As a follow on to Ryan’s article on osteoarthritis, today’s article topic is physiotherapy and total knee replacement.
The Australian Bureau of Statistics estimates that 3.3 million Australians are living with arthritis. For 56% of them, it is osteoarthritis (OA), the wear and tear type. Advanced OA is a common cause for people electing to undergo total knee replacement (TKR). Around 45 000 people received a TKR in 2013 and the rate of joint replacement is on the rise.
A TKR involves replacing the arthritic knee joint with a metal prosthesis, done through an extended incision through the front of the knee. This is done under general anaesthetic and takes approximately 3 hours.
Recovery following TKR is not a small undertaking. Surgical trauma to the knee structures leave the knee initially swollen, stiff and usually very painful. Physiotherapy starts on the first day after surgery and continues up until at least 3 months post-operatively. The initial focus of physiotherapy is on achieving a functional range of knee movement, and enabling people to weight bear through their operated leg. Advice is also given on the use of analgesia (pain-relief), swelling management and how to manage tasks at home which may have become difficult while the knee is recovering. Basic exercises to minimise muscle wasting are given and need to be performed regularly.
As range of motion improves in the weeks following, the focus is on building muscle strength in the quadriceps, gluteal, hamstring and calf muscles. This is done with a structured exercise program that targets people’s exercises to their physical goals. For example, a patient who enjoys bowls needs to have good eccentric or lowering control of their knee as they lunge toward the ground.
Another important aspect of the physiotherapy program is gait or walking education. Frequently, pain or stiffness prior to the operation has meant people have adapted their walking styles to compensate for a painful joint. Physiotherapy aims to normalise people’s walking pattern to optimise their movement efficiency and avoid overload on surrounding joints.
Finally, orthopaedic surgeons often encourage their patients to do a program of strengthening for their lower limb muscles prior to surgery. In our experience this markedly improves people’s recovery post-operatively as it means they have a strength base to work with and build on. It also makes the first few days post-surgery more manageable when basic mobility tasks such as getting in and out of bed can be very demanding.
At SquareOne physio we work closely with local orthopaedic surgeons to maximise people’s potential post-operatively and give them the best possible outcome. We love accompanying people on their rehab journey and work closely with them to achieve their physical goals.