Total knee Replacements (TKA) also known as Total Knee Arthroplasty’s (TKA), A TKA is a surgical procedure to replace the weight-bearing surfaces of the knee joint to relieve pain and disability. TKA’s have improved significantly in the last 5 years, but physical therapy will help speed up the recovery process.
Why Physical Therapy is needed and how it can help
The best care for TKA is progressive strengthening and ROM exercises. This is vital so the patient does not develop poor walking habits and is able to strengthen the muscles around the knee.
A common problem with a TKA right after post-op occurs when the patient doesn’t use his or her own muscles of the surgical knee. This happens when the patient uses the other leg or hands to lift the surgical leg in and out of bed and in and out of the car. Additionally, a caregiver can help them move their leg in and out of a bed or car. Thus, the leg muscles that are responsible for doing this are used minimally and sets the patient up for a longer recovery.
The best approach is to have the patient strain and slowly raise their own leg thus activating the correct muscles. It may seem cruel, but if the patient does this from the onset of therapy results will increase drastically. Quadriceps muscles will get stronger, faster and improve ROM in both extension and flexion.
Another aspect of recovery from TKA surgery is proper gait and form. The patient needs to be instructed on proper heel to toe walking and full extension of the surgical knee (when in stance phase of gait with good quadriceps contraction) which helps avoid having an extension lag. The faster a patient can get full knee extension to 0 degrees and flexion of knee to 120-130 degrees, the pain and tightness will resolve.
How Long do I have to come to Therapy?
Every person is different, but with the advances in TKA surgery, you can expect to come to therapy for 2-3 weeks.
How Sleeping can be affected by a Total Knee Replacement
Sleeping can be a challenge for some post-op TKA patients. It is recommended to not put a pillow or pad under your TKA to sleep. This is due to the fact that a slight bend in the knee will keep edema or fluid in the region and limit the extension of the joint. This prolongs recover and makes it even harder to gain extension of the knee
An easy trick to use if you wake up with pain at night is to do a heel slide which will move the knee into flexion. This is a very simple movement and will ease the tension and reduce the pain.
Simple Exercise to do at Home
An easy at home exercise to improve flexion is to sit on the edge of a chair or in a rocker and bend the surgical knee back to where it feels tight. Then just rock back and forth till it loosens up and draw the knee into more flexion, repeat as needed. This will help improve flexion and allow the patient to control the pace of bending.