Rehabilitation after knee replacementReplacement of the knee with an endoprosthesis is a very complicated operation in the technical plan conducted by top orthopedic surgeons. But nevertheless, whatever the skill of the doctors and the quality of the artificial implant, the patient necessarily needs a rehabilitation period. Restorative procedures are needed to ensure that in the future correctly, excluding traumatic risks, to ensure the optimal motor activity of the operated leg.
The main objectives of
Rehabilitation after knee replacement for the patient is as follows:
- independently rise from the bed and lie down on it;
- master the safe seat posture;
- stand with the help of improvised means;
- selection of crutches, walking on them;
- do daily special physical exercises.
To achieve the fastest recovery, and the tissues around the endoprosthesis quickly heal, do not ignore the advice of the attending physician and physiotherapist.
Pay attention to such moments:
- control the pain. Pain syndrome should be prevented when the first signs of anesthetics appear. If the pain is increasing, tell the doctor definitely;
- observe the edema of the knee joint. A small puffiness around the operated site is normal. After a certain period of time such a symptom will gradually be eliminated. Removing puffiness and relieving pain is helped by orthopedic rollers or pillows placed under the foot;
- take care of your lungs. Do breathing exercises several times a day. Since after the operation the patient spends most of the time lying down, the lungs are in a squeezed position. Therefore, the circulatory system is not saturated with oxygen. This can lead to poor wound healing or to pneumonia.
First days after operation
If there are no complications, you can sit in bed. The ascent should be started gradually and very slowly. Raising themselves, rest on the elbows first, then on the palms of both hands. On the second day you can lower your legs from the bed. You can sit down in two ways:
- grasp the operated limb with your hands and, in parallel with the healthy one, lower it to the floor;
- lean his hands on the bed, bring the second leg under the foot of the sick leg and slide down with progressive movements.
Important: : To eliminate the risk of blood clots in the vessels, an elastic bandage should be applied to both legs. The best way is to purchase special stockings.
On the second or third day the patient is allowed to stand near the bed. It's very difficult to make the very first climb. As a rule, such manipulations are performed only with the attending physician or specialist in rehabilitation, as dizziness and instability may arise. To be afraid of unpleasant sensations it is not necessary. The sooner you overcome them, the sooner you will start walking.
How to get up?
There are a number of rules that must be adhered to in the strictest order:
- If the right leg is operated, it is necessary to get up in the opposite direction, and vice versa.
- Before you lower your aching leg, keep it all the time in a straightened position.
- Before lifting, the operated limb should first be straightened and, relying on a healthy one, should be raised with crutches.
- The surface of the floor must be dry and not slippery.
The first few days you can not step on the aching leg, it can only touch the floor. In the future, physical activity gradually increases.
Movement restrictions are strictly individual. Here it is necessary to take into account the patient's age, general health, clinical indices, degree of puffiness.
If the swelling in the knee endoprosthesis area after walking is pronounced, the load should be reduced.
Daily exercise complex
Therapeutic physical training helps to restore muscle tone, improves the mobility of the endoprosthesis and the joint of a healthy leg. They must be performed at home every day for a minimum of two months.
Basic exercises of exercise therapy:
- flexion and extension movements of the ankle joint( 5-7 approaches);
- strain and hold in this position the muscles of the thigh( a few seconds);
- to lift alternately straightened legs, try to keep them in a tone( 2-3 seconds);
- bend and unbend knees. The angle of flexion of the operated leg should not exceed 90 degrees;
- standing position straight leg should be withdrawn only to the side or back.
What is contraindicated in the rehabilitation period
- To make sharp, jumplike, rotational movements with the foot.
- Do dance, big, small tennis, volleyball, basketball, football and other sports.
- Only one knee can not be rotated. Turn left-right must be done completely by the whole body, otherwise there is a risk of dislocation of the implant.
- If possible, limit descent and climb stairs. Do not allow the abutment of the operated limb.
