What is prohibited after knee replacement: precautions and restrictions

Orthopedic rehabilitation at the Reithof Park Clinic

This type of training was created specifically for the 1st week of the postoperative period after knee replacement. The exercises are intended to increase the speed of rehabilitation.

Exercises should be performed during the first month after surgery

Training is carried out daily at least 3 times a day.

• Each individual exercise should be repeated 10 times.
• Clinic specialists recommend performing the exercises as often as possible, but using multiple approaches. Frequency is more important here than large, but one-time loads.
• In addition, it is very important not to make sudden movements during training. Exercises should be done progressively and evenly until the pain is tolerable, while maintaining measured breathing.
• You should monitor the correct position of the axis - legs, ankles, knee joint and hip joint. They must form a single line.

Precautions in the first days after surgery

The day after surgery, the patient is allowed to lie exclusively on his back. The operated limb should remain completely straight. It is strictly prohibited to bend the affected leg or place a pillow under the knees. You should also not make sudden movements or roll over on your side or stomach.

Postoperative suture

If the operation went without complications and the patient’s condition is satisfactory, on the first day he is allowed to sit up in bed and even walk. Naturally, he does this only under the supervision of medical staff. Lifting from bed always begins with a healthy limb, and while walking, high walkers or crutches are used.

Before being discharged from the hospital and going home, the patient must learn to walk correctly on a flat surface and up stairs. He is taught this by medical staff.

The operated leg is always between two crutches.

Exercise therapy from 3 to 13 weeks

The answer to the question of how long rehabilitation after knee replacement will last depends on the patient’s diligence during the 3-13th week of recovery. At this stage of rehabilitation, in addition to the above-described exercises, a number of other tasks are added to facilitate the rapid development of the limb that has undergone endoprosthetics.

The opportunity to work out more diligently arises due to the disappearance of painful sensations characteristic of the first two weeks of rehabilitation. At the same time, patients should not overdo it with the load.

At this stage of recovery, patients after knee replacement should:

• bend and straighten the knee while standing or lying on your stomach (there must be support);
• lift the injured leg onto the steps (given possible problems with maintaining balance, it is necessary to hold on to the railing);
• stretch the operated leg;
• transfer weight from one limb to another (you will need the support of a healthcare worker or relative);
• perform amplitude flexion and extension of the limbs;
• roll from heel to toe.

Exercise therapy also provides for the possibility of using various equipment: step platforms, simulators for developing joints, etc.

Precautions when walking and putting weight on the operated leg

It is best to start walking on the first day after surgery. It is necessary from the very beginning to master normal walking without

lameness
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If this is not done, the load on other joints will be distributed incorrectly, which can ultimately lead to a distorted gait and an incorrect walking pattern.

Moreover, insufficient load on the operated joint can slow down its recovery. Because of this, rehabilitation will take longer, and the person will return to an active lifestyle much later.

After knee replacement, you cannot:

• strain the operated leg by walking for a long time;
• allow severe knee pain to occur while walking;
• make sudden movements;
• wear uncomfortable shoes that make it easy to trip or slip;
• put off crutches ahead of time or without a doctor’s permission.

Walking with crutches is required for 3-6 weeks after surgery. It will be possible to refuse auxiliary devices only after consultation with the attending physician and having received his permission.

Effective rehabilitation at home after knee replacement - important conditions

Active home recovery after endoprosthetics continues for 4-6 months. It is at this time that it is very important not to relax, not to violate medical recommendations and to patiently continue rehabilitation. Subsequently, the person adapts to the new joint in the body, gets used to a certain regime and leads a full life with some restrictions.

In order for rehabilitation to be successful and faster, you need to remember some points:

• set small goals for yourself and achieve them step by step;
• if swelling in the leg appears after exercise, reduce its intensity;
• monitor your temperature daily (preferably between 16 and 18 hours), low-grade fever in the first days of surgery is considered normal, but if the temperature rises 1-3 weeks after surgery, you should inform your doctor;
• physical activity should increase gradually, you should not be too zealous and zealous in physical education, at the same time you need to encourage yourself to do regular daily training without fail for several years;
• you can load yourself with household chores, cook meals, go for walks and be physically active, but the new knee joint should not experience heavy stress;
• When doing exercises, remember about exercises for the arms, back, abs, do breathing exercises, do not focus only on exercises for the legs;
• the more carefully and conscientiously you try to recover, the faster you can return to an active life;

Components of home rehabilitation

1. Walking with support devices

Doctors insist that the sooner physical activity begins, the faster and more effective the recovery will be. But physical activity must be dosed and adequate. Excessive zeal can worsen the situation and lead to negative consequences. After surgery, independent walking is impossible, so after such interventions it is necessary to unload the joint and allow the bone structures to adapt to the new mechanism. For this, various supporting devices are used - walkers, crutches, canes.

