Orthopedic surgeons routinely prescribe inpatient physical therapy for their total knee replacement patients. Most patients recuperate for several days on the orthopedic floor of the hospital. As long as there are no surgical complications, such as an infection or severe bleeding, the patient will be encouraged to walk the day after surgery with the help of one or two physical therapists. During the first day or two, physical therapy will be fairly light.
The CPM Machine
Some surgeons prescribe the use of a Continuous Passive Motion (CPM) machine for their patients. The leg that was operated on is placed in this comfortably padded machine that simply bends the new knee slowly in and out, starting at a very mild angle and slowly increasing over time. Some patients will actually wake up already in the CPM machine, while others will be placed in it a few hours after surgery or the next day. Each surgeon will differ on how many hours per day he wants the patient to use the machine and for how many days or weeks after surgery.
Although the CPM machine can be a great help in gaining range of motion and preventing scar tissue formation, active physical therapy is necessary for a full, successful recovery. After a day or two of recovery, most patients are transferred to a different floor of the hospital or to a separate inpatient rehab facility, where physical therapy (PT) becomes more aggressive and focused.
Inpatient Rehab
How long the patient stays in rehab depends on the goals set by both surgeon and patient and how fast they are achieved. In most cases, the short-term goals are intended to make the patient safe and functional when she returns home, while the long-term goal is to achieve as much range of motion (ROM) in the knee implant as possible. Again, surgeons will differ as to the exact ROM numbers they want their patients to achieve. Some will give the patient and physical therapist exact numbers, such as –5 degrees of extension (straightening the knee) and 120 degrees of flexion (bending the knee). Others give functional goals such as the ability to go up and down stairs, get dressed, get on and off the toilet, get in and out of a car, etc. Pain management is another important goal of rehab; the patient will likely be weaned slowly off pain medication and encouraged to use ice, massage, elevation and rest to control pain.
Physical Therapy at Home
When the patient is ready to go home, she will be given some combination of home exercises and outpatient physical therapy visits to continue to strengthen the new knee and make it as flexible as possible. Patients are encouraged to do their home exercises faithfully according to the doctor’s and therapist’s instructions. Exercising regularly not only produces a more successful result – a knee that works as much as possible like the original – but also helps prevent scar tissue from building under the skin. Scar tissue can be painful and prevent the knee from bending fully.
However, it’s important to note that people progress and heal at varying rates for many different reasons. Patients who have difficulty with PT or don’t reach their goals quickly can worry that they have failed or that they are weak or “wimpy.” This is not the case! Total knee replacement is a serious operation, and each person’s body reacts to major surgery in a different way. The key is to work with the entire medical team to find what works best for each patient.
For example, it is important for the patient to push herself to a certain extent and work hard in physical therapy. But it’s also crucial to pay attention to the body’s signals. Excessive pain, swelling, discoloration of the knee or leg, fever, extreme exhaustion – all of these things are signs that something may be wrong, and these must be brought to a doctor’s attention.
Pain Management Tips
Ice packs applied to the knee before and after physical therapy help to decrease the pain and swelling. Some patients find it helpful to time their pain medications for right before therapy, so they get the most benefit during the therapy session. But PT should not be excruciatingly painful. There is always going to be some level of pain, but if the pain is unbearable, and/or lasts for hours after going home, the patient should talk to the therapist or surgeon about it.
The patient should also talk to these caregivers if she feels she is not getting the expected and desired results. Aggressive physical therapy and a great attitude are the key to a successful recovery – but it’s also a team effort.
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