- Contraindicated sitting in deep soft armchairs, on low sofas. Only sitting on a hard chair is allowed. Knees do not reduce together, do not toss one leg to the other. Keep them at a distance of shoulder width.
- Not only during rehabilitation, but also during the entire period of wearing an endoprosthesis, weight lifting should not exceed more than 3 kg.
- If scheduled or emergency surgery is indicated by the dentist, ophthalmologist, etc., the medical team should be informed of the inserted knee implant.
Additional recommendations of
Two months after endoprosthetics, a control X-ray is taken and, according to indications, short walking sessions without improvised means become possible. During the entire rehabilitation period, specialists monitor each patient: they give advice on correcting the gait, the correct distribution of muscular load, and much more. When the patient stops using the cane, it is useful to visit the swimming pool once a week, to practice swimming, to hold regular massage courses twice a year.
Knee joint rehabilitation after endoprosthetics in the hospital and at home
The operation of knee replacement can be considered successful only if the rehabilitation of the knee after endoprosthetics is performed competently and comprehensively. The need for prosthetics often leads to serious injuries, as well as degenerative-atrophic changes in the joints, in which the diseased limb almost completely loses its mobility.
Rehabilitation after knee replacement is a complex and lengthy process.
When the affected knee joint changes to an artificial prosthesis, the patient has a real chance of a full recovery.
The main goals of the rehabilitation period due to the replacement of the knee joint are to restore the patient's ability to stand up and move independently. A similar recovery period should follow the procedure of arthroscopy or the receipt of any trauma.
The first days of the rehabilitation period
When carrying out the prosthetics, the patient is usually discharged home on the fifth or sixth day. Even before this, the patient is allowed to try to sit in bed, leaning on his hands, and then get up. It is necessary to load the operated leg very gradually. If there are no complications, then it is allowed to get up somewhere on the second day after a prosthetic knee, but it must be done correctly:
- getting out of bed, it is necessary to rest on a healthy leg;
- before standing up the operated leg should be pulled forward and kept straight;
- needs to check whether the floor is slippery;
- must use crutches for support and movement.
In the course of knee replacement, effective rehabilitation can be carried out in specialized medical centers equipped with special simulators. The program of restoration is developed by the doctor, considering all features of the patient.
The first days of the recovery period after endoprosthetics should be aimed at developing an artificial knee joint and located around the muscles. With the help of crutches the patient learns to walk correctly. Physiotherapeutic procedures, massage and physiotherapy exercises are also required.
As a physiotherapeutic treatment after endoprosthetics, electrophoresis, light therapy, microwave and laser therapy, etc. are usually prescribed.
Approximately during the first month of rehabilitation it is possible to try to move without crutches. If necessary, the doctor will help correct the gait. Teach you to evenly distribute the body weight. By the end of the third month the patient will walk completely by himself. Thus, the operation of endoprosthetics allows to completely replace the diseased joint and return the person to a normal life.
For daily rehabilitation,
is used daily. Complex of daily exercises
For those people who underwent endoprosthetics, restoration must necessarily include a set of physical exercises aimed at developing the limb and its mobility. The procedure for prosthetics is a serious surgical procedure, and the result after it should be maximum three to four times a day to perform the following physical exercises:
- perform flexion and extension movements in the ankle - it is necessary to begin with five repetitions, gradually bringing the number of repetitions to twenty;
- strain the front of the thigh for a few seconds;
- strain the back of the thigh for a few seconds;
- strain the buttock muscles;
- raise and lower the straight leg;
- bend and unbend knees;
- withdraw a straight raised at an angle of 45 degrees leg to the side;
- retract and straighten the leg raised 45 degrees.
Physical activity is gradually beginning to increase after about four months from the beginning of rehabilitation. The complex of exercises can be supplemented and complicated. For example, at this stage of recovery, walking, short cycling, and swimming can be allowed.