• Walkers

Elderly and frail people suffering from poor coordination and unsteady gait should purchase walkers. Walkers can have two wheels, or they can have mobile sides that lift and move separately. If everything goes well (the patient is confident while walking with the help of a walker, balance is maintained), the doctor allows the use of crutches or a stick (usually after a few weeks, depending on the patient’s condition).

• Crutches

Ideally, the patient should learn to walk on crutches and be able to use them before surgery. In this case, you can avoid the troubles that happen to an unprepared person. The patient stands on crutches only with the permission of the attending physician. It is the doctor who prescribes measured walking and schedules the time of the “walk” literally minute by minute. Why are crutches needed? Their purpose is to protect against falls and reduce the load on the sore leg. Incomplete support relieves the sore leg and creates good conditions for the healing of the new implant. In the first days, it is absolutely forbidden to transfer your body weight to the operated leg; you can only lightly touch the floor with it.

It is important to choose the right crutches. Today, more and more people are choosing so-called “Canadian crutches” - elbow crutches, which are more maneuverable and comfortable. But in some cases, patients choose classic armpit crutches. In any case, it is important that the patient who uses crutches has trained shoulder and forearm muscles (this must be taken care of in advance). When walking with support, you must adhere to the following rule - the sore leg must be between the crutches at all times. It is very important to use the ladder correctly. When climbing stairs, the healthy leg begins the step, and the descent begins with the sore leg and crutches. The first time, mandatory insurance! And it’s better to start with improvised low steps. After 2-3 weeks, you can walk for half an hour three to four times a day.

• Cane

If the person operated on is weakened, then after crutches you can switch to a cane. Canes can now be chosen to suit every taste; they have different designs, usually they have one support point, but they can also have several support tips. It is important that the support end is non-slip and ends with a rubber stable knob. They are light, durable and provide excellent support for the patient when walking. A cane can serve as a transition to walking on your own, but it is important not to be afraid to part with it. Many patients develop a fear of falling, and they themselves slow down their rehabilitation by becoming emotionally attached to the cane. If the person operated on is a non-weakened, energetic person, then you can immediately walk on your own after using crutches, without resorting to a cane.

1. Independent walking

Crutches are used for up to 5-7 weeks if the rehabilitation period passes without complications (these terms are relative and individual). The patient then learns to walk independently. At first he takes 15-20 steps, gradually increasing them. The first steps should be taken under the supervision of a doctor and with insurance. In the future, the patient learns to walk up the steps, hold himself more confidently, and distribute the load. The main thing is to give up crutches in time, as at some stage they will begin to slow down the healing process.

1. Physiotherapy

Proper physical activity and certain physical exercises help the patient recover faster. In addition, adequate exercise will help you avoid gaining excess weight. The exercises are the same as in the early postoperative period - (link to article ort120918), but the amplitude and time of their execution increase, exercise therapy classes expand and become more complicated, the number of repetitions increases, exercises performed from the starting position “on the stomach” are added and “standing”:

• lying on your stomach, bend your knees, pulling your heel towards your buttock;
• lying on your stomach, strain the muscles of your legs and thighs;
• lying on your stomach, slowly raise your legs straightened at the knees;
• standing, holding onto a chair, bend your knee, trying to touch your heel to the gluteal region;
• standing on tiptoes;
• on the steps, holding the railing, bend your knee, lunge forward with your affected leg onto the step, and come back;
• do partial squats - mini-squats, first with support, then independently;
• rolling from heels to toes (with support);
• passive mechanotherapy can be carried out using an elastic rubber band, which, with the force of the hand, helps to bend and straighten the legs;

Exercises are performed regularly in a calm rhythm, without bringing the patient to extreme fatigue. Movements should be careful and smooth, and you should not overexert your muscles. After 1.5 months, you can exercise on an exercise bike, but in a gentle mode. You should exclude pushing exercises, jumping, and twisting your legs. Be extremely careful, there is no doctor near you!

1. Hydrokinesia

During this period, exercises in a warm water pool are especially recommended. Even basic movements, for example, steps in water, must be carried out under the supervision of an instructor for the first time. Then water aerobics is shown, which has an extremely beneficial effect on the musculoskeletal system, regulates blood flow and metabolism.

