Total Knee Replacement: Beyond the Operation

With Singapore’s Golden Jubilee this year, our ageing population is seeing a rise in degenerative conditions diagnosed at the clinical setting.

A most common occurrence would be knee osteoarthritis, and consequently, the knee replacement that follows as a form of treatment.

As with any surgery, there are many considerations made towards the patient, both before and after the surgery. At Tan Tock Seng Hospital, our rigorously monitored rehabilitation programme for Total Knee Replacement (TKR) surgery is tailored for patients who need help in getting the best out of their new set of joints.

In this article, we answer some of the most common concerns that patients may have after TKR.

What To Expect Post Operation

 

Other Common Complaints Post TKR:

  1. Decreased Function
    It is common, for the first three to four months post TKR for the patient to experience difficulty with movements that involve half squatting, moving up and down stairs, and prolonged walking (up to two hours). Being diligent with the prescribed exercises will aid in bringing about a quick recovery.
  2. Feeling Buc kling (Giving Way) or Weakness in the Knees
    It has shown that weakness of the quadriceps, one of the largest thigh muscles in charge of straightening the knee when walking, has been linked to earlier arthritis and pain in the knee. After the operation, there will be further weakness and it is common for this muscle to cause a feeling of imbalance, instability, giving way, as well as a fear of falling when a person walks or goes up and down stairs. Strengthening the quadricep muscles, along with the buttock muscles will help eliminate this.
 

Initial Days After TKR

Patients are typically warded for about four to seven days. Their length of stay is adjusted according to their home care plan, how well they progress with rehabilitation, and their level of fitness.

Day one after the operation, a physiotherapist will help patients get out of bed, starting with the help of walking aids, and progressing by teaching them exercises that help them ensure that their ‘new joint’ stays at its best. Other things that will be covered during their stay in the hospital include: education on mobility around their home setting, advice on safety, caregiver training if necessary, as well as an individualised exercise regime, accompanied with exercise booklets.

Back Home

A little help during the first few days can go a long way. Patients will normally be up and walking shortly after this period. However, some may require help when going outdoors, as well as with their household chores. Pain and stiffness, which are common post operation, is normally the biggest issue in the first month after the operation.

Some simple tips to make recovery smoother and uneventful:

A) Pain Control

  1. Always take the pain medication prescribed by the doctor.
  2. Medication should be consumed about 30 minutes before home exercises, as this may help keep pain levels to a minimum.
  3. An ice pack applied to the knee for 15 to 20 minutes every two to four hours helps in pain relief and limiting swelling and inflammation.

B) Stiffness Control

  1. Perform the prescribed exercises – a range of motion and strengthening exercises – at least two to three times per day.
  2. Do not allow the knee to be in a prolonged position for more than 30 minutes without moving.
  3. Perform gentle stretching before moving out of position – be it in the morning or before getting up from a chair.

Recovery After tkr

The duration of rehabilitation, as well as the number of sessions required vary from patient to patient. However, on the whole, outpatient rehabilitation generally spans two to four sessions and about three to six months in duration.

During the outpatient physiotherapy sessions, an individualised examination will be conducted to check on patients’ pain levels, joint swelling, amount of movement available in the joint, walking capabilities, strength and balance.

The therapist will focus on improving joint mobility, pain relief modalities, and if required, move along with individualised exercise prescription to increase functional movements and begin gait retraining.

In the long term, it is important to follow up on the advice given by the doctors and physiotherapists – that will help with the recovery.

Common advice would include avoiding any unnecessary stress on the joint, which may come from walking or standing for more than an hour at a time, without rest in between. Another important point to lengthen the lifespan of the knee replacement would be not to participate in high impact sports like basketball or football.

Common Exercises After tkr

After the operation, many exercises can help strengthen and rebalance the leg muscles. Below are some exercises that are commonly recommended after TKR.

1) Isometric Quadriceps

 

  • Lie flat and tighten the muscle in the front of your thigh as much as you can, pushing the back of your knee flat against the floor. This will pull your kneecap up your thigh, toward your hip.
  • Hold the muscle tight for as long as you can.
  • Repeat this exercise 30 times, for about 3 times a day.

2) Double Leg Bridging

 

  • Lie flat on your back. Lift your hips towards the ceiling.
  • Make sure to tilt your pelvis and pull your belly button towards your spine to engage your abdominal muscles.
  • Squeeze your buttocks to make them firm.
  • Hold this position for 10 seconds and repeat 30 times, 3 times a day.

3) Inner Range Quadriceps

 

  • Place a ball under the exercising knee, straighten your knee by squeezing the muscle located at the top of your knee.
  • Hold for 10 seconds, repeat 30 times, 3 times a day.

4) Hamstring Stretch

 

  • Sit up straight, place your heel on the ground and lean forward.
  • Ensure that you feel a stretch at the back of your knee and thigh.
  • Hold for 30 seconds, and repeat 4 to 6 times, 3 times a day.

5) Calf Stretch

  • Place your feet hip width apart.
  • Place the leg you want to stretch as far back as you can, without lifting your heel off the ground.
  • Hold for 30 seconds, repeat 4 to 6 times, 3 times a day.

Balance as well as progressive weight-bearing exercises are normally added later on in the rehabilitation phase, approximately five to ten weeks on.

6) Step Up

 

  • Place your exercising leg onto a step.
  • Shift your full body weight onto the leg on the step and straighten both your knee and hip.
  • Repeat 30 times, for 3 times a day.

7) Tandem Walk Exercise

 

  • Use a close-by wall or countertop for support when you first start this exercise.
  • Stand straight and step your right foot forward so your right heel touches the front of your left toes. Then place your right toes down so both feet are flat.
  • Do the same with your left foot. Place it forward such that the left heel touches your right toes, then lower the left foot.
  • Continue walking, touching your heels to your toes for the whole length of the countertop or hallway.

 

Ms Rachel Tang is a Physiotherapist from the Physiotherapy Department of Tan Tock Seng Hospital. She completed her undergraduate studies at the University of South Australia (UniSA), Australia. She possesses 3 years’ experience working with musculoskeletal problems, and has specific interests in sports physiotherapy and ergonomics.