Not Your Mother’s Knee Replacement...or Rehab

By: Jerry Malone, PT
CEO/Founder of Orthopaedic Rehab Specialists, P.C.
Clinical Director of Total Joint and Aquatic Center
 
     With knee replacement technology improving and the ages of knee replacement patients decreasing, the rehab of this group of patients is changing significantly. Twenty-five years ago, the object was to wait as long as possible before getting a knee replacement. Combine that with an implant that only lasted 10 years or so and you ended up with a group of patients 70+ years of age who were interested in living out their time with less pain and an increasingly sedentary lifestyle.
     Today, with implants lasting 25-30 years, we are seeing patients in their 40’s and 50’s (some younger) getting their knees replaced at a much higher frequency. Because of these changes, we have had to change our thinking about rehab and establish goals much more personalized for all age groups and lifestyles. We have now come to know that 0-120° of motion is “expected”, and altering our focus of rehab form ROM (range of motion) based goals, to strength and function based goals is necessary.
     Recent studies have shown that most patients continue to “wait” until their knee is “really bad” before considering having their knee replaced. As they continue to wait, they begin to lose ROM in the knee and strength in the entire leg, due to pain, favoring the leg, and a general decreased activity level. The studies go on to show that immediately post-op the difference in strength is more drastic, and that even at 1 year after surgery, the replacement knee side is not as strong as it was before surgery.
      Because of these changes, we at the Total Joint & Aquatic Center of ORS have altered our thinking about rehab. We still focus on early mobility and expect 110-120° of knee range of motion, but we are beginning our strengthening phase much earlier in the process. At the same time, we are incorporating gait, balance, and functional activities (such as stairs) earlier as well. We are individualizing patient goals into the rehab process.
     With changes in healthcare reimbursement and the length of time some insurance companies are allowing for rehab, it is even more important to use our rehab time optimally. There are 5 important things to be mindful of if you are thinking about getting a knee replacement:

  • 1. Don’t wait too long (but don’t rush into it). Once the knee pain, stiffness, and weakness are affecting your lifestyle, discuss your options with your orthopedic surgeon. Remember, the biggest factor in the success of a knee replacement is what shape the knee is in before surgery. Poor mobility and strength = a worse result.
  • 2. “Pre-Hab”. Once you decide to get a replacement, use the time prior to surgery wisely. Talk to your Physical Therapist about getting started on your exercise program in the weeks before surgery. This will greatly improve your post-op success.
  • 3. TJ&AC ASAP. Get into your outpatient physical therapy program as soon as possible following surgery. We start as early as 1-2 days following surgery and we have the equipment and expertise to help with pain control and the early movement necessary to get a good head-start on the program. Home physical therapy may be needed for some patients depending on their age and circumstance, but should be limited to those who are home-bound. The optimal window of opportunity for getting your knee motion back begins at surgery and lasts 6-8 weeks after. The longer the time from surgery to starting outpatient physical therapy, the more difficult the return of movement.
  • 4. Set ambitious goals (with your Physical Therapist). Just because you haven’t been active doesn’t mean you can’t be active. “I used to walk 5 miles a day” should now be, “I want to walk 5 miles a day again”, or golf, play tennis, or travel, or work in the garden, or… The days of just having less knee pain and watching TV should be history as far as goals are concerned.
  • 5. Understand the process. Rehab can be hard work, but highly beneficial. A common phrase you hear from healthcare professionals is that, “it takes a year before your knee feels normal”. That might be true, but it doesn’t mean that you can sit on the couch for a year and all will be fine. It means that with the help of your Physical Therapist at ORS you can set goals, go through rehab, continue with our Aftercare program, join the YMCA, or fitness center, and continue your new active lifestyle.

     No matter what your age or function before getting your knee replaced, life can be much better after. Call us at the Total Joint & Aquatic Center any time to schedule a FREE consultation. Let us get you back to working, playing, and living everyday!
 
Jerry is the owner, CEO, and a Physical Therapist at our Total Joint & Aquatic Center in Jackson and can be reached at: jerrypt@orsmi.com