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Thinking of skipping rehab after a knee replacement surgery (TKR)? Read this first!


Exercises after total knee arthroplasty. Image credit: Uppercut Images/ Getty Images


Do I Need Knee Replacement Surgery?


The knee is the most common joint to be replaced in the body. The choice to have knee replacement surgery is a major decision and should be made in cooperation with your orthopaedic consultant and physiotherapist. Total knee replacement surgery is often performed when a person has:


· Severe damage to the knee joint caused by osteoarthritis, rheumatoid arthritis, other bone disorders, or fracture that has not responded to conservative management options

· Severe knee pain or discomfort or leg alignment issues, that make walking or doing everyday tasks such as climb stairs and squatting difficult



X-ray image total knee arthroplasty. Image credit: Tridsanu Thopet / Shutterstock



How is Knee Replacement Surgery performed?


The arthritic or worn sections of the bones at the knee joint are removed, and replaced with artificial pieces during a total knee replacement surgery. These components include a metal cap at the femur's (thigh bone) end and a cemented piece of metal in the tibia (shin bone) with a plastic cap on it to allow the surfaces to move smoothly. When necessary, the rear of the patella (kneecap) may be replaced with a smooth plastic surface. Your orthopaedic consultant may determine only a part of the knee joint may need replacement. In such surgeries, it is known as a partial knee replacement.




How can Physiotherapy help?

Physiotherapy is essential in your recovery to improve flexibility, strength and your ability to return to regular activities that you love. At Rapha Physiotherapy, we can help you in preparing for surgery, to recover soonest after surgery, as well as developing a custom-fitted therapy plan to get you moving again in the safest and most effective manner possible.


Prior to Surgery

The better shape you are before your knee replacement surgery, the better your outcomes will be for your surgery. We will:

· Educate you on exercises to strengthen and stretch the knee joint and surrounding muscles.

· Show you how to walk with help following your surgery, and prepare you to use a walking aid, such as a walking frame, or a walking stick.


After your Surgery

The first two weeks after surgery are intended to control pain, reduce swelling, wound healing, regain normal walking, and begin exercising. Following those two weeks, Rapha physiotherapists will custom-fit a range-of-motion exercises, progressive muscle-strengthening exercises, body awareness and even balance training, to bring you back to your favourite activities!

Range of motion. Swelling and soreness may cause you to move your knee less frequently. We will demonstrate safe and effective exercises to help you regain mobility (range of motion) in your knee and resume your everyday activities. Where necessary, we will complement such exercises with Flossband therapy, Dry-Needling, and Ice.

Strength. Weakness in the thigh and lower leg muscles may necessitate the use of a cane when walking. Adjunct equipment such as Neuro-Muscular Electrical Stimulation therapy will be used in conjunction with your exercises for a quicker strength gain.

Balance and Proprioception. Specialised training exercises teach your muscles to adapt to changes in your environment, such as uneven footpaths or busy shopping centres. When you can put full weight on your knee without pain, we may also start to introduce agility exercises (such as turning and changing direction while walking or making fast stops and starts), and balance board activities that will test your balance and knee control. This will depend on what you need in your daily activities.


FAQ: I can easily follow the exercises from websites, why do I need a physiotherapist?


Websites are a rich resource with pictures and even videos to guide you through the exercises, however, one has to check the credibility of the resources provided on the webpage and really, there is no one size fits all as you are unique!

· A physiotherapist who is skilled is able to employ manual techniques to assist you to achieve greater gains in knee flexibility than what exercises can achieve alone.

· A physiotherapist with advanced rehab knowledge, experience, and skills will be able to target the mobility issues that are unique to you quickly and help you return to living your best life speedily!


FAQ: Perhaps I can try out the exercises from resources online before engaging a physiotherapist if it doesn't work out?


The first 6 weeks of recovery is the most crucial where most of the healing takes place. If rehabilitation is not done well during the initial periods, haphazard scar tissue formation can cause the inability to walk normally, climb stairs or even sit down on the toilet bowl! When this happens, rehabilitation will become protracted and revision surgery may be required in severe cases to regain knee range of motion.


Our advice? Invest 8-12 weeks of your time into good rehabilitation as that new knee is going to last you another 20 years!


When looking for a physiotherapist, keep the following in mind:

· Seek advice from your doctor, as well as your family and friends.

· When making an appointment, do check with us on our expertise and experience working with clients who have had knee replacements.

· Be prepared to discuss your symptoms in as much detail as possible at your initial session with the us, as well as what makes your problems worse.