Knee Rehabilitation


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Shoulder Replacement

Provided by Wockhardt Hospital
Brought to you by Healthbase

Shoulder ReplacementSimilar to other joint replacement procedures, shoulder replacement surgery is generally done to address persistent pain that is not controlled by non-surgical therapy. Less commonly, poor shoulder motion may also be a reason for replacement surgery.

The shoulder is a ball-and-socket joint, with the top of the arm bone (humeral head) fitting into a socket known as the glenoid. Muscles and tendons, such as the rotator cuff, help hold the joint in place. Surgery involves replacing the humeral head and the glenoid with artificial components. The humeral head replacement is generally made from a metal alloy, while the glenoid component is made from polyethylene plastic. The new components may be anchored by cement or press-fit into place so that the bone grows in around them.

During surgery, a three- to four-inch incision is made along the space between the arm and the collarbone. The procedure lasts about 90 minutes, and the incision is then closed with staples or stitches. Patients typically stay in the hospital for one to two nights, and full recovery usually takes six to 12 weeks.

 

Rehabilitation

 

Arthritic shoulders are stiff. One of the major goals of total shoulder replacement surgery is to relieve much of this stiffness. However, after surgery scar tissue will tend to recur and limit movement unless motion is started immediately. This early motion is facilitated by the complete surgical release of the tight tissues so that after surgery the patient has only to maintain the range of motion achieved at the operation. Later on, once the shoulder is comfortable and flexible, strengthening exercises and additional activities are started.

A careful, well-planned rehabilitation program is critical to the success of a shoulder replacement. You usually start gentle physical therapy on the first day after the operation. You wear an arm sling during the day for the first several weeks after surgery. You wear the sling at night for 4 to 6 weeks. Most patients are able to perform simple activities such as eating, dressing and grooming within 2 weeks after surgery. Driving a car is not allowed for 6 weeks after surgery.

Here are some “do’s and don’ts” for when you return home:

  • Don’t use the arm to push yourself up in bed or from a chair because this requires forceful contraction of muscles.

  • Do follow the program of home exercises prescribed for you. You may need to do the exercises 4 to 5 times a day for a month or more.

  • Don’t overdo it! If your shoulder pain was severe before the surgery, the experience of pain-free motion may lull you into thinking that you can do more than is prescribed. Early overuse of the shoulder may result in severe limitations in motion.

  • Don’t lift anything heavier than a glass of water for the first 6 weeks after surgery.

  • Do ask for assistance. Your physician may be able to recommend an agency or facility if you do not have home support.

  • Don’t participate in contact sports or do any repetitive heavy lifting after your shoulder replacement.

  • Do avoid placing your arm in any extreme position, such as straight out to the side or behind your body for the first 6 weeks after surgery.
    Many thousands of patients have experienced an improved quality of life after shoulder joint replacement surgery. They experience less pain, improved motion and strength, and better function

Frequently Asked Questions

 

What are the symptoms to detect Shoulder Replacement?

 

Patients with arthritis typically describe a deep ache within the shoulder joint. Initially, the pain feels worse with movement and activity, and eases with rest. As the arthritis progresses, the pain may occur even when you rest. By the time a patient sees a physician for the shoulder pain, he or she often has pain at night. This pain may be severe enough to prevent a good night’s sleep. The patient’s shoulder may make grinding or grating noises when moved. Or the shoulder may catch, grab, clunk or lock up. Over time, the patient may notice loss of motion and/or weakness in the affected shoulder. Simple daily activities like reaching into a cupboard, dressing, toileting and washing the opposite armpit may become increasingly difficult.

 

How do I know if I am ready for shoulder replacement surgery?

 

Patients who have tried the usual treatments for shoulder arthritis, but have not been able to find adequate relief, may be a candidate for shoulder replacement surgery. Patients considering the procedure should understand the potential risks of surgery, and understand that the goal of joint replacement is to alleviate pain. Patients generally find improved motion after surgery, but these improvements are not as consistent as the pain relief following shoulder replacement surgery.

 

How long is the recovery following shoulder replacement surgery?

 

Hospital stays vary from one to three days for most patients. You will be sent home wearing a sling and you should not attempt to use the arm except as specifically instructed by your doctor.

Most physicians will begin some motion immediately following surgery, but this may not be true in every case. Usually within two to three months, patients are able to return to most normal activities and place an emphasis on strengthening the muscles around the shoulder and maintaining range of motion.

 

What are the symptoms of severe arthritis of the shoulder?

