To prepare for and recover from a Total Knee Joint Replacement (TKJR) is not without its challenges and we at surgerycoach.net are here to help you every step of the way (literally)!
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A GOOD KNEE HAS TO BE STRAIGHT, STRONG WITH A GOOD KNEE BEND.
1. A STRAIGHT KNEE:
Osteoarthritic knees are often stiff and may lose their ability to straighten as the person holds them slightly bent when their knee hurts, to reduce the stress on the knee. If the knee stays bent for too long, the bend becomes permanent and the knee is stiff. Sometimes the surgeon can correct this, but you need to do more work the get the knee completely straight after the operation.
2. A STRONG KNEE:
The big muscle (quadriceps) on the front of your thigh keeps the knee stable when you take weight through your leg. It pushes you up stairs and out of a chair and allows you to sit down in a controlled fashion, without using your arms for support. You need this muscle to be strong, to straighten your knee under load right through the full range of movement. This provides good knee control in walking.
3. A GOOD BEND:
The knee is designed to bend at least 120 degrees and it is useful to have a good range of bending movement. Knees bend to 70 degrees in normal walking and 110 degrees is necessary to go up and down stairs normally. While you can manage with less knee bend, it is convenient.
PREP (PRE OP SURGERY PREPARATION)
NB: Surgerycoach.net will support you all the way, that’s what we do.
Get prepared and get your home sorted prior to surgery.
Hire, beg, or borrow an exercycle so it’s ready to go when you get home –start using it now. Ensure you have a solid chair with arms you can get out of and sit down into.
Clean up your diet. Reduce carbohydrate and sugar intake to lower the inflammatory markers in your blood which can assist with reducing pain. Reduce your weight. Arthritis NZ guest speaker Prof David Hunter, a leading researcher in OA states that losing 10% of your body weight can lead to a 50% reduction in pain.
Get fit. Ask surgerycoach.net what you can do at this stage. Practise knee exercises 2x per day on most days with both of your legs.
Identify the landmarks of your knee as you exercise your muscles, this will make it much easier to do what’s required when you get home.
Practise mindful practise and relaxation techniques to aid recovery such as deep breathing and meditation. Get your sleep sorted so that you can wake refreshed and recovered.
EXERCISE FOR A STRAIGHT KNEE
STRETCH THE KNEE STRAIGHT
Sit or lie with your leg out in front of you. Put the heel up on a block or pillow so that the knee hangs in mid air. Let the knee stretch for a short time, building up to 5 minutes, less if it is too painful.
This stretches the tight structures behind the knee which are stopping it going completely straight.
STATIC QUADRICEPS EXERCISE
This exercise can be done right after your operation and it really is good if you can practise it before surgery.
With the knee as straight as you can, tense up the muscles in the front of your thigh and try to lift off your heel. Hold for a few seconds and then relax Up to 10 x, 2x per day.
INNER RANGE QUADS
Sit with the knee bent over a towel, high enough to be able to lift the keep off the ground.
Push you knee into the towel and raise the heel as high as you can.
Hold 5 seconds then relax and repeat
10x, 2x per day.
STRAIGHT LEG RAISE
Sit with your leg out straight. Tighten the thigh muscles (quadriceps), straighten the knee and lift the whole leg up off the surface you are on. Hold for 5 seconds and then lower slowly.
10x, 2x per day.
EXERCISE FOR A GOOD KNEE BEND
KNEE BENDS ASSISTED
Keep the heel down and slide the foot forward towards you, bending the knee.
10x, 2x per day.
KNEE BENDS IN SITTING
Sit in a chair with your foot on the ground. Slide the foot firmly towards you and then release. Hold for 5 seconds in the fully bend position. Do not allow your hips to move, just the foot. Release and repeat 10x, 2x per day.
You can use a board or plastic bag for this exercise to assist in moving.
Once you are discharged from hospital it is expected and encouraged that you will build up to practise walking for 10 minutes, 2x per day. Initially for up to 2 weeks this will be with 2 crutches. At Day 14 you will go to 1 crutch. At Day 28 days you will go without crutches.
How can you prepare for walking with your new knee?
- If it is not too painful or unstable, start by timing your walking on a flat surface such as around your garden or driveway, perhaps the hallway?
- Is it possible to walk with walking poles, a walking stick or use the pool for walking?
- If it is too painful or unstable, you may find you can use an exercycle instead. This will be very useful from 28 Days when it is encouraged to commence using an exercycle. So getting prepared by hiring, borrowing or purchasing one now, to be ready to go. *
- If you are unable to manage an exercycle, can you practise stepping with alternate legs forward and backwards 10x, like marching on the spot, holding onto the back of a chair, or Tai chi movements that involve stepping?
REHAB – EXERCISE REGIME ONCE DISCHARGED – TWICE DAILY.
- Walk 10 minutes
- 10 x small knee bends
- 10 x up-on-toes
- 20 x knee bend in sitting
- 20 x leg lift Straight leg Raise
- EXERCYCLE from Week 4
- SWIMMING from Week 6
- DRIVING – Check with Surgeon
- DAY 14 1x Crutch in opposite hand
- DAY 28 No Crutches
GAS up: Good leg – Affected leg – Stick
SAG down: Stick – Affected leg – Good leg