at least 6 weeks. This is primarily to avoid the motions involved with getting in and out of a tub, but generally it also is not a good idea to completely submerge the surgical site for a couple of weeks.

You may use a regular toilet, although a raised toilet seat is sometimes helpful by decreasing the strain on the knees associated with getting on and off the commode.

Sleeping at Night

Unlike hip replacement patients, knee replacement patients do not require a pillow between the legs and may sleep in whatever position they find most comfortable. However, it is a good idea to elevate the leg and prop a couple of pillows under the calf and knee to prevent swelling, particularly in the first week or two after surgery.

Exercises

The exercise program after joint replacement is not temporary, but continuous. It is an important part of the ongoing management of your knee replacement.

As noted above, walking is the most important exercise. You should walk at least 4 or 5 times a day, increasing the distance each time. It is better in general to walk for shorter periods with rests in between than to attempt a marathon session once or twice a day. Rest periods are helpful in between. The walking should be at a slow, steady pace on level ground. (I often recommend going to the mall several weeks after surgery for most patients, as it is level ground and weather is not a concern.) Walking faster will not be particularly beneficial, and if you strain the muscles by walking too quickly, it is possible to have some muscle bleeding and swelling in the first week or so. A slow and steady gait, on the other hand, is very beneficial.

Some surgeons will routinely prescribe the use of a mechanical device to slowly move the knee, called a continuous passive motion (CPM) machine. We will prescribe these on occasion in our practice, but typically only for those patients who have cannot comply with exercises on their own. Active exercises and walking are more beneficial.

The following exercises are the ones we recommend in our practice, primarily focusing on walking and bending the knee. If you are reading this and have another surgeon, be sure to check with him about your exercise instructions and routine (and any special precautions or limitations) in case it differs.

Ten sets of the following exercises should be done each day, and at least 10 repetitions of each exercise should be done during each set. The standing exercises should be done while holding on to a table or using a crutch or cane for balance.

Bend the Knee And Hip

Bend both the knee and hip in a standing position, lifting the leg up and down 10 times. Hold on to a table or walker for balance. Make an effort to completely straighten the knee. You should also keep moving the knee even while seated or reclining in bed. In this way, try to bend and straighten the knee "a thousand times" a day.

Ankle Motion

Do not forget to flex both ankles up and down whenever you think about it, like stepping on the gas pedal. This helps the circulation and prevents clots. It is particularly helpful while laying in bed.

Knee Isometric (Quads) Strengthening

Lying flat, keep the legs straight and a little apart. Try to tighten the thigh (quads) muscles and also push the knee downward against the floor or bed, holding the contraction for 5 seconds. Repeat 10 times.

Isometric (Quads) strengthening. Try to tighten the muscles of the thigh while pushing the knee downwards.

Heel Slides

Lying flat, slide the operated foot up as far as you can while keeping the heel in contact with the floor or bed, then allow it to slowly slide back. Repeat 10 times.

Heel slides. Bring the knee up as far as you can, then allow it to slide out, straightening it.

Knee Range of Motion / Straight Leg Raise

While laying flat, place a rolled towel or round pillow under the knee, then extend the knee so that the foot rises completely off the floor or bed. Hold it up for 5 seconds, then release. Repeat 10 times.

Straight Leg Raises. A pillow behind the knee can be helpful while trying to straighten and extend the knee.

Please remember the information on this site is for educational purposes only and should not be used to make a decision on a condition or a procedure. All decisions should be made in conjunction with your surgeon and your primary care provider.