Over the past decade the number of total knee replacements (TKR) has doubled in the United States. The recovery and rehabilitation process plays a crucial role in helping you get back on your feet and resume an active lifestyle. It can help you heal from surgery faster and greatly improve your chances for long-term success. Rehabilitation after a TKR starts, usually, post operative day 1. Here is some of what you can except throughout the process and the goals for the different phases of rehabilitation.
The first physical therapy a patient will encounter is an acute care physical therapist in the hospital usually the afternoon or day after surgery your surgery. Their role is to fit you with an assistive device such as a cane or walker, teach you exercises to increase range of motion and strength, learning to walk (gait training), stair climbing, and pain/swelling control. Discharge planning is one of the most important roles of acute care physical therapists; they work closely with the patient’s medical team (nursing, physician, social worker, case manager, etc.) to ensure that a patient is discharged appropriately.
Many times after a TKR you may be discharged from the hospital and go straight home. Occasionally you may require more extensive physical therapy in rehabilitation or nursing center after your surgery is required. You may not be ready to go home after discharge from the hospital due to lack of family support, difficulty with mobility, or other problems that may require more intensive care than you would receive at home. At the sub-acute rehabilitation facility the physical therapist will continue to work on your ROM and strength, but will also focus on functional mobility. This includes all the skills you will need to in order to return home, i.e. going up and down stairs, getting in and out bed, and dressing. The main goal of sub-acute care is to make sure that you are safe with functional mobility so that you can return home quickly.
HOME HEALTH CARE:
Once you have safely returned home, most people have a difficult time leaving their house to attend physical therapy. This may be due to knee stiffness, inability to get into a car, and general discomfort. In this case you may receive physical therapy services in your home. A home health physical therapist will continue to work on improving your range of motion and strength in order to improve mobility as well as teaching you how to safely navigate your home.
After your mobility has improved enough for you to safely leave your home either driving on your own or by a family member/friend, you may be referred to outpatient physical therapy. The main focus of outpatient physical therapy is to maximize your strength, ROM, and functional mobility. They may also work on improving you endurance by using cardio equipment such as stationary bike as part of your rehabilitation program. Various therapeutic modalities and manual therapy techniques may be used to improve muscular strength, control pain, decrease swelling, and improve scar mobility. Even though you will be going to physical therapy at a clinic it is still important during this phase to perform your home exercise program, given you by your therapist, in order to maximize your improvement.
As you progress through the phases of physical therapy your mobility should improve and your pain level should decrease, as this happens your physical therapist will be able to challenge you more and advance your program in order for you to reach your full potential following your TKR. Remember every patient is assessed independently and they progress at different levels but hopefully this break down of the different phases gives you a better understanding of what to except from during your recovery process.
Leah Jamerson, DPT
OrthoVirginia Johnston Willis Physical Therapy