Total Knee Replacement
Total knee replacement (TKR) is a surgical procedure where a damaged knee joint is replaced with an artificial joint. This surgery is often recommended for patients with severe arthritis, knee deformities, or significant pain that limits daily activities. Common reasons for TKR include osteoarthritis, rheumatoid arthritis, post-traumatic arthritis, and knee injuries. The surgery involves removing the damaged cartilage and bone from the knee joint and replacing it with metal and plastic components. Post-surgery, patients typically stay in the hospital for a few days and then continue recovery at home or in a rehabilitation facility.
Indication for TKR:
- Osteoarthritis: This is the most common reason for TKR. Osteoarthritis causes wear and tear of the knee joint cartilage, leading to pain, stiffness, and decreased mobility.
- Rheumatoid Arthritis: This autoimmune disorder causes chronic inflammation of the knee joint, which can lead to pain, swelling, and joint deformity.
- Post-Traumatic Arthritis: This can occur after a knee injury, such as a fracture or ligament tear, leading to long-term damage and pain in the joint.
- Severe Knee Pain and Stiffness: When knee pain is persistent and severe enough to limit daily activities (e.g., walking, climbing stairs, getting up from a chair), TKR may be necessary.
- Deformities: If the knee joint is deformed, such as in cases of bow-legged or knock-knee deformities, and if conservative treatments do not correct the issue, TKR may be indicated.
- Failed Conservative Treatments: When non-surgical treatments like physical therapy, medications, injections (corticosteroids or hyaluronic acid), or lifestyle changes no longer provide relief.
Physiotherapy Managements:
- Phases of Physiotherapy Management
- Preoperative Phase:
- Exercise: Prehab exercises may be prescribed to strengthen muscles and improve range of motion.
- Education: Patients learn about the procedure, recovery expectations, and the importance of rehabilitation.
- Immediate Postoperative Phase (Days 1-7):
- Range of Motion Exercises: Knee bends and straightening exercises to tolerance are encouraged.
- Exercises: Focus on ankle pumps, quadriceps sets, and straight leg raises.
- Early Mobilization: Patients are encouraged to start moving as soon as possible to reduce stiffness and promote circulation.
- Pain Management: Techniques may include ice, elevation, and modalities like TENS.
- Early Rehabilitation Phase (Weeks 1-4):
- Range of Motion Exercises: Gradually increase knee flexion and extension. Techniques may include heel slides and wall slides.
- Strengthening Exercises: Introduce gentle strengthening for the quadriceps, hamstrings, and hip muscles.
- Gait Training: Patients learn to walk with the proper use of assistive devices (like walkers or crutches).
- Balance and Proprioceptive Exercises: Patients learn to control muscles coordination surrounding the knee joint, and to improve static (stationary) and dynamic (walking) balance
- Late Rehabilitation Phase (Weeks 4-12):
- Progressive Strengthening: Increase the intensity of exercises to build strength and stability.
- Functional Training: Include activities of daily living and begin stair climbing and balance exercises.
- Endurance Training: Introduce low-impact aerobic exercises, such as cycling or swimming.
- Maintenance Phase (3 months and beyond):
- Continued Strengthening: Focus on a comprehensive strength and flexibility program.
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