Post-Operative Exercise Program Overview
After undergoing knee joint replacement surgery, it's essential to follow a post-operative exercise program. This program is key to regaining your knee strength, flexibility, and overall mobility.
Importance of Exercise After Knee Replacement
Most patients are discharged one to two days after knee replacement surgery, and the first walk after surgery typically occurs within hours of waking from the procedure, with assistance from nurses and a walking device [1]. Walking throughout the day is crucial to help regain independence, gradually increasing distance and effort over time until walking without discomfort or limitations is achieved.
Exercises recommended after knee replacement surgery include sticking with the recommended physical therapy plan and continuing to challenge yourself without overexerting your healing knee. Most orthopedic surgeons and physical therapists recommend exercising for at least 20 to 30 minutes daily after knee replacement surgery, whether it's walking or stretching, and increasing the duration as the knee gains strength.
Three Phases of Post-Operative Exercise Program
The post-operative exercise program after knee replacement surgery is divided into three phases (Hospital for Special Surgery):
- In-hospital phase (1 to 3 days after surgery): This phase begins in the hospital with basic movements and exercises.
- At-home phase (2 or 3 weeks after surgery): The exercises become more intense during this phase, focusing on strengthening muscles and improving flexibility.
- Outpatient therapy phase (up to 4 months after surgery): This phase includes advanced exercises to further strengthen muscles, improve flexibility, and boost cardiovascular capacity.
Patients are advised to continue their prescribed exercise program two or three times a week until at least eight or 10 months post-op. Even in months 10 to 12, they should perform knee workouts once a week along with additional types of activity for long-term recovery.
By understanding the importance of exercise after a knee joint replacement surgery and following the outlined phases of the post-operative exercise program, patients can significantly improve their recovery process and overall quality of life.
Exercises After Knee Replacement Surgery
Following a knee joint replacement surgery, it's crucial to adhere to a well-structured post-operative exercise program. This regimen typically progresses in stages, beginning with simple, early post-operative exercises and gradually moving toward more complex physical therapy exercises aimed at building strength, particularly in the quadriceps.
Early Post-Operative Exercises
The first walk after surgery typically occurs within hours of waking from the procedure, involving assistance from nurses and a walking device. Most patients are then discharged one to two days after surgery, at which point it's important to stick to the recommended physical therapy plan and gradually increase effort over time without overexerting the healing knee. Walking is one of the most highly recommended exercises, and patients are generally advised to walk as much as they find comfortable, starting with small, manageable steps over short distances [1].
Quadriceps Strengthening Exercises
Strengthening the quadriceps muscle is an essential aspect of recovery after knee replacement surgery. Most individuals undergoing the procedure have weak quadriceps due to pain and muscle disuse. Exercises for quadriceps strengthening include extending, squatting, stepping, and stretching.
Progression of Physical Therapy Exercises
The post-operative exercise program after knee replacement surgery is divided into three phases: in the hospital (1 to 3 days after surgery), at home (2 or 3 weeks after surgery), and outpatient therapy (up to 4 months after surgery) [2].
The progression of exercises in physical therapy starts with body weight exercises and gradually moves to exercises that involve elastic bands, ankle weights, and light handheld weights.
Patients are advised to continue their prescribed exercise program two or three times a week until at least eight or 10 months post-op, and even in months 10 to 12, they should perform knee workouts once a week along with additional types of activity for long-term recovery.
By adhering to a well-structured exercise program and gradually increasing the intensity and complexity of the exercises, individuals can significantly improve their recovery after knee joint replacement surgery. These exercises aim to strengthen the surrounding muscles, restore joint mobility, and ultimately enhance the overall function of the new knee joint.
Cardiovascular and Balance Exercises
Following knee joint replacement surgery, it's essential to incorporate a structured exercise program into your rehabilitation process. This not only aids in strengthening the knee but also improves overall mobility and cardiovascular health.
