home healthcarehomecareforyou.com/brochure/knee_replacement.pdf · most patients who undergo total...

Knee ReplacementPROGRAM

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Home HealthcareNightingale

With the help of Nightingale’s experienced and professional rehabilitation team, you will be guided through a more complete and successful recovery from your joint replacement surgery.

Knee replacements are performed because something has happened to the knee joint that has made it too painful for activity and structurally inadequate for weight bearing (putting weight onto) activities.

Though these are usually the only reasons a knee replacement is performed, there are many reasons why the knee becomes painful and structurally unsound. The most common issues are as follows:

Osteoarthritis (OA) - usually occurs in people 50 years of age and older and often in individuals with a family history of arthritis. The cartilage that cushions the bones of the knee softens and wears away. The bones then rub against one another, causing knee pain and stiffness. OA mainly attacks large joints, such as knees and hips.

Rheumatoid Arthritis (RA) - is an autoimmune disease in which the synovial membrane becomes thickened and inflamed, producing too much synovial fluid that overfills the joint space. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain and stiffness. RA is associated with decreased range of motion, morning joint stiffness (that lasts about an hour) and moderate to severe pain.

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

http://orthoinfo.aaos.org

Why Do I Need A Knee Replacement?

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Indications You May Need A Knee Replacement:

Severe knee pain that limits your everyday •activities, including walking, climbing stairs and getting in and out of a chair or vehicle. You may find it hard to walk more than a few •blocks without significant pain and you may

need to use a cane or walker

Most patients who undergo total knee replacement are age 60 to 80, but orthopaedic surgeons evaluate patients individually. Recommendations for surgery are based on a patient’s pain and disability, not age. Total knee replacements have been performed successfully at all ages, from the young teenager with juvenile arthritis to the elderly patient with degenerative arthritis.

Knee stiffness: inability to bend and straighten •your knee Failure to obtain pain relief from nonsteroidal •anti-inflammatory drugs (aspirin, ibuprofen, etc.)Inability to tolerate pain medications •Failure to substantially improve with treatments •such as cortisone injections, physical therapy or other surgeries

Knee deformity: a bowing out or in of your •knee

Moderate or severe knee pain while •restingChronic knee inflammation and •swelling that does not improve with rest or medications

What To Expect After Surgery

After your surgery, you should expect to be in the hospital for two or more days. Our goal is to prepare you for what is expected after your surgery, including answering questions and addressing your after surgery exercise program. You will use a specialized exercise program at home, after your surgery, with the guidance professional home healthcare team. Walking, knee, foot and ankle movement is important in your recovery that begins immediately after your surgery. These types of movements are encouraged immediately following surgery to increase blood flow and to help prevent leg swelling and blood clots.

Most patients begin exercising their knee the day after surgery. Your physical therapist will work with you to learn specific exercises that will strengthen your leg and restore knee movement soon after your surgery.

Our goal is to prepare you for what is expected after your surgery, including answering questions and addressing your after surgery exercise program.


Weight Bearing Precautions:

Weight bearing is defined as the ability to put weight on your surgical leg. Depending on which surgical technique is used by your orthopaedic surgeon, will determine what your weight bearing status will be after surgery.

It is important to follow the below, marked weight bearing recommendation until advised differently by your physician.

Non Weight Bearing (NWB) ƛ - No weight applied to your surgical leg. You must use a walker or crutches to avoid bearing any weight.

T ƛ oe Touch Weight Bearing (TTWB) - Minimal weight is allowed on your surgical leg. You may rest your toes of your surgical leg on the ground to gain balance but not to bear weight.

P ƛ artial Weight Bearing (PWB) - Approximately 25-50% of the body’s weight is allowed on your surgical leg. Assistive devices such as a walker or crutches must be used for assistance.

Weight Bearing As Tolerated ƛ (WBAT) - Ability to put as much weight on your surgical leg as needed - as long as it does not cause sharp or an increased level of pain lasting for more than 20 minutes. Even though you are allowed to bear as much weight as you like, you may be instructed by your orthopaedic surgeon or physical therapist to continue using assistive devices for safety reasons.

F ƛ ull Weight Bearing (FWB) - The ability to place your full body weight on your surgical leg.


Common Recovery Information:

You may feel some numbness in the skin around •your incision and stiffness, particularly with excessive bending activities. Improvement of knee motion is a goal of knee •replacement, but restoration of full motion is uncommon. The motion of your knee replacement after •surgery is predicted by the motion of your knee prior to surgery. Most patients can expect to be able to almost fully straighten the replaced knee and to bend the knee sufficiently to climb stairs and get in and out of a car. Occasionally, you may feel some soft clicking •of the metal and plastic with knee bending or walking. These differences often diminish with time and most patients find them to be tolerable when compared to the pain and limited function they experienced prior to surgery.

Most patients can expect to be able to almost fully straighten the replaced knee and to bend the knee sufficiently.

http://www.upstate.edu/uh/ortho/joint/tgknee.php

Your therapist will work with you on how to perform your exercises correctly. Exercises are personalized to your needs and should be completed as instructed. Following a proper exercise program will help your recovery by improving your range of motion, muscle strength and mobility after surgery.

Home Based Physical Therapy After Knee Replacement

Only perform exercises that are marked on the •following pages by your physical therapist When resting, keep your knee as straight as possible•NEVER place a pillow or anything under the knee •while sleeping or relaxing

IMPORTANT:

Use ice on you knee for 15-20 minutes ___before and/or ___after you do your exercises.

Tip: You can use a bag of frozen vegetables instead of ice.

