HIP REPLACEMENT PHYSIOTHERAPY
Mr Tomas Mac Namara works as a physiotherapist in Spire Washington Hospital. Tommy was instrumental in developing this physiotherapy section for my web page. To make it easy for patients to understand, Tommy has also attached lots of photos to explain different exercise routines. I hope you find this information useful.
TOMAS MACNAMARA
Goals:
Reduce swelling
Achieve a fully straight knee
Progressing with knee bend (100 degrees or more)
Regain normal walking pattern
We aim to commence your physiotherapy as soon as it is safe to do so. It is very likely that the physiotherapist may commence your mobilisation and exercises regimen on the same day of your surgery depending on the time your surgery took place.
The physiotherapist will initially assess your muscle function and movement. Once satisfied that your muscles are working well, they will assist you with mobilisation. This is usually done with a walking frame/sticks for a short distance. Early mobilisation helps to reduce the risk of developing blood clots and improves recovery.
The following day, our physiotherapist will help you progress with your mobility and negotiate stairs safely. You will also receive adequate advice regarding various exercises to be performed over the coming days and weeks. Your stay in hospital can vary but most patients are discharged within 24 to 48hrs.
Once discharged, it is important to follow the advice received from our physiotherapist. We will organise an out-patient review appointment with our physiotherapist approximately 2 weeks after your surgery. Our outpatient physiotherapist will help guide your recovery and answer any questions you may have but it is important that you take control of your recovery in order to achieve a good result.
Physiotherapy:
Taking appropriate pain relief following your surgery is very important to aid recovery and help perform your physiotherapy exercise.
Achieving good knee movements after surgery is very important and time critical. It becomes more difficult to achieve this as time passes. Pain is one of the main barrier to achieving good knee movement. It is therefore important to get your pain under control to allow you to perform your exercises frequently and to a good standard. Adequate pain relief also helps you to sleep better which can be difficult in the first few weeks after surgery.
If you experience any side effects from your pain killers, please contact the hospital staff for advice and alternative options. Similarly, if you have any questions regarding pain relief or require more, contact the hospital staff.
Moderate swelling after knee replacement surgery is not uncommon and can cause significant pain. Whilst the swelling usually improves within 6 to 8 weeks, occasionally, it can take 6 months or longer to fully resolve.
There are a few things that you can do to help reduce the swelling. Frequent ice packs and elevation usually helps. Regular elevation of your ankle and knee above the level of your hip for 30 minutes at a time (4-6 times) over the course of a day also helps. You can apply ice packs/cryocuff while you are elevating your leg. Please avoid activities that cause excessive pain/swelling. This includes walking too much, standing on your feet for too long, doing too many exercises together or pushing your exercises too hard. In the first 2 weeks, walking little and often (every 1-2 hours) around your home/garden with your walking aids will be enough. We would recommend that you continue to use your walking aids until your next physiotherapy appointment at 2 weeks. Our physiotherapist will assess you and advise accordingly.
Pain Relief:
You need to provide your body with sufficient calories and nutrition to aid the healing process.
It is recommended to have 50% more calories after major surgery to help heal the wound, muscles and bone after surgery. Additional protein intake in particular is very important after surgery. Foods rich in Protein includes red meat, poultry, fish, nuts, eggs, cheese, soybeans and tofu. Ideally, you should try to include a good source of protein with every meal, including breakfast.
It is common to have reduced appetite after surgery making it difficult to consume enough calories/protein. It is however important to continue eating healthy food for faster recovery. If you are struggling with big meals, try smaller portions but more frequently and try having foods that you enjoy.
Most supermarkets now stock a good selection of protein rich foods such as protein drinks, yoghurts and bars. They can also help boost your calorie and protein intake if you are struggling with regular food.
Food:
Regular exercises allow you to get the best out of the surgery and significantly reduces the risk of a stiff knee. Exercise should be done frequently throughout the day.
It is important to recognise your tolerance level with the exercise regimen. You need to be aware of how hard to push the exercises, how many to do in one session and how frequently to do them over the day. Please speak to our Physiotherapist. They can help you with finding the tolerance level. Once you are tolerating the exercises, you can slowly increase your endurance by holding stretches for longer duration, performing more repetitions or increasing the frequency.
Do not perform all the exercises together as this will potentially cause unnecessary swelling and pain. We recommend that you break the exercises routine into more manageable chunks. First pick a couple of exercises to perform. An hour or two later pick a different set and repeat this process throughout the day.