Swimming is possible after a few weeks according to doctor's instructions. The issue of playing sports is also resolved. Only the attending physician can recommend the choice of sport. Heavy physical activity should be avoided.

1. Physiotherapy

Physiotherapy is an essential part of quality rehabilitation. It helps improve lymphatic drainage, activate blood circulation, and enhance bone cell regeneration. The following procedures are usually prescribed:

• electromyostimulation and ultrasound therapy;
• electrophoresis,
• MBST;
• UHF;
• laser ray;
• blood plasma treatment using ArthrexACP System technology;

It is optimal to undergo full physiotherapeutic procedures after surgery in a rehabilitation center. The doctor monitors the dynamics and the body’s reaction to the procedure; he will adjust the prescription at any time and increase or decrease the number of sessions. But if possible, the patient can receive physical therapy on an outpatient basis in his clinic. We must remember that after the procedure you should not immediately go outside, but sit for 20-30 minutes (especially in the cold season)

1. Massage

Massage should be treated with caution. A rough and deep impact on the muscles can only cause harm. Hand movements should be stroking, kneading, rubbing. The doctor must be experienced and highly qualified. Only in this case will the massage be beneficial.

1. Weight correction

Every extra kilogram puts a lot of stress on your joints. Therefore, it is necessary to monitor your weight and, if necessary, get rid of extra pounds. Using the most primitive formula, you can calculate normal weight - “person’s height in cm - 110 = weight” and focus on it. For more accurate numbers, you can use more professional formulas or the Quetelet index. Obesity aggravates osteoporosis and is a serious factor influencing the loosening of the knee joint and its premature wear.

1. Safe home environment

You need to take care of a safe and comfortable environment at home in advance. It may be worth nailing handrails in the bathroom and bathroom so that there are additional points of support. For the toilet, you may have to buy a higher seat to make it more comfortable to sit and stand. The bed should be easy to approach. All necessary items should be within reach: there should be glasses, a flashlight, a telephone on the nightstand next to the bed, and crutches should be located nearby. The passage to the toilet and kitchen should be clear, the rugs should fit snugly to the floor and not slip, the light should be moderately bright and comfortable. Be sure to choose high-quality orthopedic indoor shoes that provide foot stability. There should be a footrest under the chair that the patient uses.

1. Regular visits to the orthopedist

After 8-10 weeks, even with an excellent recovery process and no complaints, you should visit a doctor for examination. If quality rehabilitation is confirmed, you should then visit a specialist once every 2-3 years. After 15-20 years, revision surgery may be required to replace the implant.

Only strict adherence to all doctor’s recommendations can guarantee a full recovery. If a person is weakened and far from self-discipline, it is better to undergo rehabilitation in a specialized rehabilitation center under the supervision of professionals.

Poses prohibited for sleeping and sitting

In the first 3-4 days after surgery, the patient can sleep in only one position - on his back. Then, if the postoperative period proceeds without complications, he is allowed to lie on his side. Sleeping on your stomach is allowed at least two weeks after surgery.

As for sitting postures, you should not allow the operated leg to bend excessively at the knee. It is also not recommended to sit with your legs crossed. Please note that after knee replacement surgery it is strictly forbidden to kneel.

Neglecting these recommendations can lead to dislocation of the endoprosthesis, periprosthetic fracture and other dangerous complications.

Postoperative stage

When answering the question of how rehabilitation proceeds after knee replacement, it should be noted that its success depends on how the patient complies with the rehabilitation regulations. Therefore, he needs to be determined to work hard for several months. There should be no room for despair during recovery. The patient must set himself the task of achieving his goal at any cost. Motivation plays one of the most important roles during the rehabilitation period.

To achieve the expected result, the patient must:

• perform chest and diaphragmatic breathing exercises;
• take prescribed antibiotics, vitamin-mineral complexes, painkillers, anti-inflammatory and other medications;
• treat the knee joint with antiseptic compounds, bandage it, and drain the wound;
• apply cold bags to the kneecap area, which will reduce pain and reduce the degree of swelling.

Precautions when caring for a postoperative wound

Due to the risk of infection, the postoperative wound should not be wetted with running water for the first two weeks. Therefore, you should wash with extreme caution, and it is better to avoid baths and showers altogether. When washing, you must ensure that the bandage does not get wet. If this happens, then it should be replaced. Otherwise, the risk of postoperative wound suppuration will increase.

Until the postoperative scar heals, you should not rub it with a washcloth. After all, the skin there is very thin and delicate, and it is extremely easy to injure it. You should care for the suture after surgery according to the recommendations of a specialist.

