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What is a Total Knee Replacement?

Total Knee Replacement

Sheilah Hallman, PT, DPT

A total knee arthroplasty, or total knee replacement, is a surgical procedure that results from some sort of degenerative joint disease, such as osteoarthritis, in which the joint is removed and replaced with metal or prosthetic parts. Knee replacements are one of the most commonly performed orthopedic surgery on the legs. 

Factors that are associated with positive outcomes following a total knee replacement include:

  • Preoperative education
  • Preoperative exercise programs
  • Postoperative use of ice for pain management early-on
  • Early physical activity and mobility with appropriate progressions post-op
  • Balance training
  • Gait training

Factors that are associated with negative outcomes or complications following a total knee replacement include:

  • Higher BMI
  • Depression
  • Higher number of comorbidities
  • Lack of mobility, strength, and regular physical activity
  • Tobacco use
  • Lack of patient support

Common therapy timeline:

  • Typically begins within initial 24 hours post-op in the hospital → home therapy or subacute rehab → outpatient therapy

Common types of outpatient physical therapy in a post-operative care plan for a patient who has undergone a total knee replacement include: 

  • Active and passive range of motion (ROM) and stretching to the knee into flexion and extension
  • Utilization of a stationary bicycle for ROM and strength, starting with partial revolutions and eventually progressing to full revolutions
  • Joint mobilizations as appropriate for the knee
  • Transfer training, including sit-to-stand transitions, car transfers, and bed mobility
  • Postural reeducation
  • Gait training to increase independence and decrease reliance on assistive devices
  • Balance training
  • Modalities such as cryotherapy, superficial heat, and neuromuscular electrical stimulation (NMES)
  • Strengthening and exercises for not only the post-operative knee, but also the opposite knee, both hips, ankles, etc.

References:

https://academic.oup.com/ptj/article/100/9/1603/5857258?login=true

https://www.brighamandwomens.org/assets/bwh/patients-and-families/rehabilitation-services/pdfs/knee-tkr-protocol-bwh.pdf

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