 

Common symptoms of shoulder arthritis include:

  • Pain with activities

  • Limited range of motion

  • Stiffness of the shoulder

  • Swelling of the joint

  • Tenderness around the joint

  • A feeling of grinding or catching within the joint

Can rehabilitation be done at home?

 

In general the exercises are best performed by the patient at home. Occasional visits to the surgeon or therapist may be useful to check the progress and to review the program.

 

When can I return to ordinary daily activities?

 

In general, patients are able to perform gentle activities of daily living using the operated arm from two to six weeks after surgery. Walking is strongly encouraged. Driving should wait until the patient can perform the necessary functions comfortably and confidently. Recovery of driving ability may take six weeks if the surgery has been performed on the right shoulder, because of the increased demands on the right shoulder for shifting gears.

With the consent of their surgeon, patients can often return to activities such as swimming, golf and tennis at six months after their surgery.


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Unicondylar Knee Replacement

Provided by Wockhardt Hospital
Brought to you by Healthbase

Most people are aware of the total knee replacement surgery. This involves replacing the unhealthy surface of the entire knee joint with metal and plastic implants. It is a very successful operation with good long term results. However a large percentage of patients have arthritis limited to one part of the joint alone. Replacing the whole joint in these patients is overkill and unnecessary.

Knee ReplacementMany middle aged men and women develop osteoarthritis of the knee. Osteoarthritis of the knee affects the inner half or medial compartment to start with and then proceeds to affect the outer half or lateral compartment.

In this operation only that part of the knee, which is unhealthy, is replaced. The normal surfaces are left alone. This operation has several advantages over total knee replacement surgery.

  • It can be done through a very small incision.

  • It is minimally invasive and hence tissue damage is far less.

  • The patient gets complete pain relief and the implant lasts long

  • The knee feels more natural as ligaments are preserved

  • Range of movement is full and it allows squatting and sitting crosslegged

  • Post operative hospitalization is reduced and return to normal is much faster than total knee replacement surgery.

Dr. Kaushal Malhan is a Joint Replacement and sports surgeon at the Wockhardt hospital. He was the first surgeon in India to do the mobile bearing oxford unicompartmental knee replacement and has been in the forefront in the field of full bending knee replacement surgery.

 

 

 

 

 

 

 

Frequently Asked Questions

 

  • What is unicondylar arthroplaty, or partial knee replacement?
  • What are the advantages unicondylar arthroplasty?
  • How is it different from total knee replacement?
  • You mentioned recovery is faster. What does that mean?
  • What does the surgeon do during a unicondylar arthroplasty?
  • How do I know if I am a candidate for this surgery?
What is unicondylar arthroplaty, or partial knee replacement?Partial knee replaces only the area of the knee that is worn out, sparing patients the more medically complicated and involved total knee replacement surgery.

 

What are the advantages unicondylar arthroplasty?With a partial knee replacement, there is a dramatically shorter recovery time due to less surgical trauma, less scarring and fuller range of motion.

 

How is it different from total knee replacement?

During total knee replacement, surgeons typically make a 7 to 8-inch incision over the knee, patients stay in the hospital for approximately four days, and there is a recovery period of up to three months. During minimally-invasive partial knee surgery, a part of the knee to be replaced through a small, 3-inch incision. There is minimal damage to the muscles and tendons around the knee and the required hospital stay is up to two days. The recovery period is about one month.

 

Total Knee Replacement

 

You mentioned recovery is faster. What does that mean?

Patients often walk unassisted within a week or two of the operation. Even those who have both knees done at once are able to walk without the assistance of a walker or cane fairly quickly.

 

What does the surgeon do during a unicondylar arthroplasty?When a knee replacement is performed, some bone and cartage are removed using precise instruments to create exact surfaces to accommodate a metal and plastic prostheses.

 

How do I know if I am a candidate for this surgery?

Candidates for this surgery are generally younger, more active patients. The partial knee replacement allows for symptoms of pain or discomfort. The procedure allows younger patients to buy time before they need a full knee replacement. The procedure is also effective for older patients if they have disease localized to one half of the joint.

 


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To become a Healthbase member, just click here. It takes less than two minutes to register. Registration is simple, easy and free.

©2006 Healthbase Online Inc. All rights reserved.  |  About us
The contents or materials provided in this website are for general information only and are not intended as medical advice

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Total Knee Replacement

Provided by Wockhardt Hospital
Brought to you by Healthbase

Your knees work hard during your daily routine, and arthritis of the knee or a knee injury can make it hard for you to perform normal tasks. If your injury or arthritis is severe, you may begin to experience pain when you are sitting down or trying to sleep.

