Post Op Knee Therapy
What Causes Knee Joint Deterioration?
Knee arthritis (inflammation of your knee joint) is a major cause of knee joint deterioration. The most common arthritis is osteoarthritis, which is inflammation related to wear and tear of the knee joint. Wearing of your knee joint is a common problem with ageing. However, certain conditions can accelerate the process of wear. Injury to your knee joint, surgical procedures, muscle weakness or increased body weight all accelerate the load and hence the wear and tear of the knee joint. Rheumatoid disease, gout or infection can also increase your joint wear and tear. Interesting fact: If you lose just 10 kilograms of weight you can reduce the load on your knees by half!
What are the Symptoms of Knee Joint Arthritis?
The obvious sign of wear and tear of the knee joint is pain. Knee pain can be achy or sharp and may be accompanied by swelling. Because your knees do not wear equally across the joint surface, a deformity may begin to appear over time. This can be both knock kneed or bow legged in appearance, or windswept knees (one of each). You may also find one or both knees lacking full movement, especially extension.
How is Knee Arthritis Diagnosed?
On examination, your physiotherapist or doctor will look for signs of limited knee movement and deformity, swelling and, importantly, knee pain. In most cases an X-ray will be sufficient to show the degree of wear and tear. An MRI may also be used to to exclude soft tissue pathology.
What is the Treatment for Total Knee Replacement?
Pre Operative Physiotherapy
Pre-operatively you may be prescribed a course of physiotherapy to better prepare your knee and its surrounding muscles for the upcoming surgery. Studies indicate that the better your muscle strength and knee range of movement before surgery, then the better your recovery.
Post Operative Physiotherapy
Many patients who have a Total Knee Replacement (TKR) start to feel better within a few weeks of the surgery.
Post-operative physiotherapy is important to regain full knee motion, strength and day to day function.
Your post-operative physiotherapy treatment will aim to:
• Reduce knee pain and inflammation.
•Normalise knee joint range of motion.
•Strengthen your knee muscles: quadriceps (esp VMO) and hamstrings.
•Strengthen your lower limb: calves, hip and pelvis muscles.
•Improve patellofemoral (knee cap) alignment
•Normalise your muscle lengths
•Improve your proprioception, agility and balance
•Improve your technique and function eg walking, stair climbing, squatting and bending
•Minimise your chance of re-injury.
•Risks of Knee Replacement Surgery
•Risks of knee replacement surgery include: infection, persistent instability and knee pain, knee stiffness, and difficulty returning to your previous level of activity.
The good news is that better than 90% of patients have no complications post-surgery.
The first Total Knee Replacement (TKR) was pioneered by Leslie Gordon Percival Shiers (FRCS) in 1954. He refused to patent his invention, but rather allow other surgeons to modify and improve on his ideas.
Return to Activity Post-Total Knee Replacement
Most activities can be returned to following a successful knee replacement. Unfortunately, because of the nature of the knee prosthesis, it currently not recommended to return to high impact activities such as running and jumping. Less high impact sports such as golf, bowls or swimming are encouraged.
For more information about knee replacement, please ask the advice of your physiotherapist or doctor.
Most surgeons will recommend a few weeks of physiotherapy treatment prior to contemplating surgery.
Pre-operative physiotherapy has two main benefits:
Successfully rehabilitating your knee injury without the need for surgery.
Strengthening your knee to better prepare you for your post-operative rehabilitation.
If surgery is required, surgery is usually performed arthroscopically (via a fibre-optic camera about the size of a pencil) to either resect (remove) the torn fragment or repair (stitch) a tear in the outer zone.
Generally, the best treatment option is to repair the torn meniscus and save as much of the shock absorber as possible. This will leave you with near “normal” structures and decrease the likelihood of degenerative arthritic changes in later life.
Post-Surgical Physiotherapy for Meniscal Injuries
Resected Meniscal Tears
Physiotherapy rehabilitation for resected meniscal tears can normally be reasonably aggressive, targeting early return to function. You will be progressed through rehabilitation as your pain and swelling allow. Most arthroscopic patients can return to normal function within 3 to 6 weeks.
Rehabilitation after a meniscus repair is usually different than a resection due to healing time require where a meniscus has been stitched. Most surgeons will have you non-weight bearing for 4 to 8 weeks to allow the meniscus to heal before commencing weight-bearing exercises.
Physiotherapy rehabilitation should focus on early mobilisation of the knee (tibiofemoral) and kneecap (patellofemoral) joints, plus strengthening of your quadriceps, hamstrings and leg muscles.
Your treatment guidelines will be similar to the nonoperative approach taking into consideration the findings and operative procedures performed. For more specific information, please ask your physiotherapist.
• Reconstruction using the patellar tendon
• Reconstruction using an allograft (donor tendon)
Reconstruction with semitendinous, or gracilis tissues are now the most commonly used options. These surgeries involve the use of two medial flexor muscles from the thigh, which are then passed through a bone tunnel into the joint, usually arthroscopically. The time it takes these flexor muscles to heal after surgery is important to consider during the rehabilitation process. Reconstruction using the patellar tendon involves the removal of the central third of the patellar tendon through an incision, approximately 5 cm in length. This tendon is then inserted into the joint through a bone tunnel using arthroscopic guidance. This type of intervention tends to weaken the extensor apparatus of the knee which can lead to painful tendinopathy of the quadriceps and patellar tendon if excessive load is used during rehabilitation – therefore increasing the recovery time and making it a less popular option.
For any of these post surgical conditions, contact us for an assessment