All exercises demonstrated are done so by a Physical Therapist


Repeat ______Times. _______Sets. __________Daily.

Home Exercise #1: Ankle Pumps

Do ankle pumps by pointing and flexing your feet.


Home Exercise #2: Quad Sets

You may complete by lying on your back or sitting up with leg straight. Tighten the muscle at the front of the thigh as you press the back of your knee down toward the bed. Hold for a few seconds. Then relax the leg.



Home Exercise #3: Hamstring Contraction

Lie on your back with your knees bent in a 10 to 15 degree angle. Without moving your leg, pull your heel into the floor. This will cause the muscles on the back of your thigh to contract. Hold this for five seconds. Relax and repeat 10 more times.


Home Exercise #4: Gluteal Sets

You may complete by lying on your back or in a sitting position with your knees bent in a 10 to 15 degree angle. Squeeze your buttock muscles together. Hold for five seconds. Relax and repeat 10 more times.


Home Exercise #5: Knee Flexion

Lie down or sit with your legs stretched out in front of you. Put a plastic bag or cookie sheet under one foot to help it slide. Slide the heel toward your buttocks while keeping it on the bed. Move it as far as you comfortably can. Hold for a few seconds, then slide your heel back.



Home Exercise #6: Straight Leg Raise

Lie in bed. Tighten your Quad or front thigh muscle.Lift your leg as high as you comfortably can, but not higher than 12 inches. Hold for a few seconds. Then slowly lower the leg.* You may be advised to bend opposite leg, especially if you have back problems. Repeat on other leg.


Hold ________Seconds. Repeat ______Times. _____Sets. ________Daily.

Home Exercise #7: Extension Stretch

Passive Extension – Put a small roll (towel) under your heel. Gently straighten your knee. Press gently above the knee with your hands and/or tightening your thigh muscles.


Home Exercise #8: Prone Knee Flexion Stretch

Lie on your stomach, use a pillow under your abdomen if needed for comfort, bend your surgical leg back as far as you can, wrap a sheet or towel around your ankle, then relax and use the sheet to guide your knee to bend back as far as possible.



Home Exercise #9: Seated Knee Flexion Stretch

Sit at bedside or in a chair with your thigh supported, bend your knee as far as you can while keeping your foot on the floor. With your foot lightly resting on the floor, slide your upper body forward in the chair to increase your knee bend. Hold for 5 to 10 seconds. Then relax to a resting position.

Home Exercise #10: Long Arc Quads

Sit in a chair with your feet on the ground. Slowly straighten your knee - as straight as your are able.



Home Exercise #11: Heel Raises

Stand behind a sturdy surface, such as a heavy chair or a table, slowly raise your heels off of the floor, then relax back down.


Home Exercise #12: Standing Knee Flexion

Stand while holding on to a steady surface, such as a heavy chair or table. Bend your knee as far as it will go comfortably. Hold for a few seconds. Slowly lower the leg.



Home Exercise #13: Standing Single Leg Stance

Stand along a sturdy surface, such as a heavy chair or table, lift one leg off of the ground, while maintaining your balance.


Home Exercise #14: Standing Squats

Stand behind a sturdy chair or counter. Slowly bend knees, lowering body. Then return to stand up position.



Home Exercise #15: Standing Step Stretch

With your surgical leg’s foot on the step, lean forward while holding onto a steady surface such as a heavy chair or table, until a stretch is felt within knee, focus on keeping your heel down during the exercises.


Home Exercise #15: Standing Step Stretch Home Exercise #16: Standing Step Ups

Standing facing a _____ inch step. If advised by your Physical Therapist, hold onto a sturdy surface such as a heavy chair or table for balance. Place the foot of your surgical leg up onto the step. Slowly step up. Slowly return to your starting position.



Home Exercise #17: Lateral Step Ups

Stand to the side of a ___ inch step. If advised by your Physical Therapist, hold onto a sturdy surface such as a heavy chair or table for balance. Place the foot of your surgical leg up onto the step. Slowly step up. Slowly return to your starting position.


Home Exercise #18: Step Downs

Stand on a ___ inch low step. If advised by your Physical Therapist, hold onto a sturdy surface such as a heavy chair or table for balance. Step down slowly with your non-surgical leg. Slowly return to your starting position.



Other Services:Everyone’s needs following a knee replacement differ. You may find physical therapy is not the only assistance you need. Please do not hesitate to inform your therapist if you feel further care is needed.

Other services available include:

Occupational Therapy: Assessment of your upper body needs and help locating appropriate adaptive equipment – such as equipment to assist with picking up items up from the floor or putting on your socks.

Skilled Nursing: Assistance with incision care and dressing changes.

Home Health Aide /Homemaker/Companion: Assistance with personal care, cleaning, laundry or meal preparation.

Nightingale Home Healthcare is dedicated to providing the highest quality of care while respecting the individuality of every patient we serve. For this reason we are dedicated to working with you over the next few months to develop an individualized program that will get you back on your feet after your Knee Replacement surgery.

Upon discharge from the hospital, please inform your discharge staff that you have already contacted Nightingale Home Healthcare to provide your home based rehabilitation.

To ensure you will have everything you need when you get home, a Nightingale representative will help coordinate your care and any special equipment needed.

Again, thank you for choosing Nightingale Home Healthcare.

We will work with you to help regain your independence as soon as possible and help you meet all your rehabilitation needs. Please let us know if you have any questions or concerns.

Dr. Dev Brar, President, Nightingale

IN: (866) 334 - 7777IL: (866) 334 - 7774MN: (866) 334 - 7776

NV: (888) 334 - 7779TX: (877) 334 - 7776CA: (866) 634 - 7774

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