How Physical Therapy Can Help You

Total Knee Replacement (TKR)

Anatomy of the knee joint
The knee joint is comprised of the femur or thigh bone, the tibia or shin bone, and the patella or knee cap. It is stabilized by the cruciate ligaments, cartilage and hamstring, calf and quadriceps muscle.

What is Degenerative Joint Disease (DJD)?
Degenerative joint disease is the degeneration of the cartilage in the knee joint that may cause pain, stiffness and loss of motion of the joint. Rheumatoid arthritis, osteoarthritis or a traumatic injury can lead to degenerative joint disease.

Treatment of DJD:
Non-Operative:	Operative:
Weight Loss Strengthening the Quadricep Muscles Range of Motion Exercises Synvisc Injection Steriod Injections	Arthroscopic Debridment Osteotomy TKR

What are the indications for a TKR?

• Disabling pain resulting in decreased functional mobility
• Radiographic evidence of severe degeneration
• Failed non-operative treatment

What does a surgeon do when he/she replaces a knee joint?
A surgeon performs a total knee replacement by replacing the ends of the femur and the corresponding tibia with a prosthesis or metal component. The undersurface of the patella can also receive a prosthesis.

How long does the surgery take? What will I expect when I wake up?
The operation usually takes 2 1/2-3 hours. When you wake up from surgery your knee will either be in an immobilizer brace or in a CPM (constant passive motion) machine. The CPM will gently bend and straighten you knee. The use of the CPM is very important for early range of motion of the knee joint and may be used for at least 8 hours a day. You will also have a surgical bandage around the knee.

What rehabilitation will I have after a TKR?
You will receive PT in the hospital. The physical therapist will review gait training with an assistive device. The therapist will instruct on exercises to increase quadriceps strength and improve ROM. When you are discharged from the hospital, you will either be scheduled for home physical therapy or outpatient physical therapy. Therapy will continue to help you improve strength and ROM so that you will be able to return to prior level of activity. It is very important to be diligent with all aspects of the physical therapy to maximize your outcome. For example, studies indicate that patients who can achieve 90° of bend to the knee as quickly as tolerated, find that rehabilitation is more comfortable than those who do not.

What activities can I do after my TKR?
Some activities that you can do after your TKR include bicycling, dancing, golf, swimming, walking, bowling, rowing, cross country skiing, horseback riding and weight lifting. Activities that you should avoid include those that involve high impact, such as basketball, football, racquetball and hockey.