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Rehabilitation and Physical Therapy
Post Surgery Rehabilitation & exercise program :Rehabilitation at Home
Your rehabilitation program at home will be an extremely important part of your continuing recovery. During the first few weeks at home, you should adapt what you learned at the hospital to your own setting. For this, you will need to first prepare your home for your recovery.
Be sure all walking areas are free of clutter.
Remove throw rugs.
Watch for small pets and grandchildren.
Make sure hallways/stairways and bathrooms are well-lighted.
During your hospital stay, you should take balanced, nutritious meals with adequate calories and nutrients to maintain your nutritional status. This will enable your body to heal with less risk of complications, such as infection or poor wound healing. Your dietitian will plan your diet while you are at the hospital. After the surgery, you will be on a clear liquid diet, like juices. By the next day, you may be ready for a general diet unless you have special diet needs.
A therapeutic or modified diet such as a sodium-restricted diet, low fat diet, or diabetic diet may be ordered by your physician based on your medical condition. Your registered dietitian will visit you during your hospital stay to provide diet instruction on the therapeutic diet.
You should keep in mind that your body is in a healing process and requires adequate nourishment for tissue regeneration at this time. Therefore, do not consider any weight loss program during this time.
After you leave the hospital, your diet continues to be important for your successful healing, as well as for building the muscle structure and strength required to take full advantage of your knee(s). Continue a well-balanced diet and follow the diet instructions given to you during your hospital stay.
It is helpful to be aware that due to reduced physical activity and use of pain medication, you might face constipation problem. To avoid this, we advise you to drink at least 8-12 glasses of water daily. Add fiber to your diet by eating at least 5 servings of fruits and vegetables, and 3-4 servings of whole grains such as multigrain bread, brown rice, and whole grain cereals. If you do experience constipation, you may take an over-the-counter stool softener, laxative or fiber supplements. 
Self Care post Surgery: A catheter may be in place after the surgery. It is normally removed when you can get out of the bed to commode or restroom. Your bandage will be changed twice or once a day during your stay at the hospital. Your surgeon will visit you and physiotherapist will begin post-operative exercises. Your pain will be managed with injection or pills.
Self care: Our care take rill help you to walk to the wash room till you are able to support yourself. Walking to the restroom, will build your strength and prepare you to discharge to your home
Depending on your situation your doctor may recommend that you may be transferred to the Fortis Rehabilitation facility after you are discharged from the hospital. You may require a few days so that you can begin your physiotherapy and your health will be monitored
It is very important o follow the doctor's instructions. The following suggestions should be discussed with your surgeon before your hospital discharge
As you move into rehabilitation from your total knee replacement, physiotherapy forms an integral part of your post-operative care at Fortis as well as at your home. Immediately following your surgery, your physiotherapist will visit you in the PACU to initiate Continuous Passive Motion (CPM) for your knee and Cryo therapy.
Your physiotherapist will plan a daily exercise regime for you. He or she will visit you on the day of the surgery to instruct you in your exercise program. This program is directed towards improving your functional mobility by increasing the range of motion and strength of your legs.
For the first few days after the surgery, some patients benefit from taking pain medication 30-45 minutes prior to their therapy session. We recommend that you discuss this with your physiotherapist.
As you gradually recover from your surgery, your physiotherapist will help you in sitting up with your feet over the bedside, we call it dangling. You will then stand with the use of a walker with the continued help of your therapist. As soon as possible, you will be allowed to bear full weight on the operative leg, and gradually will try walking.
As the days progress, you will be able to increase the distance you walk. If appropriate, you will be able to practice stair climbing several times before your discharge from the hospital.
Just in a few weeks, you can expect to almost straighten the replaced knee and bend the knee sufficiently to go up and down stairs, and get in and out of a car. Kneeling is usually uncomfortable, but it is not harmful. Occasionally, you may feel some soft clicking of the metal and plastic during knee bending or walking, this is completely normal. These differences often diminish with time and most patients find these are minor, compared to the pain and limited function they experienced prior to surgery.
