Recovery after knee arthroplasty

Endoprosthetics of the knee joint is the replacement of damaged bone and cartilage with metal and polymer components. This procedure can dramatically improve the quality of life of patients who experience pain and problems with joint function. But to achieve a greater effect, it is necessary to consciously approach rehabilitation after arthroplasty. Hard work will be required not so much for doctors as for the patient himself.

Preoperative preparation

The most problem-free recovery after hospital procedures, whether it is total arthroplasty or only partial, is facilitated by preliminary preparation, even before the operation.

First of all, the patient needs to take work on his own body seriously. Physical exercises will have a positive effect: aerobic, on muscle strength, range of motion and training in joint protection. The presence of obesity has a negative impact: it can not only complicate rehabilitation and accelerate the wear of the prosthesis, but also become a contraindication for surgery. We are talking about the 3rd and 4th degree of this disease.

In the process of preparing your body, you can begin to adjust the house for the return. It is recommended to create conditions that simplify the period of adaptation to the prosthesis:

1. Mount (and securely fix) handrails in the bathroom, as well as along the stairs, if any.
2. Prepare a stable high chair with strong armrests, backrest and leg support. The height also applies to the requirements for a seat in the toilet.
3. If the patient takes a shower while sitting, a high chair or bench should be available.
4. Corners of carpets and wires should be fixed so that they cannot be accidentally tripped over.

First day of rehabilitation

Endoprosthesis replacement of the knee joint does not require a long pause between the operation and the patient's self-rehabilitating activity. Immediately upon transfer to the recovery room, you can begin to act.

At this stage, it is supposed to be in a supine state, or sit on the bed without hanging your legs. But opinions differ on the latter point: many experts believe that it is much more useful to sit with your legs dangling, and even get up with crutches on the first day, because this speeds up the restoration of the functioning of the joint. On this issue, you should consult with your doctor. During the rehabilitation period after the operation, in no case should the instructions of medical workers be neglected.

In any case, it is recommended to wrap an elastic bandage around the affected limb from the hip to the fingertips before starting to lower the legs from the bed and walk. In addition, being with your feet out of bed in the early days should not take more than 40-45 minutes a day. Compliance with these measures is important to prevent an increase in edema.

On this day, gentle exercises should be included in rehabilitation after arthroplasty:

1. Move your feet and toes to reduce the risk of blood clots and reduce swelling.
2. Rotate the foot in and out to prevent bedsores (heel area).

All actions must be accompanied by breathing exercises: when the muscles tense up - take a deep breath, when they relax - exhale. This will save the lungs from possible postoperative complications.

Rehabilitation in a hospital

The patient stays in the hospital for about 16-17 days. All this time should be devoted to hard work on recovery after arthroplasty.

Around the second day, you can begin to develop the leg in the joint. After surgery, due to pain, bending and unbending the leg at the knee is not an easy task. The main task is to overcome these unpleasant sensations by performing special exercises. It is necessary to come to full flexion and extension of the joint that has undergone surgical intervention. In the hospital, this is done with the patient by a specialist in physical therapy.

Exercises with an exercise therapy methodologist in a state medical institution are not enough to quickly restore functionality, so it is important to practice on your own throughout the day. Optimal frequency: once an hour for 10-15 minutes. In order not to harm yourself, you should follow a simple rule: the operated joint should be trained smoothly, evenly, the range of motion increases gradually. In no case should you work “through pain”, this can aggravate the situation.

A set of exercises after knee arthroplasty

To strengthen leg muscles:

1. Having straightened the leg, it is necessary to tighten the femoral muscles - this will be the starting position. It needs to be fixed for 5-10 seconds and relax. Repeat 10 times. After a short rest, repeat until you feel tired in the thigh.
2. The starting position is the same as in the previous exercise. Having accepted it, raise your leg a few centimeters and hold it for 5-10 seconds. Lower carefully. Repeat 10 times. Then you need to rest for a while and repeat until the thigh gets tired.
3. In order to prevent congestive disorders, exercises for the ankle are performed. To do this, it is necessary to raise and lower the foot with tension in the muscles of the lower leg for 2-3 minutes 2-3 times per hour.

To extend the leg at the knee joint:

• Put a rolled towel under the heel, and then try to straighten the lower leg so that the back of the knee touches the bed. Do this until the thigh muscles are tired.

To bend the leg at the knee joint:

1. Lying option. Sliding your foot on the bed, bend your leg as far as possible, and then hold for 5-10 seconds. Unbend and repeat several times.
2. Sitting option with support. Sit on the edge of a bed or chair so that your thigh is supported. The foot of the healthy leg is under the heel of the operated one. Slowly bend the lower limb in the joint to be rehabilitated and hold for 5-10 seconds. Repeat until fatigue sets in.
3. Sitting without support. Sit on the edge of a bed or chair so that your thigh is supported. Slowly bend the lower limb in the joint to be rehabilitated and hold for 5-10 seconds. Repeat until fatigue sets in.