Sometimes a total knee replacement is the only option for reducing pain and restoring a normal activity level. If your and your doctor decide a total knee replacement is right for you, the following information will give you an understanding about what to expect.

A total knee replacement involves replacing the damaged bone and cartilage of the knee joint, which provides articulating surfaces.

The total procedure takes approximately an hour to hour and a half to perform and recovery time varies between patients. Correct rehabilitation following surgery significantly improves outcomes.

 

Implant Components

 

Total Knee ReplacementIn the total knee replacement procedure, each prosthesis is made up of four parts. The tibial component has two elements and replaces the top of the shin bone (tibia). This prosthesis is made up of a metal tray attached directly to the bone and a plastic spacer that provides the bearing surface.

The femoral component replaces the bottom of the thigh bone (femur). This component also replaces the groove where the patella (kneecap) sits.

The patellar component replaces the surface of the kneecap, which rubs against the femur. The kneecap protects the joint, and the resurfaced patellar button slides smoothly on the front of the joint. This may or may not be replaced depending on the condition of the patient.

 

Advantages of Total Knee Replacement

 

The most important advantage is that this operation produces very effective and long lasting relief from joint pain. It also gives a joint which functions normally. The recovery period from the operation is very short and the patient is able to walk from the second or the third day after the operation. Walking support that is needed can often be discarded by around a month’s time. The patient regain a normal lifestyle and mobility with significant improvement in quality of life.

 

Exercise Program and Physical Therapy/ Rehabilitation after Knee Surgery

 

Knee replacement surgery is a complex procedure, and physical knee rehabilitation is crucial to a full recovery. In order for you to meet the goals of total knee surgery, you must take ownership of the rehabilitation process and work diligently on your own, as well as with your physical therapist, to achieve optimal clinical and functional results. The knee rehabilitation process following total knee replacement surgery can be quite painful at times.

Your knee rehabilitation program begins in the hospital after surgery. Early goals of knee rehabilitation in the hospital are to reduce knee stiffness, maximize post-operative range of motion, and get you ready for discharge.


When muscles are not used, they become weak and do not perform well in supporting and moving the body. Your leg muscles are probably weak because you haven’t used them much due to your knee problems. The surgery can correct the knee problem, but the muscles will remain weak and will only be strengthened through regular exercise. You will be assisted and advised how to do this, but the responsibility for exercising is yours.

Your overall progress, amount of pain, and condition of the incision will determine when you will start going to physical therapy. You will work with physical therapy until you meet the following goals:

1. Independent in getting in and out of bed.
2. Independent in walking with crutches or walker on a level surface.
3. Independent in walking up and down 3 stairs.
4. Independent in your home exercise program.

Your doctor and therapist may modify these goals somewhat to fit your particular condition.

In your physical therapy sessions you will walk, using crutches or a walker, bearing as much weight as indicated by your doctor or physical therapist. You will also work on an exercise program designed to strengthen your leg and increase the motion of your knee.

Your exercise program will include the following exercises:

 


Quadriceps Setting
The quadriceps is a set of four muscles located on the front of the thigh and is important in stabilizing and moving your knee. These muscles must be strong if you are to walk after surgery. A “quad set” is one of the simplest exercises that will help strengthen them.

Lie on your back with legs straight, together, and flat on the bed, arms by your side. Perform this exercise one leg at a time. Tighten the muscles on the top of one of your thighs. At the same time, push the back of your knee downward into the bed. The result should be straightening of your leg. Hold for 5 seconds, relax 5 seconds; repeat 10 times for each leg.

You may start doing this exercise with both legs the day after surgery before you go to physical therapy. The amount of pain will determine how many you can do, but you should strive to do several every hour. The more you can do, the faster your progress will be. Your nurses can assist you to get started. The following diagram can be used for review.

 

Terminal Knee Extension
This exercise helps strengthen the quadriceps muscle. It is done by straightening your knee joint.

Lie on your back with a blanket roll under your involved knee so that the knee bends about 30-40 degrees. Tighten your quadriceps and straighten your knee by lifting your heel off the bed. Hold 5 seconds, then slowly your heel to the bed. You may repeat 10-20 times.

