Knee prosthesis: rehabilitation, pain and prognosis

Recovery time and prognosis

The results of a full denture operation on the knee are often excellent.
After surgery, nine out of ten patients feel less pain and better mobility.

It is necessary to carry out regular check-ups (follow-ups) of the knee joint and rehabilitation with physiotherapy exercises.
Most people do not need walkers after a full recovery.

How long does a prosthesis last?

The knee prosthesis lasts about 10-15 years. Some can last 20-25 years until they are no longer suitable, and then need to be replaced again.

Rehabilitation after a knee prosthesis

Therapeutic exercise and functional exercise:

• Passive exercises (sitting and lying down), active with the help of the physiotherapist.
• Passive mobilization of the knee joint.
• Massage therapy of soft tissues.
• Isometric contraction (without movement) of the muscles.
• Raised leg stretched (elevation).
• Expand range of motion (ROM) and strengthen muscles.
• Exercises with closed kinetic chain (with the foot off) only if the joint hurts little and there is good muscle strength.
• Training on walking on flat surfaces and stairs.
• Learning the change of position of the body.

Resumption of normal activities
After discharge from the hospital, physical activity must be continued.
“Good days” and “bad days” are to be expected, a gradual improvement and progressive increase in muscle strength should be noticed in the following 6-12 months.

Physiotherapy exercises – Continue with the prescribed exercises for at least two months after surgery. An exercise bike can help maintain high muscle tone and favor flexion of the knee joint.
One should aim for the maximum degree of flexion (flexion) and extension.

Driving – If your left knee joint has been operated on and you drive a car with an automatic transmission, you can start driving after a week or a little later.
It is important to stop the drug pain treatment.
If the operated knee is the right one, you have to wait six to seven weeks before driving. It should be noted that the reflexes are not yet present as before the operation.

Metal detectors at airports – The sound signal at the passage depends on the sensitivity of the machine and it is unlikely that the prosthesis will trigger an alarm.
You should carry a medical certificate that identifies a metal knee joint.

Sexual activity – Sexual activity can resume four to six weeks after surgery.

Sleeping positions – You can sleep on your back, on both sides or on your stomach.

Return to work – Return to work depends on the type of activity. It can take six to eight weeks before you can return to work.

Other activities – walking at will, but it must be remembered that walking does not replace the exercises recommended by the doctor and physiotherapist. Swimming is recommended.
You can start as soon as the stitches are removed and the wound has healed about 6-8 weeks after the operation.
Permitted activities are dancing, playing golf and cycling on flat tracks.
To avoid: tennis, climbing, contact sports (such as football, baseball, American football and rugby), squash, skiing or running.
You should not do heavy work (loads over 18 kg) or lift weights.

Rehabilitation protocol

Phase I: postoperative phase (day 0-3)

The goals of physiotherapy in the early postoperative period are:

– reduce swelling, – increase range of motion, – improve muscle strength,

– maximize patient autonomy.

Phase II – Phase of movement (3rd day – 6th week)

Therapeutic exercises:

• Stretching in flexion and extension.
• Exercise bike: you start with partial circular movements (quarter circle) and then expand the amplitude until you finally reach a whole revolution.
• Mobilization of the kneecap and knee joint.
• Continue with isometric exercises of quadriceps, thigh biceps and glutes.
• Movements with the stretched leg in 4 planes (flexion, abduction, adduction, extension)

4th-6th week

• Continue with the previous exercises and isometric activities (contractions without movement).
• Start with isotonic exercises (the isotonic movement involves muscle contraction as the leg moves).
• Step frontally and sideways.
• 1/4 lunge forward.
• Use the sitting position during breaks to increase knee flexion.
• Continue with the exercise bike to extend the range of motion.
• Start a rehabilitation program in the pool when the skin lesion has healed after surgery.

Phase III – Intermediate Phase (week 7-12)

Therapeutic exercises:

• Continue with the exercises from Phase II with increasing resistance and repetition. It is recommended to evaluate the stability of hip and knee joints and to explain well to patients how to perform the exercises.
• Continue with the mobilization of the kneecap and knee joint.
• Start with an endurance program (walking or swimming).
• Perform exercises to restore balance according to the age of the patient.

Phase IV – advanced strengthening (12th-16th week):

Therapeutic exercises:

• The previous exercises continue with increasing consistency and repetition.
• Increase the duration and severity of the exercises.
• Resume leisure activities: running, tennis, golf, etc.

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