Useful recommendations during the rehabilitation period
So, in order to make the prosthesis procedure really useful and significantly facilitate the patient's life, during the rehabilitation period it is necessary:
- to comply with all medical recommendations;
- regularly perform the prescribed gymnastics, because it is the regularity of the exercises that determines the usefulness of the established endoprosthesis;
- engage in training of the lungs and breathing, so that sufficient oxygen enters the bloodstream, which promotes the rapid regeneration of tissues as a result of trauma or surgery;
- to control painful sensations - the pain should not become an obstacle to the performance of medical gymnastics. If necessary, you can take painkillers;
- apply cold compresses to reduce swelling in the knee area;
- is always fully rest and do not overload your own organism.
What can not be done
Throughout the recovery period as a result of endoprosthetics, it is strongly discouraged:
- to perform movements that can cause new trauma;
- to run, weightlifting, contact sports, aerobics, tennis;
- perform jumps;
- twist the knee - if it is necessary to perform a turn, then it should be done by the whole body in order to avoid damaging the implant;
- to stand on your knees or carry the center of gravity to them;
- to carry weights - from lifting weights will have to be abandoned not only during rehabilitation, but for all time wearing an endoprosthesis.
The complex of therapeutic exercises should be developed by the doctor-rehabilitologist
If it becomes necessary to perform any even the most minimal surgical interventions, for example, with dental treatment, it is necessary to inform the doctor that an operation of endoprosthetics has been performed some time ago.
Rehabilitation after arthroscopy in the hospital and at home
Arthroscopy of the knee joint is a medical and diagnostic procedure that represents a full-fledged surgical intervention and requires appropriate rehabilitation, as well as a procedure for endoprosthetics. Most often, arthroscopy is tolerated by patients relatively easily, but the recovery period must necessarily include hospital treatment for the first few days and subsequent rehabilitation at home.
In the hospital immediately after the completion of arthroscopy( during the first day), the patient is once administered antibiotics. Also, the rehabilitation period in the hospital as a result of arthroscopy includes:
- wearing a special elastic bandage or compression jersey;
- fixation of the operated joint with the help of an orthodontic bandage;
- analgesic therapy;
- lymph drainage massage performed by hand;
- therapeutic exercise.
At home, you must follow the doctor's recommendations clearly, keep your feet in a raised position. Bandages imposed on the operated area require regular replacement, for this you will have to visit a doctor. In order to avoid complications from the performed arthroscopy, anti-inflammatory and vascular drugs are prescribed. The motor load and therapeutic exercises due to arthroscopy are controlled by the attending physician.
In the rehabilitation period it is good to do knee massage
Recovery after injury
Injuries( as well as knee joint prosthesis) require that rehabilitation be performed correctly, even if the treatment was performed conservatively. Traditionally, the recovery period due to trauma includes:
- physiotherapy procedures - UHF therapy, magnetotherapy, electrophoresis, muscle electrostimulation and laser therapy;
- curative gymnastics;
- regular massage and manual therapy;
- rapid recovery of the motor function of the injured limb is also facilitated by spa treatment.
Thus, recovery is an important stage on the way to recovery and return to a normal rhythm of life after trauma.
Rehabilitation after knee replacement
Endoprosthetics of joints have been practiced since the early 80s of the last century. In America, over four hundred thousand such operations are carried out annually. The modern level of development of medicine has allowed to perfect endoprostheses, which now represent complex technical designs designed to improve the mobility of the joint, as well as eliminate pain.
Endoprosthetics have a long history. Attempts to replace affected joint surfaces were made as far back as the nineteenth century, but due to the development of medicine at that time, they could not succeed. To date, the situation has changed and now endoprosthetics helps to achieve the most successful results by ten to fifteen, or even twenty years. Annually around the world about eight hundred thousand such operations are performed, 90% of which are successful.
Indications for arthroplasty
The knee joint is the largest joint in the human body. Its strength is provided by the muscles of the thigh. It consists of three bones, which are covered with articular cartilage, as well as smooth substance. The latter and allows the bones to move freely. All other surfaces of the joint are covered with a very thin and smooth tissue - synovial membrane. It helps in the release of fluid that lubricates the joint and reduces friction to zero.
