Information and Exercise for Patients and Carers
We hope this information will help you prepare for your knee replacement surgery and remind you of the physiotherapy needed following the operation.
A Physiotherapist will work with you following your operation. The aims before discharge home are to be walking safely with an appropriate walking aid, usually crutches, to be exercising independently to regain knee stability and range of movement, and to manage stairs safely when appropriate.
Day of surgery/1st day post-operation
A Physiotherapist will visit you after your operation and encourage you to weight-bear on your operated leg. This may be on the day of surgery if you feel well enough to do so. Early mobilisation reduces the risk of complications such as deep vein thrombosis (DVT) and chest infection following surgery.
If you need to stay in bed on your first post-operative day you will be encouraged to do deep breathing and circulatory exercises to reduce these risks. Knee exercises can be started immediately after surgery.
N.B. Adequate pain relief is essential to your progress. If your pain levels are too high to walk or complete your exercises you must let a member of the nursing or therapy team know in order for this to be addressed.
Deep breathing exercises to reduce the risk of developing a chest infection.
Take 3 deep breaths filling your lungs as much as possible.
Foot and ankle exercises to improve your circulation. Move your ankles up and down. Circle your ankles around.
Do not rest with a cushion/pillow under your operated knee. It will potentially cause your knee to stiffen in that position.
Keep your leg raised when resting for up to one hour, particularly towards the end of the day. This can help reduce swelling.
Tighten up the muscles around your knee and push your
knee straight. Also squeeze your buttock muscles together.
Hold for a count of 3 seconds.
Day 1 or 2 onwards
Continue previous exercises above and add the following:
Hip and knee flexion.
On a smooth surface slide your heel up and down by bending and straightening your hip and knee
Lie back with a towel rolled up under your knee.
Straighten knee and lift your foot.
Do not lift leg off towel.
Hold for a count of 3 seconds.
Tighten up the muscles around your knee and push
your knee straight. Now lift your leg 10cm off the bed.
Hold for a count of 3 seconds Straight leg raises may not be possible immediately.
Lie back, rest your heel on a rolled-up towel.
Leave in this position for up to 30 minutes maximum.
This will stretch the muscles down the back of your knee preventing it becoming fixed in a bent position.
Sit on a chair.
Tighten your thigh muscles and straighten your knee.
Hold for a count of 3 seconds.
Slowly relax your leg back down.
The aim of physiotherapy from this point onwards is to help you progress your mobility and exercise programme. Before going home your knee should straighten fully and bend to 90 degrees and preferably beyond.
You will be encouraged to walk hourly using the walking aids provided when you are safe to do so.
On discharge it is essential that you continue with your exercise programme. You will be referred to your local out-patient physiotherapy department for follow-up treatment, normally about 3 weeks later.
Progression of knee exercises
Sit in a chair.
Take your non-operated leg over your operated leg and pull back as far as you can.
Hold for a count of 3 seconds.
Stand holding on to a support.
Bend your knee lifting your foot off the floor.
Try to bring your heel towards your buttock.
Step your operated leg on to a step. Keeping that foot still, shift your body forward over the operated leg causing your knee to bend. Hold for a count of 3 seconds
N.B. You should do 5-10 of each exercise 3 x daily when you return home, unless otherwise instructed by your Physiotherapist.
Progression of mobility
Upon discharge from hospital, you should continue to gradually increase the distance you walk daily with the elbow crutches.
When you feel safe and ready to do so, you can progress to walking with one crutch rather than two. The crutch should be used on the opposite side to your operated leg. Try this first indoors and continue with two crutches outdoors. If you find you are limping, you should revert back to two crutches and try again in a few days.
Similarly, when you feel safe and ready to do so, you can walk without a walking aid. Again, try this indoors first and if you find this causes you to limp, you should continue using a crutch until this improves.
How to use stairs safely
Walking upstairs:
Hold onto the handrail with one hand and the crutches with the other.
Lean slightly forwards.
Take a step up with your un-operated leg.
Then step up with your operated leg and crutches together.
Always go one step at a time!
Walking downstairs:
Hold onto the handrail with one hand and the crutches with the other.
Lean slightly backwards.
Place the crutch on the step below. Take a step down with your operated leg. Then take a step down with your Unoperated leg.
Always go one step at a time!