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• What Is Total Knee Replacement (TKR)?
• How Can a Physical Therapist Help?
• Can This Injury or Condition Be Prevented?
• What Kind of Physical Therapist Do I Need?

What Is Total Knee Replacement (TKR)?

How Can a Physical Therapist Help?

If you have knee replacement surgery, your physical therapist will be a vital part of your health care team. Physical therapists can help you prepare in advance of surgery and will help you recover from it. They will work with you to help you regain your movement and function so you can return to your daily activities. Your physical therapist will develop a personalized treatment program. They will work with you to get you safely moving again in the most effective way possible.

Before Surgery

A recent study showed that completing a six-week exercise program before knee replacement led to much better pain and function scores (right after and six months after surgery) compared with not doing so.

“Prehab” is physical preparation and structured education before surgery to minimize physical decline. As movement experts, physical therapists are uniquely qualified to:

• Assess any physical deficits prior to surgery.
• Identify potential physical effects related to surgery.
• Provide prevention strategies.

Before surgery, your physical therapist may:

• Teach you exercises to improve the strength and flexibility of the:
• Knee joint.
• Upper body.
• Surrounding muscles.
• Prepare you to use a walker or other assistive device.
• Recommend changes you should make at home before you have surgery. These may include:
• Making sure spaces around your home are clear and hazard-free to prevent tripping and falling.
• Placing a chair to allow you to sit rather than squat to get something out of a low cabinet.

Good physical health before surgery improves your chances for better results (especially short-term). It also reduces your risk for complications. Long before surgery, it is helpful to:

• Lose excess body weight. This can help you recover more quickly and help improve your function and overall results after surgery.
• Stop smoking. Being tobacco-free will improve the healing process after surgery. Seek help or advice from your physician on stopping smoking, as you schedule and plan for your surgery.

After Surgery

Many people go home on the same day as total knee replacement surgery, depending on their condition and other factors. People with chronic conditions or physical disabilities may stay overnight following surgery. Or they may need to discharge to a skilled nursing facility before going home.

Shortly after your surgery, a physical therapist may:

• Work with you to show you how to move safely so you can function at home.
• Show you how to safely get in and out of a bed and chairs.

• Show you how to use a walker or crutches and get in and out of a car.
• Educate you on applying ice, elevating your leg, and using compression wraps or stockings. These activities will control swelling in the knee area and help your incision heal.
• Teach you breathing exercises to help you relax.
• Help you continue the exercises that you may have learned before your surgery.

As You Begin to Recover

In the first two weeks of recovery, you will mostly focus on:

• Bending your knee.
• Stretching your knee straight.
• Managing pain and making it bearable during your recovery.
• Decreasing swelling.
• Restoring normal walking.
• Doing exercises to help you move through the different stages of recovery.

After two weeks, your physical therapist will tailor your exercise program to address your specific needs. Your program may include:

• Higher degree range-of-motion exercises.
• Progressive muscle-strengthening exercises.
• Body awareness and balance training.
• Functional training.
• Activity-specific training. This training addresses your specific goals.

Your specific treatment plan may include:

Range-of-motion exercises. Active knee bending and straightening helps to improve pain and swelling. Your physical therapist will safely guide you through exercises to restore your knee range of motion. Movement flexibility is key to beginning a strengthening program.

Strengthening exercises. Your physical therapist will guide you through the right exercises to ensure a healthy recovery. This will help you build the muscle strength needed to walk and then use stairs. If your thigh and lower leg muscles are too weak, you may first need a walker, then graduate to using a cane, until you gain enough strength to walk and use the stairs on your own.

Balance training. Specialized training exercises help your muscles "learn" to respond to changes around you, such as a sidewalk becoming uneven or finding yourself on rocky ground. Working to support full weight on your leg will improve your balance and decrease chances of falling. Balance training will prepare you for real-life situations. Your physical therapist may have you do activities that challenge your balance and knee control to help you improve. They will design your program based on your specific needs, goals, activity level, and general health.

Functional training. When you can walk without pain, your physical therapist may add activities. They will help you get back to doing what you used to do before knee pain limited you. Your training might include crossing a busy street or getting on and off an escalator. The specific activities will be based on your needs and goals.

Activity-specific training. The timeline for returning to work, daily, leisure, or sports activities varies from person to person. Your physical therapist can estimate your unique timeline based on your specific condition. Depending on your job or sport, you may need additional visits tailored to your specific activities (such as climbing a ladder or swinging a golf club). Your physical therapist can personalize an exercise program that takes all these demands into account.

Can This Injury or Condition Be Prevented?

What Kind of Physical Therapist Do I Need?