PT on the Net Research

Total Knee Replacement


Question:

I would like to know a basic protocol to follow five months after total knee replacement surgery. Along with that, what would be the difference between the upright versus recumbent cycle for a total knee replacement client?

Answer:

The knee is considered the most complicated joint in the body. There are several things to consider when trying to regain function in a replaced knee. The top two are the age and sex of the person. Older women with knee replacements tend to take longer to improve. Bone mass is another concern and develops slower in older people. Other concerns are with the joint capsule. If it is still swollen and painful, this may limit your exercise selection. There is a difference between the recumbent bike and the upright bike, but I am unsure what the mechanics of the false knee will be.

There are a few things you'll need to keep in mind when training someone with a replaced knee. The first is range of motion. Determine whether there are any limitations in flexion or extension. To my knowledge, it is usually flexion that is limited. Most people have up to 120 degrees (0 degrees is when the leg is straight, 90 degrees is half bent), but some have more. Most rehab places start with leg extension and leg flexion and range of motion stationary bike work. Talk to your client's doctor and/or therapist directly for exact instruction before recommending anything.

Next, how is the client's functional stability? Are they stable on their feet? Proprioception of the lower limbs can be affected by a knee replacement. The balance board (two feet by one foot) and stepping up and down on aerobic steps are good (line them up and have them walk through). You can elevate the steps as they progress. Moving sideways in both directions is also great for mobility and coordination.

How are the contiguous joints doing (hip and ankle)? Are they functional? Usually, the joints above and below the replaced joint regress. In this case, hip and back extension, abdominal flexion and ankle extension (plantar flexion) exercises must also be included in the program. Introduce the leg press after the client can get up and down out of a chair without too much lateral compensation (leaning to the side). Be careful not to go too deep (knee flexion) or too heavy. Increasing the work load by reps and sets is the safest route.

In my view, it is better to go slower than faster when dealing with someone with a replaced joint. Most people are somewhat uncertain of their new knee and deal with a lack of trust issue, both for themselves and you. The stationary bike is a great tool for quad development and general fitness and poses little threat to the new joint-bone union and the person. It may not be exciting, but it is effective. If you pepper your routine with five minutes of bike work between exercises, it may help to alleviate boredom.

References:

  1. Calliet, R. Knee Pain and Disability 2nd Edition Davis Publishing. Philadelphia.