Knee Replacement, Total

Ideally, rehabilitation begins before total knee replacement surgery by assessing the individual's medical and social condition to determine what might be required postoperatively for a successful outcome. The main goal of the rehabilitation is to restore function by controlling pain, improving range of motion, and strengthening the knee (Ranawat).

Individuals who undergo total knee replacement require both physical and occupational therapy. Occupational therapy is needed after surgery for instruction in all transfer training, equipment needs, and activities of daily living modifications. The occupational therapist should assess and train individuals in use of equipment such as an elevated commode, tub seat, reacher, long-handled shoe horn, and long-handled sponges, because these facilitate activities of daily living in the postoperative period.

Physical therapy begins in the hospital and continues on an outpatient basis. The first goal of physical therapy is to control of pain, initiate ambulation and begin range of motion of the operative knee. Preoperative gait instruction might facilitate early postoperative ambulation. Weight bearing status is determined by the physician's protocol, and individuals may use assistive devices as needed for independent ambulation on level and uneven surfaces. Cold packs may be used to decrease pain and swelling, with care used to protect the surgical wound.

The second goal of physical therapy emphasizes full knee range of motion. Range of motion restrictions are determined by the surgical approach and type of prosthesis to protect the prosthesis and surrounding soft tissue. Common clinical practice includes use of continuous passive motion machines combined with physical therapy to facilitate recovery and knee motion (Milne).

Physical therapy's final goal is to increase knee and hip strength, normalize gait, and increase functional abilities. Because many individuals experience an abnormal (antalgic) gait or limb weakness preoperatively, continued gait training and strengthening exercises may take longer than anticipated. All weight bearing and exercise should be continued under the direct guidance of the surgeon to protect the integrity of the knee prosthesis. Besides undergoing supervised rehabilitation, the individual should be instructed in a home exercise program to be practiced daily, and continued independently under physician supervision after the completion of rehabilitation (Fitzgerald; Roos).