In various diseases of the joint, damage and destruction of the protective cartilage and knee bending occur. The cause of this can be arthritis, trauma and arthrosis. Patients who suffer from these diseases are first prescribed conservative treatment, which is designed to improve the condition and nutrition of cartilage tissue, as well as reduce its inflammation.
However, this type of treatment only helps in the early stages of the development of the disease, in far-reaching cases it is already powerless and it is necessary to resort to replacing the destroyed surfaces. In the operation of endoprosthetics, damaged parts are replaced by artificial implants made of plastic or metal.
Candidates for such an operation are patients with the following symptoms:
- daily severe pain limiting normal life;
- significant restriction of joint motion;
- severe knee deformity.
The most common cases of
The most common cause of joint pain and subsequent loss of its functionality is arthritis, namely: osteoarthritis, polyarthritis and traumatic arthritis. Osteoarthritis is a frequent companion of people, whose age has reached fifty years. The cartilage that covered the bones gradually wears out and becomes stiff, thereby causing pain. Rheumatoid polyarthritis has a slightly different scheme. In this case, the synovial membrane thickens, increases in size and becomes inflamed. An excessively large amount of fluid is produced which, over time, overflows all the space around the joint, which subsequently leads to its destruction. Traumatic arthritis is also responsible for the destruction of the knee joint and can occur after a serious injury: fracture, rupture of ligaments, etc.
The use of the
endoprosthesis The endoprosthesis is not an exact copy of a healthy human joint, however it is a good replacement. The most important goal of surgery for endoprosthetics is to reduce or completely get rid of the pain for ten to twelve years. Moreover, after a successful operation, almost ninety percent of patients note that the volume of joint movements increases markedly.
Many patients with time go back to an active lifestyle and even sports.
Endoprosthetics As with any other surgery, complications may occur after endoprosthetics. The operation is traumatic and may be accompanied by blood loss, but frequent complications are those caused by exacerbation of various chronic diseases that every elderly person necessarily has. Also, occasionally, nevertheless, development of thrombosis of the veins of the lower extremities, infectious complications, as well as the development of urinary tract infection are noted. Fortunately, the appearance of such problems is unlikely.
The most severe variant of the development of events can become an infectious complication, the treatment of which is long, painful and expensive. Most often, the process of infection can be stopped only by removing the delivered endoprosthesis.
There are also patients who have a higher risk of getting a postoperative infectious complication than others. These are overweight patients, as well as patients suffering from rheumatoid arthritis and having to take hormonal drugs.
Most of the time, the endoprosthesis is used most of the patients for twelve years, after which it requires replacement - re-prosthesis. After this period, some loosening of the implants, which is associated with the destruction of bone cement or resorption of the bone, to which it is fixed, is possible. During the first ten years, only ten to fifteen percent of patients experience a loosening of the endoprosthesis. If the patient experiences pain, then a second operation is performed.
endoprosthesis service life
In the first hours after surgery, the patient has no sensitivity of the lower limbs. Since the operation is accompanied by a loss of blood, transfusion of the blood-substitution solutions is carried out, as well as the injection of antibiotics and anesthetics.
A few days of constant monitoring of all vital indicators: pulse, pressure, electrocardiogram. Blood is monitored. If everything is normal, then the patient is transferred to a regular ward in one day.
Features of rehabilitation
The main factor of rehabilitation after knee replacement is time. After the operation, it should take about three months before the patient is healthy. In some cases, much more time is required.
The main objectives of the recovery period are the following:
- increasing the volume of joint motion;
- protector protection;
- return to the previous level of physical activity.
Doctors recommend gymnastic exercises, which the patient must perform daily. For this purpose, a special order of their conduct was specially created. After being in a specialized clinic, the patient goes to the rehabilitation center, where he should spend about three to four weeks.
