Designed by Neej Patel and Samuel Hwang, UQ-Ochsner Clinical School, Class of 2014

Introduction

 The knee is the largest joint in your body, and a major surgery to replace it. After a successful surgery, it takes active participation on your part to quickly recover from surgery and regain mobility. The activities we have listed below are suggested exercises to help you quickly regain mobility during the recovery process.

Consult your physician before you start these exercises. The set and repetition numbers for these exercises are general suggestions. Please remember to be careful and pay attention to your body’s signs of pain and fatigue.

Do not continue with these exercises if you feel you are putting too much strain on your new knee or if they go against your physician’s/therapists’ recommendations.

Pain Management Tips After Knee Replacement

  • In order to improve progress and early mobility, it is better to prevent pain than to treat pain.
  • Icing your knee can help reduce inflammation/swelling, which can then relieve pain and help you improve in your therapy sessions.
  • Acetaminophen (Tylenol) and Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) like ibuprofen and naproxen can be bought at local drug stores to be used for pain relief; however, please talk to your physician before using these.
  • Your Content Goes Here

Goals After Knee Replacement Surgery

  • The ultimate goal of these exercises is to maximize mobility and to gain as much independence as possible.
  • Pain reduction as swelling improves and range of motion improves.
  • Return to your prior functional level or better.

Day Of  Surgery (Day 0)

Perform deep breathing exercises:

  • Breathe in slowly and hold your breath for 2-5 seconds. Repeat 10-15 times.
  • Breathing exercises will help you recover well from anesthesia

Ice your knee for 20 minutes before and after each of the below exercises.

  • Try to ice your knee at least 5 times per day.

Ankle Pumps: 15 times every hour

  • Move your feet up and down, and in full circles, while in bed (see picture)
  • Ankle pumps will help prevent clots from forming in your legs, help reduce swelling, and improve early mobility.

1 Ankle Pumps

First Day After Knee Surgery (Day 1)

Your physician and/or therapists may want to begin gentle weight bearing and walking on your new knee very soon after your surgery. Follow their instructions closely regarding how and when to begin putting any form of weight on your knee.

Isometric exercises for your leg muscles:

Quadriceps Sets – muscles in the front of your thigh: (see picture)

  • Tighten the muscles just above your knee by straightening your knee completely.
  • Attempt to push the backside of your knee into the bed.
  • Hold this tightly for 5 seconds, then relax and repeat.
  • Do this 15 times every hour

2 Quad Sets

Gluteal Sets:

  • Flex your buttocks for 3 seconds and relax.
  • Do 3 sets of 10 repetitions.
  • Remember to ice your knee for 20 minutes before and after exercising.

Second Day After Knee Surgery (Day 2)

Now you should begin active leg exercises if okay with your doctor or therapist.

Hip and Knee Bends:

  • While lying on your back, gradually slide your heel back towards your buttocks.
  • As your range of motion improves, try to bend your knee more by bringing your heel closer to your buttocks
  • Do 3 sets of 10 repetitions.

3 Hip-Knee Bend

Knee Straightening:

  • Place 2 pillows under your knee.
  • Straighten your knee by lifting your foot off of the bed.
  • Hold your leg straight for 5 seconds, and then slowly lower your foot back to the bed.
  • Do 3 sets of 10 repetitions.

4 Knee Extension

–          Remember to ice your knee!

Third Day After Surgery (Day 3)

Now your may be able to begin slightly more difficult exercises.

Straight Leg Raises:

  • Lift your operated leg up while keeping your knee straight, and hold for 3 seconds. If it is more comfortable, you can bend your “good” leg during the exercise.
  • Lower your operated leg slowly down onto the bed.
  • Do 3 sets of 10 repetitions.

4 Knee Extension

Supine Hip Abduction:

  • Lift your operated leg about 4 inches off of the bed, and slide your leg out to the side.
  • Keep your leg straight, hold for 3 seconds, and bring your leg back to the center starting position.
  • Do 3 sets of 10 repetitions.

6 Supine Hip Abduction

Side-lying Hip Abduction:

  • Lie on your “good” side so that your operated leg is positioned up.
  • Lift your leg to the ceiling as far as you can tolerate.
  • Hold for 3 seconds, and then carefully relax your leg back down.
  • Do 3 sets of 10 repetitions.

7 Side Hip Abduction

Remember to ice your knee!

Criteria for Progression to the Next Phase of Knee Rehabilitation

  • You are able to contract your quadriceps and perform straight leg raises with minimal pain.
  • You gain reasonable range of motion with your new knee.
  • You can bear weight and walk at least 100ft with assistance.

Training Phase (Day 4 – Week 16)

During this time period after your hospital stay, you will most likely be going to outpatient Physical Therapy and Occupational Therapy to continue your rehabilitation after surgery. It is important to follow your physician’s and therapists’ instructions to get the most out of your sessions and individual efforts. In addition to the above exercises, below are some exercises you can do at home to continue helping your therapy. Remember to ice your knee 20 minutes before and after therapy sessions or performing exercises.

What to Expect From Occupational Therapy

The goal of occupational therapy is to improve function in activities of daily living (for example, learning how to move yourself around your house, your bathroom, getting into and out of a car, etc.). You may need to adjust things in your home, bathroom, kitchen, and car in order to make your life easier as you are regaining stability, strength, and mobility in your knee. It is important to take care while progressing to more challenging activities. Make sure you follow the advice and instructions that your therapists give you before trying more difficult activities.

