Physiotherapy and the Management of Knee Replacement

Major joint replacement is one of the success storiestherapy device, can be used to apply pressure to the
of the late twentieth century, providing the greatestswelling and keep up cold therapy for pain relief, with
changes in quality of life measurements of all medicalthe patient encouraged to take the analgesia
treatments or operations. Total knee replacementregularly. This improves muscle activation as the
has now developed from a less predictable operationphysio teaches knee flexion and static quadriceps
to a routine procedure with good long-term resultsexercises to be performed every hour, to
for severely osteoarthritic joints. Populations inre-establish knee range of movement and muscular
developed countries are rapidly getting older and totalcontrol of the joint.
knee replacement is set to overtake total hipNext the physiotherapist assesses the patient for
replacement as the most performed jointsuitability for their first mobilisation, checking the
replacement.operation note, the patient's medical observations and
Osteoarthritis is a degenerative joint condition whichthe condition of the legs themselves. The operated
is more common the older a person becomes, and isknee has to have enough stability to safely weight
the most prevalent joint condition in humanbear, as an epidural can cause profound loss of
populations. The most affected joints vary, withmuscle power and prevent safe mobilisation until the
some people having spinal and finger changes whilstdrugs wear off. The patient is mobilised into standing
other suffer OA of the major joints such as the hipsby the physio with an assistant and encouraged to
and the knees. Major joint disease is more disablingwalk a small distance with elbow crutches or a
as it tends to compromise normal mobility and soZimmer frame for more elderly persons. Operative
reduce independence. The patient can suffer fromprotocol usually encourages normal weight bearing
loss of knee movement, reduction of knee power,through the new knee as this helps restore normal
grating and crunching of the joint and pain, for whichpatterns of muscular activity and improves circulation.
weight loss, muscle strengthening, painkillingOutpatient physiotherapy aims to restore normal
medication and physiotherapy can be useful. If normalmuscle power and function, joint range of motion and
therapies are not successful then knee replacementregain functional abilities. Initial exercises include knee
is the remaining option.hangs for full passive extension (very important for
The osteoarthritic joint surfaces are precisely cutnormal knee function), inner range quadriceps to
away in knee replacement and metal and plasticrestore active extension to full range and knee
surfaces are substituted. These are:flexion to increase range. Resisted flexion over the
Femoral component. This is a steel alloy and replacesedge of a bed helps the quadriceps relax by
the arthritic end of the thigh bone.reciprocal inhibition and allows increases in flexion
The tibial component, again of metal, replaces the flatrange. This can be manually resisted by a physio or
top of the shin bone.performed against a spring or Theraband. Massage to
Plastic insert. This is a high density polyethylene andthe scar area is also useful to mobilise the scar and
reduces friction between the two main components.free up the tissues.
Patellar button. This is also plastic and replaces theFurther rehabilitation is more likely to take place in the
back surfaces of the kneecap. If this is not replacedgym, concentrating on functional activities such as
then persistent anterior knee pain can be a problem.moving from sitting to standing and step ups and
These components are placed in position usingstrengthening work with Theraband and the
cement which acts more like a grout than angymnastic ball. Work on range of motion will continue
adhesive.using resisted exercises and static bicycling and
After the surgery the physio needs to address thepatients can usefully work on proprioception using the
immediate problems that the operation causes in thewobble board and other balance related activities.
patient's knee. Inflammation, knee swelling, muscularProprioception is the normal ability of a joint to sense
weakness and pain interfere with the rehabilitationits position in space and this is very important for
and the physiotherapist initially targets treatment atnormal activity and safe walking. Normal gait patterns
these problems. A Cryocuff, a compression and coldare encouraged and abnormal patterns corrected.