Stepwiseness of the rehabilitation process
The first two months after the operation is the period that the patient should be in the clinic and do the exercises that are shown to him by the doctor. Gradually, their build-up should lead to greater mobility of the joint and a return to the habitual way of life. It is possible and the patient's discharge home. Being engaged in simple household work on the au pair, the patient can quickly return to the previous loads.
After two or three months, yoga, swimming, cycling, and dancing will be useful. Nevertheless, the patient can not be overworked, significant loads in this case are contraindicated.
Complex of exercises
These exercises are recommended for daily execution for four to five times.
- Flexion - Ankle Extension. Start better with five times, and then, increase the volume to twelve times.
- Strain the front muscles of the thigh for three to five seconds.
- The tension of the hamstrings of the hamstrings for three to five seconds.
- Raising a straight leg.
- Strain of the gluteus muscle for three to five seconds.
- Flexion - extension of the knee.
- Hip to the side.
- Raising a straightened leg at an angle of 45 degrees and holding it in this position for up to five seconds.
- Machi straightened his foot at an angle of 45 degrees and holding it in this position until five seconds.
- Using the Dikul apparatus.
Contraindications are divided into two types: relative and absolute. In the first case it is:
- oncological diseases;
- obesity of the second or third degree;
- lack of motivation in the patient.
- complete absence of the possibility of independent movement;
- diseases of the cardiovascular system;
- serious pathology of external respiration and chronic respiratory failure;
- presence of infection in the body;
Rehabilitation after the endoprosthesis( total) knee joint includes exercise therapy, massage, swimming and mud treatment
Endoprosthetics is an actively developed and promising area. Due to the operation to introduce into the knee implants, thousands of patients got rid of the pain and returned mobility to their limbs. The percentage of successful surgical interventions is constantly growing and now amounts to about 90%.A significant role in restoring mobility is played by the correct course of rehabilitation after prosthetics of the knee joint.
Types of knee endoprosthetics and indications for operation
Endoprosthetics is a complex and expensive operation involving the introduction of foreign material into the human body. Therefore, for her appointment, you need serious testimony. It is performed with such diseases as arthritis, arthrosis, necrosis, untreated dislocation, tuberculosis of bones. Rehabilitation after the replacement of the knee joint is also a difficult and long process. Indications for knee arthroplasty are the following cases:
- infringement of limb mobility;
- a strong pain symptom interferes with a patient's normal life;
- lack of opportunities for conservative treatment.
There are several types of partial or full joint replacement.
- Total knee arthroplasty .This type involves the replacement of surfaces on both bones of the knee - femoral and tibia, if the surfaces and meniscus themselves are completely damaged. At the same time, metal structures are fixed on the bones, and the knee cap is replaced by a plastic-metal implant.
- Single pole prosthesis provides for the replacement of only one of the knee sections. This may be a side front or middle compartment. This operation is considered more sparing compared to the previous one, but later, with the progression of the underlying disease( eg, arthritis), it may be necessary to repeat it. These two types of surgery are primary.
- Revision( secondary) prosthetics of bone surfaces are made to replace worn out prostheses with new ones. In this case, the risk of complications is higher, the amplitude of movements and the shortening of the limb may decrease.
In the hospital, the patient spends up to 2 weeks, after removing the sutures and without complications he is discharged home. In the first day, bed rest is prescribed since the third one can get up. Postoperative period of knee arthroplasty is extremely important for further recovery. In a hospital or clinic, the patient receives medications - antibiotics and pain medications. Also, the doctor gives advice on the recovery period and gymnastics.
At home it is important to continue to do daily exercises to strengthen the muscles of the thigh and lower leg for speedy rehabilitation. For 4-12 weeks it is necessary to wear a compression knitwear. When walking, you need to use an additional support - walkers, crutches, in time you can go to the cane. This will limit the load on the operated leg in the first weeks and reduce the risk of complications.
With special care you need to take a shower, use a car and public transport. For the rest of the next life, after knee arthroplasty, one must avoid actions that overload the operated operation. These include:
- running and related sports;
- lifting and carrying weights;
- long walking on the stairs;
- unwanted is a set of excess weight.