What to Expect From Physical Therapy

The goal in physical therapy is to increase range of motion, strengthen muscles, increase endurance and improve walking (equipment may be used to help you in the beginning). Most patients will not require assistive devices by 6-12 weeks postoperatively, but these are some walking aids that you may use during your therapy, in sequence:

  1. Parallel bars in physical therapy
  2. A walker or crutches, depending on your stability and comfort
  3. A single crutch or cane before progressing to using no aids at all

More Exercises You Can Perform at Home With Doctor/Therapist Approval

Don’t forget to ice your knee!

Active Knee Bending:

  • Sit in a chair with both of your feet flat on the floor.
  • Slide the foot of your operated leg back until it is slightly under the chair.
  • Hold for 10 seconds, and then bring your foot back to the starting position.
  • Do 3 sets of 10 repetitions.

8 Active Knee Bend in Chair

Passive Knee Bending:

  • Sit in a chair with both of your feet flat on the floor.
  • Slide the foot of your operated leg back until it is slightly under the chair.
  • Plant your foot there, and then slide your hips forward on the chair so your knee bends as much as tolerable.
  • Hold for 10 seconds, and then relax by sliding your hips back to the starting position.
  • Do 3 sets of 10 repetitions.

9 Passive Knee Bend

Knee Extension Stretch:

  • Sit in a chair with your foot resting on a stool in front of you.
  • Let gravity help straighten your knee completely.
  • Do NOT stay in this position for longer than 30 minutes.

10 Knee Extension Stretch

Prone Knee Bending:

  • Roll onto your belly, and place a towel under the front of your thigh to keep pressure off of your incision(s).
  • Bend your knee so the heel of your foot moves toward your buttocks, then relax, and allow your foot to return to its starting position.
  • Keep your thigh down flat while doing this exercise.
  • Do 3 sets of 10 repetitions.

11 Prone Knee Bend

Prone Hip Extension:

  • Roll onto your belly, and place a towel under the front of your thigh to keep pressure off of your incision(s).
  • With your knee bent, raise your thigh off the floor/bed about 1-2 inches, and hold for a count of 5 seconds.
  • Carefully lower your thigh back to the starting position.
  • Do 3 sets of 5 repetitions; progress to more repetitions per set as your strength and mobility improve.

12 Prone Hip Extension

Prone Passive Knee Extension:

  • While on a bed, roll onto your belly, and place a towel under the front of your thigh to keep pressure off of your incision(s).
  • Position yourself so that the lower half of your legs are hanging off of the bed.
  • Use either an ankle weight (1-5 pounds heavy) or your other foot to push your knee completely straight.
  • Hold this stretch for about 15-20 seconds or as tolerated, then relax.
  • Do 3 sets of 5 repetitions to begin with, and progress as tolerated.

13 Prone Passive Knee Extension

Advanced Knee Exercises That Can Be Performed Every Other Day

Leg Straightening:

  • Sit on a chair with your feel resting flat on the floor. You can place a rolled-up towel under your operated knee for comfort.
  • Lift the foot of your operated leg up so that you straighten your knee and flex your thigh muscles (quadriceps).
  • Hold your leg up for 5 seconds while it is straight; focus on pointing your toes straight up.
  • Slowly lower your foot back to the starting position. Rest for 2 seconds and repeat.
  • Do 3 sets of 10 repetitions.

14 Active Knee Extension Chair

Step Up-Down Exercise:

  • Stand with the foot of your operated leg on a 3-5 inch tall platform (like a piece of wood or a stool, etc.), and place the foot of your “good” leg flat on the floor next to the platform.
  • Step up, and shift your weight onto the foot that is on the platform. Straighten your knee so that your other foot is completely off of the floor.
  • Then, slowly move back down so that your foot lightly touches the floor, and then step back up again.
  • Start by doing 3 sets of 5 repetitions, and then add a repetition in each set as your pain and strength levels improve. Your goal is to end up doing 3 sets of 10 repetitions.

15 Step Up-Down

Wall Slides:

  • Stand with your back and head against a wall and your feet shoulder-width apart. Leave a space of about 6-12 inches between the wall and your heels.
  • Slowly slide down the wall until your knees are slightly bent (about 45 degrees).
  • Hold this for 5 seconds, and then slowly slide back up to the starting position.
  • Start by doing 3 sets of 5 repetitions, and then add a repetition in each set as you have less pain and improve your strength. Your goal is to end up doing 3 sets of 10 repetitions.
  • As you improve, move on to bending your knees even further (90 degrees, so thighs parallel with the floor) and/or using only one leg at a time.

16 Wall Slides

17 Deep Wall Slides

O’Young BJ, Young MA, Stiens SA. Physical Medicine & Rehabilitation Secrets. 3rd ed. Mosby; 2007: 389-390. Duke Medicine Physical & Occupational Therapy Home Exercise Program Following Knee Surgery: http://www.dukehealth.org/orthopaedics/services/joint-replacement/care-guides/knee-replacement-surgery-information/physical-therapy-after-knee-replacement-surgery Brigham and Women’s Hospital Department of Rehabilitation Services Total Knee Arthroplasy Protocol: http://www.brighamandwomens.org/patients_visitors/pcs/rehabilitationservices/physical%20therapy%20standards%20of%20care%20and%20protocols/knee%20-%20tkr%20protocol.pdf Massachusetts General Hospital Sports Physical Therapy: Strength Training for the Knee http://www.massgeneral.org/ortho/services/sports/rehab/Strength%20Training%20for%20the%20Knee.pdf The Sports Medicine Patient Advisor: http://hmcdoctors.com/wp-content/uploads/2013/07/patellafemoral-pain-syndrome-frazier.pdf