A total knee replacement (TKR) is a surgical procedure designed to alleviate pain and restore function in a damaged knee joint. A crucial aspect of recovery involves regaining knee flexion, the ability to bend the knee, which is essential for everyday activities.
Understanding Knee Flexion After TKR
Knee flexion, the degree to which the knee can bend, is a key measure of recovery after total knee replacement. Restoring this range of motion is important for performing routine daily tasks. Activities such as walking, climbing stairs, sitting down, and getting in and out of a car or bathtub all depend on adequate knee flexion.
While individual needs vary, a minimum of 100-110 degrees of knee flexion is generally considered necessary for basic activities like sitting and walking. More demanding activities, such as squatting or kneeling, may require a greater range, potentially up to 135 degrees or more.
Effective Exercises and Home Strategies
Regaining knee flexion after TKR requires consistent effort through specific exercises and home strategies, guided by your physical therapist.
The heel slide can be performed while sitting or lying down. Gently slide the heel of your operated leg towards your buttocks, bending your knee as far as comfortable, then slowly straighten the leg. Using a plastic bag or towel under your heel can help it slide smoothly.
The wall slide helps improve both flexion and extension. Lie on your back with your feet resting on a wall, then slowly slide your operated leg down the wall to bend your knee. You can use your other leg for gentle assistance. This exercise leverages gravity to aid in increasing the bend.
For improving knee extension, the prone hang exercise is effective. Lie face down on a bed with your kneecaps just off the edge, allowing gravity to gently pull your lower leg downwards. You can increase the stretch by placing your other foot on the heel of your operated leg. Maintain this position for several minutes for a gentle, sustained stretch.
A continuous passive motion (CPM) machine may be recommended in early recovery. This motorized device gently moves the knee through a set range of motion without requiring muscle exertion. While its long-term benefits are debated, it can reduce stiffness and improve pain and function in the initial weeks. Remember to perform exercises with controlled, gentle movements within a pain-free range, gradually increasing the stretch.
Overcoming Common Obstacles
Patients often encounter challenges when working to increase knee flexion, with pain and swelling being among the most common. Effective pain management ensures consistent exercise participation. Your healthcare provider will prescribe pain medication, which should be taken as directed, especially before physical therapy sessions. Applying ice packs to the knee can also help reduce both pain and swelling.
Swelling is a normal response to surgery and can persist for several weeks or even months. To help control it, elevate your leg above the level of your heart whenever possible. Performing ankle pumps can improve circulation and reduce swelling. Compression stockings may also be recommended.
Maintaining consistency with your exercise program is paramount, even when progress seems to plateau. Recovery is a gradual process, requiring patience and persistence. If you experience a plateau, discuss it with your physical therapist, as they can adjust your program to introduce new techniques or modify existing ones to help you continue progressing.
Recognizing Progress and Knowing When to Consult Professionals
Monitoring progress after TKR involves observing daily activities and improvements in knee range of motion. Most significant gains in knee flexion occur within the first few months, often plateauing around three months. By the end of week one, a common goal is to achieve at least 90 degrees of knee flexion, progressing to 100 degrees by weeks two to three, and 110-120 degrees by weeks four to six.
While discomfort is expected, certain signs indicate a need to consult your physical therapist or surgeon. These include sudden, severe pain, increased or persistent swelling, or signs of infection like redness, warmth, or discharge from the incision site. If you notice a lack of progress despite consistent effort, or if your knee feels unstable, professional guidance is important.