General Advive

Welcome to the JRIN exercise and safe procedures section

We are indebted to Jill Pope - Clinical Physiotherapy Specialist at Broadgreen Hospital for supplying most of the invaluable information contained within these pages

Guidelines for progression of patients who have had total knee joint replacement following discharge from hospital

The aims of post-operative procedure are:

To increase mobility of the knee

     - Flexion 90º

     - Extension 0°

To increase the strength of the quadriceps (thigh muscles) and hamstring muscles to grade 5 (normal)

To regain stability of the knee when weight bearing

To regain normal function within the limits of the surgical procedure

To encourage a lifetime maintenance program.

Method

The method of meeting these aims is that patients are taught stretching and strengthening exercises

Weight bearing progression -

Progress to one elbow crutch / walking stick when they are able to maintain knee extension and a level pelvis in single leg stand (SLS) on the operated side for 10 seconds

Progress to full weight-bearing as confidence increases (a walking stick may be used for walking long distances)

Advice

Sleeping Position

Avoid sleeping on your back with a pillow under your affected knee

You may sleep on either side but may find it more comfortable, when lying on the unoperated side to have your affected knee supported by a pillow

Hobbies

Patients may swim from six weeks following the procedure (do not use the breast stroke or kick against the side of the pool

Patients may play golf / bowls from 6 weeks

Driving

Patients should not drive until 6 weeks after the operation

If affected leg is the right leg the patient may drive after 6 weeks and when able to right SLS x 10 seconds

If affected leg is the left leg the patient may drive after 6 weeks and when comfortable in the car

Drivers should inform their insurance companies that they have had a knee joint replacement.

Circulation Exercises

These should be continued while you are in hospital and continued at home for up to two weeks after your operation.

Quadriceps Exercises

This exercise works the muscle at the front of the thigh. It is an important muscle for moving your leg and walking.

Tighten the muscle by pulling toes towards you and push the back of the knee down into the bed - hold for three seconds then relax. Try to do 10 of these every hour.

Your physiotherapist will help you progress this exercise as you recover.

Knee Flexion (Bend) Exercise

It is essential to restore/regain knee flexion as soon as possible. The physiotherapist will guide you with your exercises. It may be necessary for your physiotherapist to do gentle manipulation to help improve your range of movement.

Sit Down

A. Keep your operated leg a little in front of you.

B. Lower yourself down onto the edge of the seat using your arms, letting your operate knee bend.

C. As your knee flexion improves over the weeks after your operation you should aim to bring your
C. operated leg back in line with your other leg as you sit/stand.

Walking Upstairs with Handrail

A. Stand to the stairs. Hold onto the handrail with one hand and crutch/crutches with the other hand.

B. First take a step up with your healthy leg.

C. Then take a step up with your affected leg. Bring your crutches up on to the step. Always go one
C. step at a time.

Walking down stairs with handrail

A. Stand close to the stairs. Hold onto the handrail with one hand and the crutch/crutches with the
A. other hand.

B. First put your crutch one step down. Then take a step with your affected leg.

C. Then take a step down with your healthy leg, onto the same step as your affected leg. Always go
C. one step at a time.

Walking up stairs without handrail

A. Stand close to the stairs with the crutches.

B. First take a step up with your healthy leg.

C. Then take a step up with your affected leg. Bring your crutches up on to the step. Always go
C. one step at a time.

Walking down stairs without handrail

(Same for kerbs)

A. Stand with crutches/sticks close to the stairs.

B. First put your crutches one step down. Then take a step down with your affected leg.

C. Then take a step down with your healthy leg onto the same step as your affected leg. Always go
C. one step at a time.

Driving

Your physiotherapist will give you guidance regarding when you can return to driving, (6-12 weeks is the rough guide). If after a period you find it possible to sit comfortably in a car, and when it is stationary you are able to perform an emergency stop without hesitation or discomfort, then you may return to driving. This can be clarified at your outpatient clinic appointment.

Before you drive, you must contact your motor insurance company and inform then that you have had a total knee replacement. (Some companies may ask you for a doctor’s note to confirm you are medically fit to drive). Failure to do so may render your policy invalid.

If you take a new motor insurance policy out in the future (even in several years time) it is still advisable to inform the insurance company about your new knee. If you currently hold an ordinary car licence you do not need to inform DVLC at Swansea. (Please inform DVLC if you hold a HGV licence).

Getting in and out of your car

Getting into the passenger seat

• Move the seat as far back as possible and if possible recline the seat backwards. If possible get
• into the car from a driveway or road rather than a pavement.

• Keeping your operated leg straight out in front of you, or if you are able to bend your knee you
• may do so, then lower your bottom onto the seat.

• Slide your bottom back towards the driver’s seat.

• Turn carefully and slide legs down into the well of the car one at a time.

Getting out of the car

• Reverse of getting in the car.

Quadriceps Exercise with support

A. Lie on the floor with your good leg bent and your affected leg supported by a plastic bottle
A. wrapped in a towel.
B. Exercise your affected leg by pulling your foot and toes up tightening your Quadriceps muscle.

C. Hold for five seconds and repeat 10 times.

After discharge from hospital you may progress to the following exercises. Your physiotherapist will advise you.

Sitting down knee extension (straighten) exercise.

This exercise works the quadriceps muscle at the front of the thigh.

A. Sit comfortably in a chair such as a dining chair.

B. Slowly raise the foot of the affected leg to a level position.

C. Hold for five seconds and then lower.

Standing with support knee bend

A. Standing with support for balance.

B. Keep the thigh straight and bend your knee at a 90° angle. Do not lean forward but try to stay as
B. straight as possible.

C. Hold for five seconds and lower, perform this exercise slowly as you are able to maintain control
C. and balance. Ankle weights may be used to increase resistance - Ask your physiotherapist.