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Knee Replacement

When a Total Knee replacement is the best course of action

Any number of things that may have led you to needing knee replacement. You had a previous injury left untreated, your family has a history of knee arthritis or you’ve have tried knee physiotherapy but it has not resulted in significant improvements. A total knee replacement is undertaken if more conservative measures can’t improve things.

For many people, the main reason for a knee replacement is that the pain has become unbearable, and is affecting the quality of life.

Physiotherapy Knee Replacement

Total knee replacement – the mechanics

Arthritis leads to the surfaces of the knee joint wearing away; this includes the surfaces of the upper leg and lower leg. The cartilage is no longer smooth, which can leads to the pain, stiffness and swelling in the joint. As time goes on, the joint wears out to the extent that the bone of the upper leg can begin to grind on the bone of the lower leg as the cartilage completely wears out.

The reason for having this type of treatment is to improve the stability of the joint, achieve a better range of movement and to reduce joint pain. Surgery typically take up to an hour and a half and it includes putting in place a prosthesis that covers the damaged areas of the joint. The surface of the tibia, the surface of the femur and sometimes the surface of the patella are replaced.

Post-operative rehab and recovery normally begins as early as the day after surgery. Your job here will be to follow the exercise program provided by your knee physio to improve the strength of the muscles that support the knee and to improve the range of motion of the knee.

Knee replacement – what the evidence says

Evidence strongly suggests that knee physiotherapy is beneficial for patients before and following total knee replacement surgery. Knee rehab programs will vary from patient to patient, depending on their individual physical condition. The motivation provided by a physio coupled with guidance and reassurance throughout the rehabilitation process can significantly assist recovery.

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Knee Physiotherapy: Before surgery

A knee replacement can seem like a daunting prospect, but with the right physiotherapy support, you can have a huge positive impact on your recovery and the range of movement you are able to achieve with your new joint.

Unfortunately, for financial reasons most NHS and Private hospitals will only point patients towards post-operative knee physiotherapy. But for you as an individual, this makes no sense, because it means that you are attempting to achieve all your necessary muscle strengthening after surgery, the same time as you are trying to recuperate.

So the best approach is to work with a physiotherapist before your knee operation so that you are in the best possible condition to recover after your surgery. Before your surgery, the job of the physiotherapist is to help you to achieve the best possible physical condition while making you as comfortable as possible. This means gaining as much muscle strength around the knee as you can.

The physio can also talk you through what to expect from the surgery and its effects. Knee replacement is a significant procedure, which will require some patience, diligence and a solid level of commitment to help maximise the benefits to you. Having a reasonable insight into the recovery process before going in to have surgery is helpful for most patients.

Knee Physiotherapy: After surgery

Once surgery has taken place, the physio should liaise with your surgeon and to ensure that treatment matches your specific needs, including any limitations the surgeon specifies on your early recovery stages, such as the permitted range of movement.

Physiotherapy can commence on the day after surgery. The anaesthetist will have prescribed pain killers for you and it is normal that some ongoing pain relief will be needed during the first three months, (progressively reducing in strength). The pain relief should be sufficient to enable you to carry out the essential exercises to repair and strengthen the supporting structures around the knee. The physio should show you precisely how to carry out each exercise, and adjust the exercises as you progress.

The physio should also advise you on other measures you should take – including the application of ice packs to take away heat from the area and reduce inflammation. In addition, once the dressing has been removed and the wound fully healed over, the application of an appropriate bio oil will help the skin tissue to heal.

The physio can also help you during the recovery period by hands-on therapy. This can include range of motion routines, hamstring and calf massage, and soft tissue work around the scar area.

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Knee Replacement physiotherapy

Knee replacement: the mental challenge

Major surgery such as knee replacement can present an emotional challenge as well as a physical one. It’s normal to feel overwhelmed at times – perhaps not being able to see the light at the end of the tunnel. A good physio can really help you in this respect – by reassuring you when you are on the right track, and giving you the confidence to continue the journey.

Not all physios are comfortable with this side of patient care: sometimes they lack the empathy required to really appreciate the patients’ feelings. Part of the problem is a lack of understanding of what chronic pain really feels like and how wearing it can be.

So it is important to select a physio who will be your ‘partner’ in recovery. Someone who listens to you, and properly responds to your views, adjusting treatment where necessary.

The reality is, that knee replacement surgery is normally extremely effective. Having a physio to guide you through your recovery can help you get there with confidence.

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If you choose Full Motion Physio

I have trained at centres renowned for joint replacement surgeries – including Wrightington Hospital, so I have the knowledge and experience to help you back to your best potential.

I will tailor your program specifically to you, by consulting with your surgeon, discussing your expectations with you and assessing your knee at every step of the way.

I will address both the physical and emotional challenges of recovery, to most effectively partner you through each stage of your recovery.

My approach is described in the Full Motion Method page. Extensive research has identified four essential elements for the best physiotherapy. The Full Motion Method covers each of these elements.

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