Possible complications of the postoperative period

Having figured out how long rehabilitation lasts after knee replacement, it is necessary to talk about the problems that may arise during this process. After knee replacement, there is a risk that the prosthesis will become dislodged or blood clots will form in the veins. During rehabilitation, joint mobility is also sometimes limited. This problem occurs because scar tissue forms. In addition, inflammatory processes develop at this stage. Moreover, sometimes they can arise as a result of infection.

Practical advice for everyday life

Simple precautions will help you avoid a number of complications after surgery:

1. When returning home from the hospital, sit in the front seat, next to the driver. Be sure to make sure that it is moved as far back as possible before doing this.
2. If you notice a difference in leg length after surgery, wear elevated insoles to compensate. This way you will avoid lameness and the negative consequences caused by it.
3. Wear comfortable shoes that fit snugly around your feet. Give preference to slippers, sneakers or shoes with non-slip soles. When your doctor allows you to wear platform shoes and low heels, be extremely careful with them.
4. After the operation, do not make sudden movements, jumps, or deep squats. Avoid trips and slips in the shower, bath, sauna, ice, etc.
5. When walking on uneven and slippery surfaces, use assistive devices (cane, crutches or a spiked stick designed for walking on ice).
6. After endoprosthetics, do not kneel or lift anything weighing more than 15 kg.
7. Try not to gain excess weight after surgery. Otherwise, every extra kilogram will accelerate the wear of the endoprosthesis.

Worn platform of the tibia component of the knee endoprosthesis.

Failure to take precautions after knee replacement can lead to dangerous complications. A person may experience a dislocation of the endoprosthesis or a periprosthetic fracture. Aseptic loosening of the implant and its premature wear are also possible.

Preoperative preparation for rehabilitation

Preparation for postoperative rehabilitation begins not after the end of the operation, but even before the start of surgical procedures. The need for this is due to the fact that this operation has risks of complications. To mitigate these risks, it is necessary to take certain preventive measures.

Impact on problem muscle areas must begin before the operation. The need for this is due to the fact that after the operation the already weak muscles will become even weaker. This nuance is the reason for the high risk of complications in the form of contractures, atrophy, thromboembolism, vein thrombosis, etc. Elimination of hypotonicity and increased blood supply allow us to count on the absence of these problems. In addition, the implant can function normally only if the muscle-ligamentous structures are elastic and sufficiently elastic.

Developing the muscles before installing the knee joint also helps to simplify and speed up the recovery process. The patient will be able to endure the early stage of rehabilitation more easily if he learns in advance to walk correctly on crutches, do basic physical therapy exercises, etc.

Day of surgery

The attending physician tells his patient about how the operation went.

After the operation, until the next morning, the patient is transferred to the intensive care ward, where he will be constantly monitored and the necessary medications will be administered.

Physiotherapy.

When the patient wakes up, while lying down, he needs to perform several exercises that reduce swelling of the limb and prevent the formation of blood clots in the blood vessels.

• Movements in the ankle joints.
• Breathing exercises.
• Sit in bed without lowering your legs (if the intensive care unit doctor allows it).

To reduce swelling of the operated knee joint and reduce pain in the joint, you can use an elevated position of the leg and cooling of the operated joint. An ice pack should be wrapped in a diaper and applied to the knee for 20-30 minutes two to three times a day.

Rehabilitation after knee replacement: general recommendations

• do not apply antibiotic creams or any other creams to the incision
• Baths/pools/saunas are prohibited for four weeks after surgery
• Do not place pillows under your knee! This may slow knee extension. Place a rolled towel under your ankle to aid extension. Keep your ankle on a towel while you are not using the machine.

Prevention of thrombosis

• To prevent thrombosis, use compression devices while you are in the clinic
• Wear compression stockings 23 hours a day for 4 weeks

Treatment methods for contractures

Fresh functional contractures are treated conservatively. The patient is given a set of exercises aimed at restoring muscle contractility. At the same time, he is prescribed warm baths, massage, and physiotherapeutic procedures. All this helps restore blood circulation and trophism in the tissues, which has a beneficial effect on the patient’s condition.

Surgery.

In case of persistent contractures caused by scar changes in the periarticular tissues, the patient requires surgical intervention. During the operation, doctors excise the scars, after which the mobility of the joint is restored. Note that if the prosthesis is installed incorrectly, you can only get rid of knee deformity with the help of revision endoprosthetics.

Functional contracture can be distinguished from organic contracture using magnetic resonance imaging (MRI). The first is characterized by the absence of pathological changes on tomograms, the second is characterized by the presence of scars or adhesions.