Your new knee may activate metal detectors required for security at airports and some buildings. In these situations, tell the security agent about your knee replacement.
If you have questions, it is advisable for you to ask your physiotherapist before you leave the hospital. Your surgeon may also have additional instructions for you to follow upon discharge. Remember to record them as a reminder.
Your rehabilitation program at home will be an extremely important part of your continuing recovery. During the first few weeks at home, you should adapt what you learned at the hospital to your own setting. For this, you will need to first prepare your home for your recovery.
- You will need a firm chair with arms. Add two firm pillows to low chair to provide proper height.
- Make sure your bed height is 18 inches, or more, in order to keep your hips above your knee when you sit on the edge. Add a second mattress, if necessary.
- Follow general safety measures:
Be sure all walking areas are free of clutter. Remove throw rugs. Watch for small pets and grandchildren. Make sure hallways/stairways and bathrooms are well-lighted.- Store items within easy reach, not in high or low cabinets.
- If you are discharged with staples still in place, you may not shower unless otherwise advised by your surgeon. After sutures or staples are removed, you may take a shower, but not a tub bath, until given permission by your surgeon.
- Once you start taking a bath, you will find that your new knee(s) may make it easier for you to get in and out of a tub/shower than before. However, for your safety, equip your tub or shower with safety handrails and a non-slip surface. Please arrange for this prior to your hospitalization, if possible.
Your home care physiotherapist will put you on a guided knee rehabilitation protocol set by the hospital. In addition to quad sets and gluteal sets that we learned earlier in this video, you should perform ankle pumps, knee bends, leg raises, stair stretches and hamstring isometrics. Let's look at these one by one.
To perform ankle pumps, move your foot up and down rhythmically by contracting the calf and shin muscles.
To perform sitting unsupported knee bends, bend your knee as far as you can until your foot rests on the floor while sitting at bedside or in a chair with your thigh supported. Now, with your foot lightly resting on the floor, slide your upper body forward in the chair to increase your knee bend and hold for 5-10 seconds. Straiten your knee fully and then repeat.
To perform straight leg raises, Tighten the thigh muscle with your knee fully straightened on the bed, as with the Quad set. Now, lift your leg several inches, hold for 5-10 seconds, and slowly lower.
To perform the Knee Straightening Exercise, place a small rolled towel just above your heel so that it is not touching the bed. Tighten your thigh and try to fully straighten your knee and to touch the back of your knee to the bed. Hold the fully straightened knee for five to 10 seconds and then relax.
To perform the bed supported knee bends, bend your knee as much as possible while sliding your foot on the bed. Hold your knee in a maximally bent position for 5 to 10 seconds and then straighten.
To perform the Sitting Supported Knee Bends, place your foot behind the heel of your operated knee for support while sitting at bedside or in a chair with your thigh supported. Now, slowly bend your knee as far as you can and hold your knee in this position for 5 to 10 seconds.
To perform the stair stretch, first place your operated leg on the first or second step. Keeping the non-operated leg on floor, lean forward towards your operated leg, bending the knee as much as possible. Hold for the count of 6, then relax and straighten your knee.
Finally, to perform a hamstring isometric, bend your operated knee slightly while lying on your back. Now, push your heel into bed and hold for the count of 6.
Your surgeon and therapist may have additional exercises added to your rehabilitation program. Please refer to any additional materials provided to you by your therapist and physician.
Your commitment to doing exercises, as instructed, is a major factor in your recovery. Some discomfort after exercise is normal, especially during your first few weeks at home. Gradually, your body builds strength and your knee gains flexibility, while you develop new degrees of mobility. Your thoughtful combination of exercise with rest, ice packs, and pain medication, is necessary, and will assure you maximum benefit from your Total Knee Replacement Surgery.