Below are some exercises that are commonly prescribed after your Total Knee Replacement. Only perform exercises prescribed to you by your physiotherapist.
Exercise:
Please note:
The exercise can be uncomfortable however, severe pain during or after exercise is not beneficial. If you are experiencing severe pain, you may need to reduce the frequency or the intensity of your exercises and contact a member of our physiotherapy team. It is important to find a correct balance between exercises and rest. If you rest too much your knee may become stiff and your knee may become swollen and painful if you exercise too much.
Passive knee extension
While sitting down, place the heel of your operated leg on a stool as shown below, the heel should roughly be at the level of your hip.
Allow your knee to relax. You should feel a stretch in the back of your knee. Hold this position for approximately 5 minutes. If this is very uncomfortable, try bringing the stool closer to your knee so that the calf is resting on the stool rather than the heel.
Once you can tolerate this, you can slowly start pushing the stool further away (closer to the heels) eventually assuming the position shown in the picture below.
Seated flexion
Sit on a chair with your knee at a comfortable angle. Place your unaffected leg over the top of your operated leg as shown above. Use your unaffected leg to help bend your operated knee until you feel a stretch over the front of the knee. Hold this position for 10-20 seconds and return to your starting position.
Once you get used to this exercise, you can hold the flexed position for a longer duration. You should see a gradual improvement in your knee bending. You should aim to do this exercise for approximately 15-20 minutes and repeat this 3-4 times a day. Use a plastic bag under your foot to make it easier to slide.
Seated assisted knee extension
Sit on a chair with your knee at a comfortable angle. This time, place your unaffected leg under your operated leg. Use your unaffected leg to assist in straightening your knee. Then slowly return to starting position with help from your unaffected leg.
Active assisted knee flexion on bed
As shown in the above picture, sit on a couch/bed (or any firm flat surface) with belt around your foot and hold it with a firm grip. Use your arms to assist the bending your knee by pulling the belt towards you. You should feel a stretch in your knee and hold this position for a few seconds before returning to starting position.
Static quadriceps exercise
As shown in the above picture, sit on a couch/bed (or any firm flat surface) with legs straight. Tense your quadriceps (thigh muscles) by pushing the back of your knee into the bed. Hold for 5 seconds then relax. Repeat this cycle for 10 to 12 times.
If you are struggling to push the back of your knee into the bed, roll a towel/soft pillow and place it under your knee and then perform the exercise (as shown below). When your knee gets straighter, you can remove the towel.
Please note:
The exercise can be uncomfortable however, severe pain during or after exercise is not beneficial. If you are experiencing severe pain, you may need to reduce the frequency or the intensity of your exercises and contact a member of our physiotherapy team. It is important to find a correct balance between exercises and rest. If you rest too much your knee may become stiff and your knee may become swollen and painful if you exercise too much.
Total Knee Replacement
Take an active role in your recovery
Take adequate pain relief
Develop a routine with exercises, ice and elevation
Eat sufficient calories and protein
Find a balance between rest and exercise
Progressively try to increase your exercises as pain allows
Do
Walk too much in one go
Return to work or hobbies too soon
Sit or rest for too long
Come off walking aids too soon
Come off pain relief too soon
Ignore signs of infection or DVT’s
Overload your knee by forcing painful exercises
Don’t
Average time scales for return to basic activities
Usually 6 weeks, earlier sometimes. You could return back to driving once you are completely off opioids, can perform an emergency stop and following your insurance policy.
Driving
We anticipate an approximately time scale of 12 weeks after surgery if it is a manual job or a job where you are on your feet for long period. You may be able to start sooner if your work place can organise light duties and/or phased return. If you work in a stationary job, we would recommend approximately 6 weeks. This would depend on your ability to elevate your leg during work, perform some exercises and avoid sitting for long periods etc.
Return to work
Pain is usually at its worst in the first 2 to 4 weeks and gradually improves, some degree of ache and stiffness can be expected up to 4 to 6 months after surgery.
Pain
Swelling is at its worst in the first month and gradually gets better thereafter. It is not unusual to have some swelling for 4 to 6 months after surgery
Swelling
Walking unaided
(if unaided prior to operation) – approximately 4-6 weeks.
It will take approximately 6 months for your knee to feel significantly better but may take up to a year for full recovery. The time it takes to recover can also be dependent on your general health. It may take longer to recover, if you suffer from other illnesses or medical conditions.
Whilst this information provides generic advice following knee replacement, please check with your physiotherapist/consultant for a more information.