The total knee replacement (TKR) surgery was first introduced in the 1970s in the United States. Since its intervention, it has offered new hope for many patients who suffered from severely degenerated knees. However, the surgery itself is not magic that takes away all pain and suffering. Results of the operation depends on many factors, such as pre-operative condition of the leg, and the rehabilitation that follows.
A patient who went through a total knee replacement does not spring out of the bed and immediately walk normally from day 1 of the operation. It is through months of painful hard work in physiotherapy that this goal is gradually achieved. Unfortunately, most of the patients and family do not fully realize this until after the operation.
Think of this process as a quarantine: you will be stuck inside your house for a while, and even after that, it cannot be “business as usual” immediately. A new norm will be formed. But with guidelines carefully followed, there is hope that your knee will be good to go!
How does it feel immediately after the operation?
Having went through an extensive operation in the knee, pain and swelling should be expected immediately afterwards. Walking can be a great challenge for several days. Medication will be prescribed to reduce the pain. Ice pack and compressive stocking will be needed to reduce the swelling. A physiotherapist will visit the you in the ward to assist you to take the first steps after the operation.
Initially a walking frame will be required, so that walking is possible with minimal weight on the operated leg. If pain is not too bad, a crutch or a stick can be used to replace the walking frame. The physiotherapist will also teach some gentle exercises to improve the movement in the operated knee and maintain the strength of the muscles around the joint.
As the patient is discharged from the hospital and resting at home, walking should continue to be assisted with a crutch or stick to allow optimal healing. Once the wound is largely healed, it is time to start proper physiotherapy in the outpatient clinic.
What is included in TKR physiotherapy?
There are two major goals for post-TKR physiotherapy: to increase the range of knee movement, and to improve the muscle strength around the knee. By achieving better range and strength, it allows patients to walk and function normally as much as possible in daily activities.
The range of knee movement is usually restricted after the operation due to swelling and the formation of scar tissue. Scarring is a natural healing process. Scar will form around the surgical wound, and deep inside the joint as well. Scar tissue is different from normal body tissue in that it is tougher and not as flexible. Therefore, when the joint bend and straighten, the movement will be restricted by the scar tissue.
An important part of physiotherapy at this stage is to massage and stretch the scar tissue to gradually increase the knee range of movement. It will be conducted in the clinic, and the patient need to perform it daily at home as well to achieve optimal result. The time required to regain full range varies largely from patient to patient. Some attains marvellous range as soon as one month after the operation, while others may need 6 months.
Good strength of the operated leg is the second most important goal in post-TKR rehabilitation. Weakness of the affected leg is observed in most, if not all patients after the operation. Pain would inhibit the muscles. Deconditioning after the operation also contributes to the weakness.
When the leg is weak, patients commonly complain of unable to walk or stand long, and the leg feels tired very easily. Many patients often just walk as the only exercise to strengthen the leg. This alone may not be adequate, as our body is programmed to use the strongest muscles to get the task done. Therefore, the weaker muscles are under-utilized and it does not have the strengthening effect.
Physiotherapists design exercise programs for each individual addressing each specific weak muscle. Good adherence to the exercise program is the key of optimal result of the operation.
How long will the rehabilitation take?
Each patient has different expectation and goals for a TKR surgery. An uncle who just retired may want to be able to travel around the world after the operation. A Japanese may wish to kneel as in the traditional way of sitting. An eighty-year-old sedentary lady, however, may just want to be able to walk around her household with minimal pain, and bending the knee to just beyond 90 degrees to allow comfortable sitting.
The duration of the Singapore physio rehabilitation varies according to each patient’s goal setting, condition before the operation, pain tolerance, and compliance to home exercises. Typically, it ranges from 3 months to 9 months.
Hopefully, you are reading this before your surgery so that you are now more mentally prepared for the surgery. Setting your expectations so that the surgery and physiotherapy is as smooth as it can be.
If you are reading this after the surgery, it is still not too late to calibrate your goals. Speak to your physiotherapist and doctors to set timeline and goals. The rehabilitation journey is tough and you can do it!