Importance of Cardiovascular Exercises
Cardiovascular exercises play a crucial role in the recovery process after knee replacement surgery. Orthopedic surgeons and physical therapists typically recommend patients to exercise for at least 20 to 30 minutes daily, whether it's walking or stretching, and gradually increase the duration as the knee gains strength.
Patients are generally advised to walk as much as they find comfortable after surgery, starting with small, manageable steps over short distances, and gradually increasing the distance without discomfort.
Walking throughout the day is crucial to help regain independence, gradually increasing distance and effort over time until walking without discomfort or limitations is achieved.
Additionally, activities such as stair climbing, advanced exercises such as standing knee bends, assisted knee bends, knee exercises with resistance, and exercycling are recommended post-total knee replacement surgery to aid in recovery, regain strength, and improve mobility.
Balance Exercises for Recovery
Balance exercises are another essential component of a post-operative exercise program following knee joint replacement surgery. They help to improve stability and coordination, which are crucial for maintaining mobility and preventing falls.
Adding specific balance exercises to a post-operative rehabilitation program significantly improved functional forward reach, single leg stance, sit-to-stand test, stair climbing time, 10-meter walk time, Timed Up and Go (TUG) scores, and WOMAC scores to a greater extent than a control group that did not receive balance retraining exercises.
These exercises work by targeting the muscles around the knee and the rest of the body, improving overall strength and stability. By incorporating balance exercises into your rehabilitation routine, you can enhance your recovery and return to your daily activities with greater confidence and ease.
Remember, it's important to perform these exercises under the supervision of a physical therapist or a trained professional to ensure safety and effectiveness. Always listen to your body and stop any exercise that causes discomfort or pain.
Challenges and Adherence in Exercise Programs
Understanding the challenges in adherence to exercise programs is crucial in the successful recovery of patients who have undergone knee joint replacement surgery. It's essential to improve the reporting of exercise interventions, the measures of exercise adherence, and identify areas for further research.
Poor Reporting in Exercise Interventions
A majority of randomized controlled trials (RCTs) examining post-operative exercise-based interventions for total knee arthroplasty (TKA) report exercise adherence poorly. In fact, only 23% of studies provided a definition of adherence, and 63% did not report exercise adherence at all. Moreover, the RCTs were of poor quality, with 85% having high or unclear risk of bias. Poor reporting limits reproducibility of research and translation into clinical practice [5].
Furthermore, description of exercises, dosage, progression of exercise, adverse events, content of home program/non-exercise components, and fidelity were not well reported. Alarmingly, there were no significant differences in the reporting of exercise interventions over time, suggesting that a significant proportion of researchers assessing post-operative TKA interventions have not adapted newer recommendations for reporting interventions [5].
Measures of Exercise Adherence
When it comes to assessing exercise adherence in post-operative TKA interventions, the most commonly used outcome measures are the number of attended sessions and patient diaries. However, these measures have poor validity and reliability.
Future studies should aim to validate existing measures of exercise adherence that can accurately assess this construct within a clinical trial. Accurate measures of adherence are critical in evaluating the effectiveness of exercise interventions and identifying areas for improvement.
Future Research Needs
There is a dearth of studies focusing on adherence to therapeutic exercise after TKA, and very little evidence surrounding patient adherence to exercise recommendations after TKA. The lack of exercise after TKA may lead to poor post-operative outcomes, including increased pain and functional disability. Therefore, future research should focus on using valid and reliable measures of adherence and proper tools for reporting exercise interventions.
Given the importance of exercise in the recovery following knee joint replacement surgery, it's crucial to improve the quality of research in this area. By addressing the current gaps in research, healthcare professionals can develop more effective post-operative exercise programs and strategies to improve patient adherence.
Outpatient Therapy and Continued Recovery
The journey to full recovery after knee joint replacement surgery involves continued commitment to a post-operative exercise program, even after being discharged from the hospital. Outpatient therapy plays a crucial role in enhancing mobility and ensuring optimal long-term outcomes.
