While some patients have a very easy time rehabilitating their knee replacement, the majority of patients find this surgery challenging to recover from. As surgeons, we do our best to provide clear instructions, multimodal pain control, encouragement and support to our patients. Even my own patients, who I personally counsel in the office, and are then directed to this website, often end up falling behind the ideal rehabilitation schedule because of this mistake.
What is this mistake?
The mistake is finding an excuse not to stretch your knee.
Excuses fall into a couple categories.
A common category relates to physical therapy. "My therapist couldn't get me in for 7 days following surgery." "The therapist was sick and canceled several visits." "I am only getting 2 PT sessions each week." "My physical therapist only told me to stretch for 5 seconds each day." Some of these relate to scheduling, and some are clearly misunderstanding/miscommunication. I can't imagine anybody honestly expecting a good result after surgery stretching for a few seconds each day, certainly not a legitimate physical therapist.
Other reasons for falling behind relate to the normal inflammatory process we expect after surgery. "My knee felt (hot/tight/swollen, etc)." "I was letting it heal a bit and feel better before stressing it."
A third category involves what exactly I mean by rehabilitation. "I have been doing a ton of walking." I have been using my stationary bike." "I have been going up and down stairs."
Please, please, please don't get caught in this trap.
I know that total knee rehabilitation is unpleasant. I know that it seems strange for me to ask you to stretch a painful, swollen joint.
The problem is that any delay in stretching your new knee replacement will make subsequent gains more difficult. Each day that goes by allows the capsular tissues to contract a bit more, allows scar tissue and adhesions to grow and thicken.
Take personal responsibility for your own rehabilitation. Begin stretching immediately. Check out this website. It was primarily designed to help you recover after surgery. I have articles and videos explaining how to rehabilitate your knee replacement properly. I explain how often to stretch and for how long. I provide a timeline for recovery. Do not wait for a physical therapist to tell you what to do. You already know what to do. Use them as a resource. Impress them with how much range of motion you regain between physical therapy sessions. Do not expect them to rehabilitate your knee for you. That will not provide an excellent outcome.
While walking/biking/etc. are fine things to do, they are really not ideal exercises for regaining knee range of motion. Walking requires very little knee range of motion, and even a stationary bike will not optimize stretching. This is why I direct patients to long duration, passive stretching exercises. These exercises are the most efficient way to recover motion following knee replacement surgery.
Expect your knee to swell. It will become discolored. It will feel tight. It will hurt. Do not let these symptoms hold you back from stretching. My rehabilitation recommendations are made expecting these symptoms to occur. Swelling, bruising, and pain are all a normal part of the recovery process. Do not wait for them to resolve before stretching. If you wait, you are likely to compromise your outcome.
2/19/2023 11:10:02 am
Having recently had bilateral total knee replacements I wish there were more info on recovery from this challenging rehab, in terms of adjusting to differences within each leg and how the back muscles also have to adjust - what exercises/stretch? I can't find anything on bilateral rehab issues.......I think more people may undergo this surgery when both knees are equally arthritic, so I wish ortho surgeons would address it - even my own surgeon who is great--seems to lack in bilateral rehab specifics. Thank you, Dr. G, in advance! :)
3/4/2023 12:44:15 pm
You don't see much on how to rehabilitate bilateral knee replacements because the recommendations are identical to those for unilateral knee replacement. You need to get your range of motion back ASAP. This is done through diligent, proper stretching. Attempting to rehabilitate both at once is definitely more challenging simply because both your knees hurt and they both require attention. Additionally, because you had double the amount of surgery, your body will need to deal with double the inflammatory process, double the blood loss, and a higher rate of complications. It is for this reason that bilateral knee replacement surgery is much less common than you might expect. Some recent literature suggests that it is actually less safe than we have thought.
2/23/2023 04:59:02 pm
Dr. G, I had bilateral TKR and am doing well with angles - I'm 12 weeks out but have difficulty getting down on the floor and up off the floor. I'm trying to resume my Ashtanga Yoga practice but since it hurts to press both knees or even just one down on the floor surface, what technique for this do you suggest? Thanks so Much!
3/4/2023 12:32:59 pm
Unfortunately, most patients do not like kneeling after knee replacement surgery. The front of the knee is usually quite sensitive in most adults, even without surgery. This may get better over time, but at 12 weeks post-op, I would simply recommend avoiding kneeling. It will only irritate your incision.
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Orthopedic Surgeon focused on the entire patient, not just a single joint.