Though Total Knee Replacement (TKR) surgery is a fairly common procedure1, it is a major surgery and recovery takes time before you can be totally adjusted to your new knee and start moving around as you wish.
We ask Ms. Bernadine Lim, Senior Physiotherapist from the Farrer Park Rehab Centre, what goes on during rehabilitation and minding the new knee.
Ms. Lim explains that rehabilitation can start as soon as the surgery is completed.
“It includes interventions by both the physiotherapists and the healthcare team to help patients reach the goal of optimal lower limb function and maximize mobility as much as possible,” she explained.
She said that these are aimed at decreasing swelling and pain, improving joint range of motion, muscle control and strength and ultimately maximizing patients’ mobility. “The total post-op rehab usually takes between three to four months from the operation date but the actual rehab duration may vary depending on each patient's capability,” she added.
According to Ms. Lim, it is possible for patients to report discomfort in walking with a 'new knee'. Common reasons include pain, limited knee range, reduced strength and fear. Whether or not discomfort is experienced, physiotherapy will assess these issues objectively and treat accordingly.
An initial thorough assessment is thus necessary to establish the patients’ current medical and physical status, pre-op function and medical history as well as their personal goals; just so that a specific rehabilitation program can be designed with realistic expectations.
A variety of treatment and management strategies then follows at the Center which includes manual therapy, modalities, exercise prescription that target the physical impairments presented. These helps with decreasing pain, improving strength and flexibility, and enhancing balance and endurance.
“We will also work on retraining proper gait and functional movements to optimize their knee function and overall posture,” Ms. Lim added.
Ms. Lim said the Center will provide education to help them better understand the surgical operation and rehabilitation process. This empowerment encourages TKR patients to take control of their rehabilitation to attain best results.
In most instances, Ms. Lim says that based on research, pain, mobility and quality of life is significantly improved in 90% of TKR patients. Most are able to resume normal activities of daily living and recreational activities with lesser problems3.
“Generally, you do not need to be mindful of doing anything specifically different. However, to prolong the life of the implant, it is recommended to participate in low-impact activities such as walking, swimming, golfing, biking instead of high-impact activities like jogging, basketball or tennis,” she explained.
While working towards normalcy, Ms. Lim also advise her patients to ask their doctors for any special instructions post-surgery as these may vary depending on their surgeons’ preferences and assessments.
There is growing evidence that supports the importance of prehab for TKR patients. Based on research2, it is generally recommended to start the prehab four to ten weeks before the operation.
“Prehab allows the lower limbs to be strengthened and function improved. This, together with proper education of the procedure and rehab, prepares patients mentally and physically for the operation and gives them an advantage in rehabilitation post-operatively,” she explained. The Center supports prehabilitation as research shows that it can provide significant benefits to patients in many ways for the entire TKR rehabilitation process.
“During prehab, we also assess other joints and musculature and may ask other questions that may influence the rehab process or outcome by asking patients about their diet and stress management. With proper holistic advice, we aim to give patients more insight into what they can do post-surgery to prevent and limit future potential pains beyond the standard TKR rehabilitation,” she advised.
Although TKR operations are commonly done, especially for moderate to severe arthritic knees, not everyone is suitable for surgery and post-surgery rehab care3. Some situations may pose a risk to a successful knee replacement. For example, patients who are prone to infection or patients with conditions that affect the muscles around the knee. Hence, it is important to seek medical advice before deciding the suitability for a TKR.
“The entire process demands months of commitment towards rehabilitation so if the arthritic knee pain does not severely limit activities of daily living and/or negatively impact quality of life on a daily basis, it is recommended to try alternative conservative methods first before considering surgery,” Ms. Lim advised.
It is essential to work out what you can do at each stage. Talk with your doctor, physiotherapist, or occupational therapist if you have questions about activities you want to do and how to do it safely. They can also recommend sports and exercises that will suit your needs; and guide you to better understand your lifestyle following a knee replacement.
1 Bozic, K. 2018. Arthritis Health. Undergoing Total Knee Replacement for Knee Arthritis. Retrieved from: https://www.arthritis-health.com/surgery/knee-surgery/undergoing-total-knee-replacement-knee-arthritis
2 Jahic, D, Omerovic, D, Tanovic, A.T, Dzankovic, F, Campara, M.T. 2018. Medical Archives. The Effect of Prehabilitation on Postoperative Outcome in Patients Following Primary Total Knee Arthroplasty. doi: 10.5455/medarh.2018.72.439-443
3 Jared J. R. H. 2020. OrthoInfo. Total Knee Replacement. Retrieved from: https://orthoinfo.aaos.org/en/treatment/total-knee-replacement/
Ms. Bernadine Lim
Farrer Park Rehab Centre