Total Knee Replacement in Happy Valley

Knee replacements are becoming one of the most common orthopedic surgeries in the US. Our beloved Baby Boomer generation in particular, who have led active lifestyles, are in the prime of feeling their activities “catch up” to them, but don’t have any plans to slow down. With mild to moderate knee arthritis, modifying activities and participation in a prescribed exercise plan can stave off or slow down the progression of arthritic degenerative changes with physical therapy. Once the arthritic changes are causing pain that is interfering with your life & recreational pursuits but not resolved with a prescriptive exercise approach, a discussion with your preferred orthopedist is warranted. The old adage of “wait until it can’t get any worse” before having your knee replacement is now outdated from newer research indicating better outcomes if you don’t wait that long.   

Physical Therapy Before Your Knee Replacement

Your physical therapist can guide you in targeted stretching and strengthening activities to maximize your function before the replacement, and help you understand what to expect after your surgery. Advice and training for activities shortly after your surgery would include among other things:

  • Getting in/out of a car
  • Set up of bathroom equipment
  • Reduction of fall risks
  • Training in assistive device use for walking

Establishing how to perform these seemingly simple tasks before they become complex and uncomfortable makes a world of difference early in recovery. Accidental falls and infections are the most common culprits of complications relating to your knee replacement.

Physical Therapy After Your Knee Replacement

Typically, you can begin outpatient rehabilitation at Ascent Physical Therapy the same week as your surgery. Establishing a home program of activities for you to be performing several times per day can greatly accelerate early recovery efforts. Even though the replacement was to fix the painful condition of arthritis, your body will interpret the surgery as a large injury. You should expect some level of discomfort following the surgery and it is important to use pain management strategies provided by your orthopedist as instructed.

Early mobility is paramount to optimal results for your knee replacement. Regaining your mobility and strength is uncomfortable, but rest assured you are not causing any damage to your knee. Initially, mobilization shouldn’t be overly aggressive while your incision is healing. Once the incision is healed, the scar tissue will also need to be mobilized to prevent long term symptoms.

Common Questions / Concerns

How long does a typical recovery take?

A typical recovery in physical therapy takes 6-10 weeks. There are many factors that influence the speed of recovery including but not limited to: general health before surgery, compliance to prescribed home program, and your bodies tendency to heal. Some individuals are back to “functional” in a month, others may take closer to 3 months. Most surgeons will tell you it can take up to a full year before your knee feels “normal”.

What are signs of complications?

  • Feeling feverish / having an elevated temperature
  • Knee is hot to touch and quite tender
  • Incision isn’t closing
  • Any foul smelling odors coming from your incision
  • Discolored fluids, especially if it is thick
  • Feeling unusual shortness of breath
  • Intense throbbing pain or deep aching in calf and/or groin

If you are experiencing these things, call your surgeon’s office for consultation. Although rare, these things do happen. In 2015, we caught an infection early in the clinic and the patient underwent surgery in less than 24 hours.

What amount of motion should I expect?

During your surgery after the replacement is complete but before you are moved to the recovery room, your surgeon passively bends your knee to ensure a full potential amount is available. At the conclusion of your physical therapy the minimum amount of bend, or flexion, should be 110 degrees, ideal is 120 degrees, and the gold standard is 130 degrees. Your knee should also be able to fully straighten. This is imperative to be able to walk normally again. If you can’t fully extend it creates a leg length discrepancy which, long term, can result in chronic: back pain, hip pain, knee pain, ankle/foot pain. Your potential amount will depend on several factors, such as – how much motion did you have before surgery? Are you following the prescribed treatment program? And how much scar tissue do you normally produce after injury?

What if I don’t achieve the ideal amount?

If the motion is quite limited and isn’t responding to conservative techniques, your surgeon may opt for a MUA, or manipulation under anesthesia, to break through the scar tissue. You are asleep for the procedure but will be quite sore afterward and it is strongly encouraged to aggressively mobilize your knee immediately after and for the next 5-7 days.

General Tips for Success!

  • Use cold packs. A lot. For the first 1-2 weeks you should be applying some form of cold therapy to your knee every few hours.
  • After your incision is closed, you’ll want to apply a scar cream or heavy moisturizer while performing a moderate pressure massage. This can keep the scar tissue pliable and flexible to achieve maximum bend.
  • Get access to a recumbent bike (the style you lean back in with a backrest). You won’t be able to pedal a full revolution at first, but rocking the pedals back and forth will assist in gaining more motion while also pumping out swelling. These are quite common at any gym. Or, you can usually find one on CraigsList for $100 or less sometimes.
  • Try to stay active within tolerance. Prolonged sitting or standing still will increase your stiffness.
  • Be sure to follow your home exercise program as instructed!

If you have had or are planning on having a knee replacement, call us today to get started on a plan of care that works for you. Ascent Physical Therapy is conveniently located off Sunnyside Road in Happy Valley. We also love treating our neighboring communities of Damascus, Gresham, Clackamas, and Sandy at our top rated physical therapy clinic!