To perform ankle pumps, move your foot up and down rhythmically by contracting the calf and shin muscles.
To perform sitting unsupported knee bends, bend your knee as far as you can until your foot rests on the floor while sitting at bedside or in a chair with your thigh supported. Now, with your foot lightly resting on the floor, slide your upper body forward in the chair to increase your knee bend and hold for 5-10 seconds. Straiten your knee fully and then repeat.
To perform straight leg raises, Tighten the thigh muscle with your knee fully straightened on the bed, as with the Quad set. Now, lift your leg several inches, hold for 5-10 seconds, and slowly lower.
To perform the Knee Straightening Exercise, place a small rolled towel just above your heel so that it is not touching the bed. Tighten your thigh and try to fully straighten your knee and to touch the back of your knee to the bed. Hold the fully straightened knee for five to 10 seconds and then relax.
To perform the bed supported knee bends, bend your knee as much as possible while sliding your foot on the bed. Hold your knee in a maximally bent position for 5 to 10 seconds and then straighten.
To perform the Sitting Supported Knee Bends, place your foot behind the heel of your operated knee for support while sitting at bedside or in a chair with your thigh supported. Now, slowly bend your knee as far as you can and hold your knee in this position for 5 to 10 seconds.
To perform the stair stretch, first place your operated leg on the first or second step. Keeping the non-operated leg on floor, lean forward towards your operated leg, bending the knee as much as possible. Hold for the count of 6, then relax and straighten your knee.
Finally, to perform a hamstring isometric, bend your operated knee slightly while lying on your back. Now, push your heel into bed and hold for the count of 6.
Your surgeon and therapist may have additional exercises added to your rehabilitation program. Please refer to any additional materials provided to you by your therapist and physician.
Your commitment to doing exercises, as instructed, is a major factor in your recovery. Some discomfort after exercise is normal, especially during your first few weeks at home. Gradually, your body builds strength and your knee gains flexibility, while you develop new degrees of mobility. Your thoughtful combination of exercise with rest, ice packs, and pain medication, is necessary, and will assure you maximum benefit from your Total Knee Replacement Surgery.
Diet Care
Healthy eating plays a crucial role in your journey through your knee surgery. If you were following a physician-prescribed diet before hospitalization, it is important that you convey this information to the physician and your registered dietitian. It is also essential that you let your doctor or nurse know if you have recently been taking any vitamins, minerals, herbals, or nutrition supplements. With this information, your doctors can avoid any possible problems with the medications and treatments you may be getting during your hospital stay.During your hospital stay, you should take balanced, nutritious meals with adequate calories and nutrients to maintain your nutritional status. This will enable your body to heal with less risk of complications, such as infection or poor wound healing. Your dietitian will plan your diet while you are at the hospital. After the surgery, you will be on a clear liquid diet, like juices. By the next day, you may be ready for a general diet unless you have special diet needs.
A therapeutic or modified diet such as a sodium-restricted diet, low fat diet, or diabetic diet may be ordered by your physician based on your medical condition. Your registered dietitian will visit you during your hospital stay to provide diet instruction on the therapeutic diet.
You should keep in mind that your body is in a healing process and requires adequate nourishment for tissue regeneration at this time. Therefore, do not consider any weight loss program during this time.
After you leave the hospital, your diet continues to be important for your successful healing, as well as for building the muscle structure and strength required to take full advantage of your knee(s). Continue a well-balanced diet and follow the diet instructions given to you during your hospital stay.
It is helpful to be aware that due to reduced physical activity and use of pain medication, you might face constipation problem. To avoid this, we advise you to drink at least 8-12 glasses of water daily. Add fiber to your diet by eating at least 5 servings of fruits and vegetables, and 3-4 servings of whole grains such as multigrain bread, brown rice, and whole grain cereals. If you do experience constipation, you may take an over-the-counter stool softener, laxative or fiber supplements.
