How Physiotherapists Treat Knee Replacement
Major joint replacement is one of the success stories of the late twentieth century, providing the greatest changes in quality of life measurements of all medical treatments or operations. Total knee replacement has now developed from a less predictable operation to a routine procedure with good long-term results for severely osteoarthritic joints. Populations in developed countries are rapidly getting older and total knee replacement is set to overtake total hip replacement as the most performed joint replacement.
Medical technology developed in the late twentieth century to the stage that joint replacement has become a common and predictable treatment for severely arthritic joints, proving to give the highest quality of life of all medical interventions. Total knee replacement is now a predictable and very successful intervention with good ten year results and beyond. Knee replacement is becoming a more popular operation than hip replacement and as western populations get older the demand will increase.
Metal and plastic components are inserted to replace the degenerative joint surfaces of the knee. In knee replacement these consist of four items:
The metal femoral insert to replace the lower end of the femur which is the top half of the knee.
The tibial component, again of metal, replaces the flat top of the shin bone.
The plastic insert, made of ultra high density polyethylene, is placed between the femoral and tibial inserts.
The patellar button is also of plastic and placed on the back of the kneecap to replace that surface.
These components are placed in position using cement which acts more like a grout than an adhesive.
Once the operation has been completed the physiotherapist must treat the consequences of the operation to ensure a successful outcome for the patient. Surgery causes pain, swelling, inflammation and muscle weakness and much of the early physiotherapy is targeted towards this. Initially the physio can use a Cryocuff, a refillable pressure cuff fitted closely to the knee, to reduce the swelling and to provide cold therapy over an extended period, reducing the pain and facilitating muscle action. Taking the painkillers regularly and static quadriceps exercises are encouraged hourly to re-establish muscular knee control and gentle knee flexion exercises to get the knee range of movement going.
The physiotherapist then gets the patient up, checking the operative record, reviewing the patient’s medical status and assessing the patient and their leg status. Muscular control of the knee must keep the knee stable while mobilising and epidurals can delay this by knocking out the muscular strength and feelings in the legs. A physio and an assistant gets the patient up walking for a short distance with a walking frame if they are older and with crutches if they are more stable. Operation instructions usually allow weight-bearing to facilitate normal muscle activity patterns and promote venous circulation.
After discharge the physiotherapist will work on increasing joint range of motion, improving functional skills and improving muscular power and control of the knee. Typical exercises include knee flexion exercises to increase movement, inner range quadriceps for quads strength into extension and knee hangs to increase extension. Resisted work to the hamstrings uses reciprocal inhibition, the technique whereby working one muscle relaxes the antagonists, in this case increasing knee bend. Physios can do this manually or use resistance bands and encourage soft tissue massage to the scar to mobilise the tissue.
Further rehabilitation is more likely to take place in the gym, concentrating on functional activities such as moving from sitting to standing and step ups and strengthening work with Theraband and the gymnastic ball. Work on range of motion will continue using resisted exercises and static bicycling and patients can usefully work on proprioception using the wobble board and other balance related activities. Proprioception is the normal ability of a joint to sense its position in space and this is very important for normal activity and safe walking. Normal gait patterns are encouraged and abnormal patterns corrected.
Tags: back injury, back pain, back pain relief, Fitness, frozen shoulder, health, injury management, pain management, physical fitness, physiotherapist, physiotherapists, physiotherapy, piriformis syndrome, sciatica
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