 

Knee Flexion
Each day you will bend your knee. The physical therapist will help you find the best method to increase the bending (flexion) of your knee. Every day you should be able to flex it a little further. Your therapist will measure the amount of bending and send a daily report to your doctor.

In addition, your therapist may add other exercises as he or she deems necessary for your rehabilitation.

 

Straight Leg Raising
This exercise helps strengthen the quadriceps muscle also.
Bend the uninvolved leg by raising the knee and keeping the foot flat on the bed. Keeping your involved leg straight, raise the straight leg about 6 to 10 inches. Hold for 5 seconds. Lower the leg slowly to the bed and repeat 10-20 times.

Once you can do 20 repetitions without any problems, you can add resistance (ie. sand bags) at the ankle to further strengthen the muscles. The amount of weight is increased in one pound increments.

 

Use of heat and ice

Ice: Ice may be used during your hospital stay and at home to help reduce the pain and swelling in your knee. Pain and swelling will slow your progress with your exercises. A bag of crushed ice may be placed in a towel over your knee for 15-20 minutes. Your sensation may be decreased after surgery, so use extra care.

Heat: If your knee is not swollen, hot or painful, you may use heat before exercising to assist with gaining range of motion. A moist heating pad or warm damp towels may be used for 15-20 minutes. Your sensation may be decreased after surgery so use extra care.

 

Long-Term Knee Rehabilitation Goals
Once you have completed your knee rehabilitation therapy, you can expect a range of motion from 100-120 degrees of knee flexion, mild or no pain with walking or other functional activities, and independence with all activities of daily living.

 

 

Guidelines at Home – What happens after I go home?

 

Medication

  • You will continue to take medications as prescribed by your doctor.

  • You will be sent home on prescribed medications to prevent blood clots. Your doctor will determine whether you will take a pill (Warfarin or coated aspirin) or give yourself an injection. If an injection is necessary, your doctor will discuss it with you, and the nursing staff will teach you or a family member what is necessary to receive this medication.

  • You will be sent home on prescribed medications to control pain. Plan to take your pain medication 30 minutes before exercises. Preventing pain is easier than chasing pain. If pain control continues to be a problem, call your doctor.

Activity

  • Continue to walk with crutches/walker.

  • Bear weight and walk on the leg as much as is comfortable.

  • Walking is one of the better kinds of physical therapy and for muscle strengthening.

  • However, walking does not replace the exercise program which you are taught in the hospital. The success of the operation depends to a great extent on how well you do the exercises and strengthen weakened muscles.

  • If excess muscle aching occurs, you should cut back on your exercises.

Other Considerations

  • For the next 4-6 weeks avoid sexual intercourse. Sexual activity can usually be resumed after your 6-week follow-up appointment.

  • You can usually return to work within two to three months, or as instructed by your doctor.

  • You should not drive a car until after the 6-week follow-up appointment.

  • Continue to wear elastic stockings (TEDS) until your return appointment.

  • No shower or tub bath until after staples are removed.

  • When using heat or ice, remember not to get your incision wet before your staples are removed.

 

Your Incision

 

Keep the incision clean and dry. Also, upon returning home, be alert for certain warning signs. If any swelling, increased pain, drainage from the incision site, redness around the incision, or fever is noticed, report this immediately to the doctor. Generally, the staples are removed in three weeks.

 

Prevention of Infection

 

If at any time (even years after the surgery) an infection develops such as strep throat or pneumonia, notify your physician. Antibiotics should be administered promptly to prevent the occasional complication of distant infection localizing in the knee area. This also applies if any teeth are pulled or dental work is performed. Inform the general physician or dentist that you have had a joint replacement. You will be given a medical alert card. This should be carried in your billfold or wallet. It will give information on antibiotics that are needed during dental or oral surgery, or if a bacterial infection develops.

 

Frequently Asked Questions

 
  • Who is a candidate for a total replacement?
  • What are the risks of total knee replacement?
  • When do I return to the clinic?
  • Should I have a total knee replacement?
  • Who develops a more severe or an earlier arthritis?
  • When can I return home?
  • What measures should be taken after the surgery/operation (Post operative instruction)
  • What activities should I Avoid after Knee Replacement?

Q 1 Who is a candidate for a total replacement?

 

Total knee replacements are usually performed on people suffering from severe arthritic conditions. Most patients who have artificial knees are over age 55, but the procedure is performed in younger people.

The circumstances vary somewhat, but generally you would be considered for a total knee replacement if:

  • You have daily pain.

  • Your pain is severe enough to restrict not only work and recreation but also the ordinary activities of daily living.

