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Patient Family Education: Post Operative Care after Total Knee Replacement Surgery

Posted: 22-Dec-2011

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     For patients who have undergone total knee replacement surgery, the muscle and tendons around the knee area requires time for healing. It is therefore important for patients who return home, to exercise, in order to strengthen and increase the flexibility in the leg muscle, and to increase mobility in the artificial knee to enable patients to return back to their  normal lives. There is also complication and risk in getting infection in the artificial knee, blood clots forming in the veins of the legs, or the inability of the patients to stretch their legs. To avoid such complications from occurring when the patients return home, they should follow the advice of the physiotherapist regarding post operative care of total knee replacement surgery.


Total Knee Replacement Post Operative Instructions
1.
There may be swelling in the knee of operative leg and it may take up to 6 months to get back to normal. Applying cold pack for 10-20 minutes each time every three to four times a day (or more) on the knee of the operative leg can help reduce the swelling and pain in knee. The cold pack should be applied for at least the first six weeks after surgery. The best time to apply the cold pack is after exercise and after the patient has walked a lot. The cold pack should be placed while the knee is stretched out straight.
 
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2. Sleeping. If you are sleeping sideways, stretch and straighten your knee. Place a rolled towel under the ankle of the operative leg. This position will help in the straightening and stretching of the knee. Patients should not place a pillow under their knee of the operative leg while sleeping.
 
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3. Sitting for a long period of time may cause stiffness or swelling in the knee area along with the leg. Patients should not sit up for more than 45 minutes at a time. If patients want to sit for longer periods to watch a movie or TV or even work, they should stand up and walk periodically. Alternatively, they may slowly move the knee of the operative leg by bending and stretching the knee several times.
 
4. Patients are susceptible to catching an infection from the time of the surgery up until one year after the surgery. Patients should immediately see the surgeon should any of the following symptoms occur: long periods of fever, redness and heat in the wound, discharge from the wound and intense pain in the knee.
5. If one year after the total knee replacement surgery, the patient requires any other surgery or undergoes a dental surgery, the patient must inform the surgeon and dentist about the total knee replacement surgery. The surgeons will then prescribe the patients some antibiotics before and after the surgery to prevent any infection from reaching the knee.
 
 
Total Knee Replacement Exercise Program
 
1.Ankle Pumps: Lie on your side and stretch your legs out straight. Raise your ankle up and down several times on the advice of your physiotherapist.
 
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2. Heel Slides: Lie on your back and stretch your legs out straight. Slowly bend your knee by sliding your heels close to each other (your heels must be placed in a flat position during the time of exercise) and then slowly stretch it back to the original position. Repeat this again as advised by the physiotherapist.

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3. Knee Press: Lie on your back and stretch your legs out straight. Tighten your thigh muscles and press the back of your knee on the bed. Hold for 5 seconds and release. Repeat this again as advised by the physiotherapist.
 
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4. Straight Leg Raise: Lie on your back. Bend the knee of your normal leg upwards and place your feet firmly on the floor. Stretch your operative leg straight. Tighten the thigh muscle and straighten the knee. Raise this leg as high as the normal leg that you have bent. The knee must be stretched straight throughout this exercise. Then slowly lower the leg to the starting position. Repeat this again as advised by the physiotherapist.

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 5. Side Lying Abduction: Lie on your side with your legs stretched straight (place the leg that requires exercising on top). Open your legs wide and keep them straight throughout the exercise. Bring the legs back to the starting position. Repeat this again as advised by the physiotherapist.
 
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6. Short Arch Quadriceps: Lie on your back. Place a round pillow under the operative knee. Tighten the thigh muscle and raise your feet, straightening the knee. Hold for 5 seconds and bring your legs back to the starting position. Repeat this again as advised by the physiotherapist.
 
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7. Sitting Knee Extension: Sit on a chair and slowly stretch the knee of your operative leg as long as you can. Hold for 5 seconds and bring your legs back to the starting position. Repeat this again as advised by the physiotherapist.
 
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8. Standing Knee Bending: Hold onto a backrest of a sturdy chair. Bend the operative knee as much as you can. Bring your leg back to the starting position. Repeat this again as advised by the physiotherapist.
 
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9. Standing Hip Abduction: Hold onto a backrest of a sturdy chair. Raise the operative leg sideways. Try to keep your body and knee straight throughout the exercise. Bring your leg back to the starting position. Repeat this again as advised by the physiotherapist.
 
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10. Standing Hip Extension: Hold onto a backrest of a sturdy chair. Raise the operative leg backwards. Try to keep your body and knee straight throughout the exercise. Bring your leg back to the starting position. Repeat this again as advised by the physiotherapist.
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11.  Standing Terminal Knee Extension: Hold onto a backrest of a sturdy chair. Bend the knee of the operative leg. Tighten the thigh muscles and raise the knee backwards, straightening the knee. Hold for 5 seconds. (Try not to bend your knee too much). Slowly release and bring the knee back to its normal position. Repeat this again as advised by the physiotherapist.
 
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12. Heel Raises: Hold onto a backrest of a sturdy chair. Raise both your heels and hold for 5 seconds. Slowly bring your heels back to starting position. Repeat this again as advised by the physiotherapist.
 
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13. Sitting Assisted Knee Bending: Sit on a chair. Cross the normal leg with the operative leg, placing the normal leg in front. Use your normal leg to push the operative leg backwards, bending the knee as much as you can. Hold for five seconds and bring the legs back to the starting position. Repeat this again as advised by the physiotherapist.
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14. Hamstring Stretching: Sit on the bed. Place the normal leg on the floor and the operative leg stretched straight on the bed. Slowly bend towards the front and touch your toe or bend as much as you can. Make sure your knee is in the straight position while you are bending. Hold for 10 seconds  and come back to the starting position. Repeat 10 times.
 
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Getting up and sitting
While getting up from a sideway position, use both hands to help you sit up. Then move yourself towards the edge of the bed. Let the caretaker assist the patient in dangling the operative leg over the edge of the bed, then slowly placing the operative leg on the floor. The patient can then place the other leg on the floor on his/her own.
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Standing up
After the patient is sitting upright with the leg dangling over the bed, bring the walker in front of patient. Let the patient hold the walker. Let the patient bring forward the operative leg so that too much weight is not placed on this leg. The patient should bend forward and place his/hand hands on the walker. Place the weight on the normal leg and stretch the body upright. Slide the operative leg next to the normal leg.
 
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Using the walker
Step 1
Let the patient lift the walker and place it in front at a comfortable distance. Make sure all flour legs of the walker are placed firmly on the floor before taking any steps.
 
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Step 2
Move your operative leg towards the walker first by placing your feet in the middle of the walker. Keep your feet straight and do not twist your feet.
 
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Step 3
Hold the walker with both your hands. Place 50% of your weight on the operative leg or as much as you can, without causing any pain to the knee. Then take a step with your normal leg, bringing it ahead of the operative leg.
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Contact Info
Physical Medicine and Rehabilitation Clinic Samitivej Sukhumvit Hospital, 1st Floor, Building 2:
<br>+66 27118399-400
Samitivej Sukhumvit Hospital
133 Sukhumvit 49, Klongtan Nua, Vadhana, Bangkok 10110
Telephone: +66 (0) 2711-8181
Fax: +66 (0) 2391-1290
E-mail: info@samitivej.co.th
               
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