Quite often, after surgery, many patients experience a slight swelling of the operated zone and a pain symptom. But do not worry about it. With edema, you can cope with the cold( apply a cold compress for 5-10 minutes), and a moderate pulling pain is well-stopped med.preparatami, and goes through 10-12 weeks.The reason for immediate contact with a specialist should be a plentiful edema and acute pain after knee replacement, accompanied by fever and redness.
Unfortunately, complications after the replacement of the knee joint, especially the total knee joint, are not uncommon. The most common problems include:
- Blood clot formation. This is caused by stagnation of blood in the veins of the shin, and also, perhaps, against the background of receiving blood thickening drugs and physiological predisposition.
- Infection. The risk of infection is about 2%, for prevention, it is necessary to take medication prescribed by a doctor, avoid colds and other diseases, and prevent their protracted course.
- Osteolysis is a process where the tissue begins to break down at the points where the bone meets the prosthesis. This is due to the body's reaction to the metal structure, subsequently osteolysis can lead to the need for repeated surgical intervention.
A successful implantation operation assumes the appointment of a group III disability in the following cases:
- endoprosthetics of both legs;
- replacement of bone surfaces not only of the tibia but also of the femur;
If the operation was unsuccessful, disability is put on an individual basis, depending on the severity of the consequences. Lifetime disability after knee replacement is prescribed if rheumatoid arthritis is the cause of the disorders.
Features and Objectives of Rehabilitation
The rehabilitation program has two objectives:
- mobility recovery;
Knee joint development after endoprosthetics should include the following types of movements:
- muscle tension of the thigh and lower leg;
- flexion and extension of the thigh, knee and ankle joint;
The total time of gymnastics is 10-15 minutes. Exercises should carry a moderate load.
Terms, stages and methods of restoring the knee function
The recovery period after prosthetics is 10-12 weeks on average. At this time, you need to slowly and smoothly move with the support, gradually build up the strength and amplitude of movements. Any exercise or movement must be stopped when feeling pain, fatigue or overstrain in the muscles. Recovery after knee replacement can be accelerated if all the doctor's recommendations are followed.
After the operation, a fluid is accumulated in the joint bag, which is removed by means of a drainage system. Lymphatic drainage or apparatus massage of the knee joint after endoprosthetics is included in the complex of mandatory measures in the first day. Physioprocedures( warming up and mud cure) the ratio among orthopedists is ambiguous. In German clinics, they are actively practiced and, according to local experts, accelerate the recovery period. Domestic doctors treat these methods skeptically, believing that they increase the risk of infection.It should be remembered that the endoprosthesis is not a new healthy joint, but a mechanism that allows you to move and live without pain. Like any other mechanism, it gradually wears out.
Physiotherapy, recommended by domestic specialists, is a combination of static and dynamic exercises with no rotation of the operated knee. The difference between LFK after knee arthroplasty and other methods is that most of the movements are performed from a lying or sitting position.
Video: "Exercises after arthroplasty of the knee joint"
There are many types of rehabilitation gymnastics. For example, neurophysiological exercises Brugger designed to correct painful sensations due to movements performed in an upright position. Another kind of complex of neurophysiological exercises can be called the gymnastics offered by Milligan. Western clinics also practice swimming and swimming in the pool and hippotherapy. When choosing the method of recovery, it is important to build on the availability of specialists in this area. Without observing the doctor, exercises can cause irreparable harm to one's health.
Endoprosthetics can significantly improve a patient's life. However, it must be understood that this operation is not a panacea, and it will impose certain restrictions on the rest of life.
Rehabilitation after arthroplasty of the knee joint part 2
The program "Your doctor" 2012 with participation of Novikova S.L.
Rehabilitation before and after endoprosthetics of the knee joint.
Questions and Answers.
Book of Novikova S.L.- "Easy Traffic" Details about the book.
Exercises / exercise therapy / gymnastics for the knee and hip joint after endoprosthetics.
What can and can not.