Recovery after total knee replacement.

Recovery after a total knee replacement takes longer and requires more active work from the patient than recovery after a hip replacement. This surprises people who have had a hip done.

The knee needs to regain movement early. Range gained in the first six weeks is much easier to achieve than range recovered later.

Weeks 0–2

The priorities are quadriceps activation, knee extension and flexion, pain and swelling management, wound care and progressive walking. Exercises commonly begin with one to two sets of 10, with isometric holds of five to 10 seconds.

• Isometric quadriceps, inner-range quadriceps, straight-leg raises and heel slides while lying down
• Seated knee extension and flexion
• Heel raises, mini squats and lunges while supported at a benchtop
• Gradually increasing walking distance on firm, flat surfaces
• Hydrotherapy from approximately day five with the wound dressing intact

Weeks 2–4

Progress knee range and strength into functional activity. Add assisted heel slides, light ankle weights where recommended, step-ups, controlled step-downs, foam or uneven-surface balance exercises and marching. Increase hydrotherapy duration and gradually reduce walking aids under physiotherapy guidance.

Weeks 4–6

Continue to progress strength, range, balance and weight-bearing. Squats may be deepened, an exercise bike introduced and walking and hydrotherapy volume gradually increased.

Beyond six weeks

Improvement continues for twelve months or more. Most of the effort in the first six weeks goes into movement; most of the effort after that goes into strength.

Swelling and warmth around the knee are expected and can persist for several months, often worse in the evening. Numbness on the outer side of the scar is common and usually permanent to some degree — it is not a problem, but it is worth knowing about in advance.

Elevation and ice as directed help. Take pain relief as prescribed, especially before physiotherapy — pain that prevents you doing the exercises will slow recovery more than the medication will.

Progression of knee range of motion after knee replacement is variable. The physiotherapy in the first 6 weeks after surgery should concentrate on strengthening and reduction of swelling. Range of motion should be progressed gradually, not forced, especially in the first 2 to 3 weeks following surgery. Excessive force will increase swelling and pain and be counterproductive. Passive gravity assisted flexion is ideal. An exercise bike can be commenced when the knee is achieving 90 degrees flexion. Bracing and CPM (Continuous Passive Movement) machines are not utilised by Dr Limbers.

The patient will see Dr Limbers with a repeat X-ray 6 weeks following surgery. If flexion beyond 90 degrees is not achieved by this 6 week follow up appointment, further physiotherapy will be ordered, with a further review 4 weeks later. If flexion has not improved at that stage, then a manipulation under anaesthesia will be performed to increase flexion range.

Driving is typically possible at around three weeks, although this varies between patients. You should be able to brake and accelerate confidently and should not be affected by medication causing drowsiness before returning to driving.

Return to desk work can often be undertaken from home after 2-3 weeks, with a return to the office at 6 weeks. Manual work, swimming, cycling and golf can commence at 6 weeks. Flying can be undertaken from 6 weeks. Running and impact sport can be undertaken cautiously, although they do carry some risk of earlier joint replacement failure due to fracture and wearing of the joint replacement.

Dental work should be deferred for 6 weeks following joint replacement if possible. Your dentist or GP should provide you with a single dose of oral antibiotics (normally Amoxycillin 1 gram orally) approximately 30 minutes before the dental procedure.

Kneeling can be undertaken at any stage after total knee replacement. Dr Limbers places the incision towards the side of the knee specifically to allow this. In practical terms the patient will need enough flexion range and enough muscle strength to be able to kneel and get back up again. This will vary widely from patient, but may be 3 to 6 months following surgery.