Outpatient PT Protocols
Outpatient physical therapy (PT) protocols for knee arthroplasty should include strengthening and intensive functional exercises delivered through land-based or aquatic programs. The progression of these exercises should be based on patient progress [4]. Particularly, patients who started a water-based exercise program on the 6th postoperative day had better Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores at 3, 6, 12, and 24 months after knee arthroplasty compared to those who started the program on the 14th postoperative day.
However, the effectiveness of home-based or telerehabilitation compared to clinic-based progressive strengthening protocols or intensive functional training is still under research and needs further studies.
Whole Body Vibration Benefits
The use of whole body vibration as a form of exercise after knee arthroplasty has shown significant improvements in quadriceps strength, Timed Up and Go (TUG) time, and flexion range of motion [4]. This form of exercise involves the use of a machine that delivers vibrations to the whole body or specific parts of the body, stimulating muscle contractions and improving strength and stability.
Importance of Balance Exercises
Balance exercises are a crucial component of the post-operative rehabilitation program after knee joint replacement surgery. Adding specific balance exercises to the program significantly improved functional forward reach, single leg stance, sit-to-stand test, stair climbing time, 10-meter walk time, TUG scores, and WOMAC scores to a greater extent than a control group that did not receive balance retraining exercises [4].
Balance exercises help improve stability, reduce the risk of falls, and enhance functional mobility, making them an essential part of the continued recovery process after knee joint replacement surgery.
The implementation of a comprehensive outpatient therapy program, including PT protocols, whole body vibration, and balance exercises, can significantly enhance recovery and improve the quality of life for patients after knee joint replacement surgery.
Transitioning to Personal Training
Once the advanced phase of rehabilitation after knee joint replacement surgery is completed, the transition to a personalized exercise regimen under the guidance of a certified personal trainer (CPT) can be the next step. This transition can provide sustained benefits and long-term well-being [6].
Role of Personal Trainers
Personal trainers play a vital role in the continued recovery of patients post knee joint replacement surgery. They are responsible for tailoring exercise programs to the patient's specific needs, addressing any remaining imbalances or weaknesses, and helping to ensure a gradual and safe progression toward functional goals. Their role extends beyond mere exercise guidance, and includes initial assessment, goal setting, exercise prescription, progression monitoring, and regular communication with the patient's orthopedic surgeon or physical therapist.
Tailored Exercise Programs
A tailored exercise program post knee joint replacement surgery is a personalized regimen designed to meet the individual needs of each patient. This program typically includes exercises that focus on improving muscle endurance and joint flexibility, continuing the work started in physical therapy sessions. Personal trainers can help patients maintain their progress, avoid injury, and work towards returning to their normal daily activities.
When creating a tailored exercise program, personal trainers take into account the patient's current physical condition, age, fitness level, and lifestyle. They identify areas where the patient may have imbalances or weaknesses and design exercises to target these areas. By regularly assessing the patient's progress, the personal trainer can adjust the program as needed to ensure the patient continues to move towards their recovery goals.
Collaboration Between PT and Trainers
The transition from physical therapy to personal training after knee joint replacement surgery should be a collaborative process. Open communication between physical therapists and personal trainers is essential to ensure continuity of care and continued progress for patients [6].
The physical therapist can provide important information about the patient's surgical procedure, recovery progress, and any special considerations that need to be taken into account when planning their exercise program. Regular communication between the physical therapist and personal trainer can ensure that the exercise program is appropriate and beneficial for the patient.
In conclusion, transitioning to personal training can be a beneficial step in the recovery process after knee joint replacement surgery. With the guidance of a personal trainer, patients can continue to work towards their recovery goals in a safe and effective manner.
References
[1]: https://www.orthobethesda.com/blog/how-much-you-should-walk-after-a-knee-replacement/
[2]: https://www.hss.edu/article_exercises-after-knee-replacement.asp
[3]: https://orthoinfo.aaos.org/en/recovery/total-knee-replacement-exercise-guide/
[4]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4131551/
[6]: https://redefinerva.com/transitioning-from-physical-therapy-to-personal-training-for-continued-rehabilitation-following-total-knee-replacement/