After about 4 days, when the position of the body will be allowed to change as you like, it is recommended to diversify the exercises:

1. Lying on your stomach, bend the operated and healthy leg alternately at the knees.
2. Also bend your legs while sitting on a chair. In this case, be sure to rewind the legs with an elastic bandage.

Walking

In the same period, as an exercise after endoprosthetics, it is necessary to increase the range of movement for a speedy recovery and restoration of muscle strength and amplitude. Walking along the ward and corridors of the department is aimed at developing strength and endurance.

It is recommended to use a walker for the first time, it maintains balance, reduces the risk of falling, and reduces the load on the operated leg. When the muscles of the knee joint and legs become strong enough, crutches can be used instead of a walker. Body weight should be distributed between the crutches and the non-operated leg.

On days 10-14, the patient begins learning to walk up and down the stairs. For this procedure, there is one main rule: to go up with a healthy one - to go down with a sick one. The healthy leg should always be higher than the operated one.

And only after 3-4 weeks, when the patient will be able to stand and walk for at least 10 minutes, the stage of transition to walking with a cane or crutch begins. Use of this additional support is mandatory until the diseased leg is fully restored.

Home rehabilitation

When all the sutures are removed, there are no complications, and the patient has mastered the mandatory movements - he is discharged home, giving the necessary recommendations for successful rehabilitation after prosthetics.

It is extremely important that by the time of discharge the patient is fully trained in self-care, and knows how to avoid risky movements for a knee prosthesis. This also applies to the use of devices and tools in everyday life; reduce the risk of falls using handles and other devices.

Exercise therapy after arthroplasty at home should not only be continued, performed daily, but even complicated by adding, for example, the following exercises:

1. Bicycle: lying on your back, alternately pull your legs to your stomach, bending them at the same time, as when riding a bicycle.
2. Lying on your back, pull your legs to your stomach, helping yourself with your hands. Bend your legs at the knees.
3. Perform leisurely squats, holding on to the back of a chair and maintaining a straight posture.
4. Climb up and down on the stand. It should be no more than 10 cm in height. Here the rule for moving up the stairs applies: the healthy leg should always be at the top first. Perform slowly.

Support measures

After knee arthroplasty, rehabilitation may include not only exercise therapy and taking care of your health. Additional measures are recommended for a speedy recovery. Some of them can be carried out in a state medical institution for free, while others can only be obtained in paid medical centers and sanatoriums.

1. Physiotherapy. The patient can be prescribed magnetic therapy, UHF therapy, ultraviolet irradiation and cryotherapy. Electrical stimulation of the thigh muscles can also be performed.
2. Trainer exercises. Of particular note are exercise bikes. After knee replacement, rehabilitation should include the restoration of muscle strength and range of motion to the full extent. Proper technique in this case requires that the seat height be adjusted so that the feet touch the pedals with the knees nearly extended. At first, you can only pedal backwards. After about 4-6 weeks of training, when the muscles become stronger, you can increase the resistance. This should be done no more than 15 minutes twice a day - at first, increasing to half an hour. The frequency of training should be 4 times a week.
3. Mechanotherapy is the use of devices for the passive development of movements in the joints. Flexion and extension in the knee joint occur without the active participation of the patient. Mechanotherapy is used to increase the range of motion, develop muscle strength, improve tissue trophism and coordination of movements. Training on devices for mechanotherapy is carried out by selecting the angle of flexion and extension, the force and frequency of exposure.
4. Massage. This useful procedure can be included in the rehabilitation program after arthroplasty at home if there are financial possibilities.
5. Recommended sports: swimming and underwater gymnastics.
6. Recommended leisure: gardening, pottery.

Additional Recommendations

During the first 6 weeks of rehabilitation after surgery, it is preferable to take a warm shower. When entering the shower, the healthy leg is placed first, and then the sick one. When exiting the shower, the reverse sequence is observed: first the diseased leg is taken out, then the healthy one.

From 4 to 12 weeks after surgery, it is recommended to wear compression stockings, which will provide a tonic effect and reduce the risk of thromboembolic complications.

With a sudden increase in body temperature, exacerbation of pain and increased swelling in the operated knee joint, the appearance of discharge in the area of ​​the postoperative scar, you should immediately contact your doctor for advice.

To maximize the life of the endoprosthesis, you should:

• avoid lifting heavy things
• avoid long climbs,
• do not gain excess weight
• avoid sports that stress the joint, such as running, jumping, skiing, snowboarding, aerobics.

In conclusion, I would like to additionally recall that the success of the operation to a large extent depends on the patient himself. You can change your life by getting rid of the pain and problems in the knee joint - you just need to try, making the maximum of your efforts.