A total knee replacement, or TKR, requires an active rehabilitation process to return you to a healthy and active lifestyle. Although it can sometimes seem overwhelming, a 12-week protocol with a licensed physical therapist (PT) can help you heal and vastly improve the long-term prognosis for your new knee. Here is what to expect.
Day 1 Through Discharge
You will begin your rehabilitation shortly after awakening from surgery, although you might not recognize the first exercises as rehab. You will learn how to get in and out of bed and start moving around with a cane, a walker, or crutches. The goals for the first day are generally to sit on the edge of the bed, walk a few steps, and use a bedside toilet without assistance. Of course, nurses will be available to help as needed, so you don’t need to do everything alone immediately.
Your PT will also talk to you about your home, including any stairs, whether you live with an adult who can help you out, and other key details, and help you create a plan of action. Depending on the circumstances, you will probably use a CPM (continuous passive motion) machine while in the hospital and possibly for a few days at home. This keeps your knee moving to prevent stiffness and a buildup of scar tissue.
On the second day, you will probably continue to use the CPM machine. However, you will also be expected to move yourself around more. You will likely be asked to take some short walks with an assistive device, use the regular bathroom in your room, and even climb a few stairs.
By the time you are discharged, you should be able to bend your knee to at least a 90-degree angle, bathe and dress yourself, get in and out of bed on your own, walk at least 25 feet (with or without an assistive device) and climb several stairs with a walker or cane. You will have a written ongoing treatment plan, and should display a willingness to progress with it. Your doctor will likely reduce the strength and frequency of pain medications at this time.
Discharge Through Week 3
You might be asked to use a CPM machine during this period. You will follow a prescribed exercise regimen from your PT, and should notice that you are gradually moving better and better. Longer walks outside with crutches or a cane and less pain medication are major goals for the first three weeks.
Weeks 4 Through 6
By this point, you should notice your knee feeling much stronger and more flexible. In addition to your daily exercise routine, your PT will likely encourage longer walks (up to a half mile by Week 6) and ask you to start weaning yourself off your crutches or cane. Activities of daily living, such as cooking and cleaning, will get much easier during this period, and you will start to regain a sense of independence.
Most people can start driving again sometime between Weeks 4 and 6, depending on individual progress and pain medications. Clear this with your surgeon when you start feeling ready to drive.
Weeks 7 Through 11
These weeks generally bring significant modifications to physical therapy. Your PT will assess your progress and find your weak spots, and prescribe targeted exercises designed to address any lingering issues. These exercises typically focus on strength and balance. This period is especially critical to your long-term success, as the decisions you make now regarding your recovery will help determine how well your knee works both now and in the future.
By the end of Week 11, you should be able to bend your knee to 115 degrees or better. You should experience rapid improvement in your mobility and significantly less pain or stiffness. Your knee should be getting strong, and you should be able to perform such activities as bicycling and swimming.
For most people, this is the last week of physical therapy following a knee replacement. Although you probably feel much like your old self, it is important to stay committed to your prescribed exercise routine and avoid high-impact activities such as running, football, and skiing. However, your PT will likely encourage low to moderate-impact activities such as dancing and recreational bicycling. You should experience little or no pain with these activities, and have nearly a full range of motion in your knee.
After Week 12
Your recovery will continue after your course of physical therapy ends. Almost everyone recovers fully within a year, and many people achieve full or nearly full recovery in just a few months. However, it is vital to stay in touch with your medical team and report any unusual symptoms in your knee right away. Continue to work towards a full rehab, but get your doctor’s clearance before returning to high-impact activities that could dislodge the knee implant. Do not get discouraged if you notice a plateau in your recovery, as plateaus often come just before another breakthrough in healing. Be kind to yourself, get regular checkups, and your new knee should serve you well for many years to come.
Founded by physical therapy innovator Dr. Joseph Simon, the Manhattan Physical Therapy and Pain Center is a leader in pain relief and injury recovery conveniently located in Midtown Manhattan. We offer several dedicated programs for different conditions, along with the latest innovations in physical therapy for all. If you are ready for the latest treatments for pain or injury, call us today at (212) 213-3480 to learn how we can help.