How will you feel after surgery
Be sure to ask your doctor how you feel after the surgery. You may feel nauseated, diy, weak experience loss of appetite, have constipation and pain. Patient usually recover in a few days after the surgery. First meal after the surgery will likely be liquids and will progress to solid food as tolerated. Check with your doctor after the first meal.Self Care post Surgery: A catheter may be in place after the surgery. It is normally removed when you can get out of the bed to commode or restroom. Your bandage will be changed twice or once a day during your stay at the hospital. Your surgeon will visit you and physiotherapist will begin post-operative exercises. Your pain will be managed with injection or pills.
Self care: Our care take rill help you to walk to the wash room till you are able to support yourself. Walking to the restroom, will build your strength and prepare you to discharge to your home
Depending on your situation your doctor may recommend that you may be transferred to the Fortis Rehabilitation facility after you are discharged from the hospital. You may require a few days so that you can begin your physiotherapy and your health will be monitored
Precautions after Joint Replacement
Once you are at homeIt is very important o follow the doctor's instructions. The following suggestions should be discussed with your surgeon before your hospital discharge
1
If you will be using a walker or crutches to assist with walking kindly ask your doctor how much weight you may put on the operated joint.
2
Remember you will tire more easily than usual. You may want to plan a rest period of 30 to 60 minutes mid morning and mid afternoon
3
Its safer and easier to get in and out of the chairs using both your arms and you should avoid low or overstuffed furniture. To increase your comfort, use a cushion or a pillow to raise your body while seated.
4
An elevated toiled seat may reduce stress to your knees/hips a as you sit and stand
5
A bathtub seat allows you to sit while bathing for increased safety and comfort
6
Avoid sweeping / mopping or running the vacuum cleaner. Use long handles feature dusters for dusting high and low
7
Constipation is common problem for patients following the surgery;. This usually due to your limited activity and medications you would be taking. Discuss your diet with your doctor. You should be taking fresh vegetable and fruits and eight glasses of liquid
8
Your doctor should probably give you a prescription for pain medication.
9
Some swelling around the incision. You will find it more comfortable to wear loose clothing to avoid pressure on the incision
10
Wound Care: Would care in some cases, when you are discharged your bandage will be removed and may be replaced with a smaller bandage. You will want to change your bandage as recommended by your Doctor which is typically once a day
Your physiotherapist will plan a daily exercise regime for you. He or she will visit you on the day of the surgery to instruct you in your exercise program. This program is directed towards improving your functional mobility by increasing the range of motion and strength of your legs.
For the first few days after the surgery, some patients benefit from taking pain medication 30-45 minutes prior to their therapy session. We recommend that you discuss this with your physiotherapist.
As you gradually recover from your surgery, your physiotherapist will help you in sitting up with your feet over the bedside, we call it dangling. You will then stand with the use of a walker with the continued help of your therapist. As soon as possible, you will be allowed to bear full weight on the operative leg, and gradually will try walking.
As the days progress, you will be able to increase the distance you walk. If appropriate, you will be able to practice stair climbing several times before your discharge from the hospital.
Just in a few weeks, you can expect to almost straighten the replaced knee and bend the knee sufficiently to go up and down stairs, and get in and out of a car. Kneeling is usually uncomfortable, but it is not harmful. Occasionally, you may feel some soft clicking of the metal and plastic during knee bending or walking, this is completely normal. These differences often diminish with time and most patients find these are minor, compared to the pain and limited function they experienced prior to surgery.
Your new knee may activate metal detectors required for security at airports and some buildings. In these situations, tell the security agent about your knee replacement.
If you have questions, it is advisable for you to ask your physiotherapist before you leave the hospital. Your surgeon may also have additional instructions for you to follow upon discharge. Remember to record them as a reminder.
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Dr. Kaushal Malhan
Dr. Sachin Bhonsle
Dr. Milind Sawant