  • You have significant stiffness of your knee.

  • You have significant instability (constant giving way) of your knee.

  • You have significant deformity (knock-knees or bowlegs).

Q 2 What are the risks of total knee replacement?

 

Total knee replacement is a major operation. The most common complications are not directly related to the knee and usually do not affect the result of the operations. These complications include urinary tract infection, blood clots in a leg, or blood clots in a lung.

Complications affecting the knee are less common, but in these cases the operation may not be as successful. These complications include:

  • some knee pain

  • loosening of the prosthesis

  • stiffness

  • infection in the knee

A few complications such as infection, loosening of prosthesis, and stiffness may require reoperation. Infected artificial knees sometimes have to be removed. This would leave a stiff leg about one to three inches shorter than normal. However, your leg would usually be reasonably comfortable, and you would be able to walk with the aid of a cane or crutches, and a shoe lift. After a course of antibiotics the surgery can often be repeated to give a normal knee.

 

Q 3 When do I return to the clinic?

 

Even if everything is fine, it is advisable to return every three years after the surgery for a review.

 

Q 4 Should I have a total knee replacement?

 

Total knee replacement is an elective operation. The decision to have the operation is not made by the doctor, it is made by you. All your questions should be answered before you decide to have the operation.

 

Q 5 Who develops a more severe or an earlier arthritis?

 

One who has family history (this having a strong hereditary influence), who has history of injury in the joint (e.g. a fracture or a ligament/meniscal injury in the knee), who has deformity of knees and the one who is overweight. Medicines are not the treatment for this form of arthritis. Weight reduction, regular exercises, local heat therapy help in early stages. Physiotherapy is the mainstay of the treatment. Painkillers should be used only occasionally as they adversely affect our kidneys, cause intestinal ulcers and bleeding.

Another form of Arthritis is Inflammatory arthritis (Rheumatoid or its variants). This does need medical treatment (DMARD’s), which changes the course of the disease and prevents further damage to joints. Surgical treatment is needed when structural joint changes have taken place. Before and after the surgery, the patient should remain under care of a Physician/Rheumatologist.

Post Traumatic Arthritis can follow a serious knee injury. A knee fracture or severe tears of the knee’s ligaments may damage the articular cartilage over time, causing knee pain and limiting knee function.

 

Q 6 When can I return home?

 

You will be discharged when you can get out of bed on your own and walk with a walker or crutches, walk up and down three steps, bend your knee 90 degrees, and straighten your knee.

 

Q 7 What measures should be taken after the surgery/operation (Post operative instruction)

 

The success of your surgery also will depend on how well you follow your orthopaedic surgeon’s instructions at home during the first few weeks after surgery.

Wound Care you will have stitches or staples running along your wound or a suture beneath your skin on the front of your knee. The stitches or staples will be removed several weeks after surgery. A suture beneath your skin will not require removal.

Avoid soaking the wound in water until the wound has thoroughly sealed and dried. A bandage may be placed over the wound to prevent irritation from clothing or support stockings.

Diet some loss of appetite is common for few days after surgery. A balanced diet, often with an iron supplement, is important to promote proper tissue healing and restore muscle strength.

Activity Exercise is a critical component of home care, particularly during the first few weeks after surgery. You should be able to resume most normal activities of daily living within three to six weeks following surgery. Some Pain with activity and at night is common for several weeks after surgery. Your activity program should include:

  • A graduated walking program to slowly increase your mobility, initially in your home and later outside.

  • Resuming other normal household activities, such as sitting and standing and walking up and down stairs.

  • Specific exercises several times a day to restore movement and strengthen your knee. You probably will be able to perform the exercises without help, but you may have a physical therapist help you at home or in a therapy center the first few weeks after surgery.

Driving usually begins when your knee bends sufficiently so you can enter and sit comfortably in your car and when your muscle control provides adequate reaction time for braking and acceleration. Most individuals resume driving about four to six weeks after surgery.

 

Q 8 What activities should I Avoid after Knee Replacement?

 

Even though you may increase your activity level after a knee replacement, you should avoid high-demand or high-impact activities. You should definitely avoid running or jogging, contact sports, jumping sports, and high impact aerobics.

You should also try to avoid vigorous walking or hiking, skiing, tennis, repetitive lifting exceeding 50 pounds, and repetitive aerobic stair climbing. The safest aerobic exercise is biking (stationary or traditional) because it places very little stress on the knee joint.

 


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