Total Knee Replacement Protocol

Post-operative Instructions

After discharge from the clinic, it’s advisable to take it easy for the first two days. Get up only to go to bed or use the toilet, taking your first steps carefully.

For the first few weeks, use two crutches. This allows for full weight-bearing unless instructed otherwise. The crutches provide support and stability while walking, ensuring your safety. In consultation with your physiotherapist, you can gradually reduce to one crutch and then to no crutches indoors. If this goes well, you can also phase out crutches outdoors.

  • Ensure you exercise at least twice a day for the first 6 weeks.
  • Exercise is important for the knee, but rest is equally important after exercising.
  • Keep a daily journal to track your progress (amount of pain, which activities are going well, which are more difficult).
  • Try to gradually increase your walking distance.
  • Knee extension is important. Maintain this for at least 6 weeks. Passive stretching with your heel on a chair in front of you is a good method.
  • Avoid movements like bending and squatting.
  • Regularly alternate between sitting, walking, and standing.
  • Make turns step by step.
  • Elevate your legs if there’s swelling.
  • Once you have sufficient control over your leg, you can resume driving after 6 weeks.
  • You may apply cold therapy for 20 minutes, maximum once every 2 hours. This is primarily for pain relief.

 

Contact your GP if you experience the following issues

  • Increasing pain in the surgical area combined with redness and fever.
  • A swollen, shiny, and painful lower leg.

 

Going Home

When you’re discharged, you’ll receive a referral for a physiotherapist. It’s recommended to be treated by a therapist experienced in knee prosthesis rehabilitation. Try to make an appointment as soon as possible and visit the therapist at least once a week.

 

Please make an appointment with your GP between 14-17 days after the surgery to have the wound checked and stitches removed. We will schedule a video meeting with you approximately 6 weeks after your surgery.

 

FAQ

The first week after discharge from the clinic is worse, why is this?

This is common. One reason is that you often have to do more on your own at home. To manage this well, it’s important to keep a diary. This way, you can clearly see what causes you difficulty and what causes a reaction in the operated leg. This allows you to take measures to get through the day pain-free.

 

How long will my knee remain painful?

The knee will gradually become less painful after the surgery. Improvement occurs up to three to four months post-operation. It’s possible to still have complaints up to a year after the surgery. ‘Start pain’ or pain during the first steps can also be present for one to two years after the surgery. The prosthesis needs a long time to settle well between the tissues.

 

How long will my knee remain swollen?

The swelling will gradually decrease after the surgery but may remain minimally present for up to a year. The swelling is usually greater in the evening. It’s helpful to alternate activities with rest and elevate the knee. You can apply an ice compress if needed.

 

When can I start cycling again?

You can start cycling again at least six weeks after the surgery. You must have sufficient control over the operated leg when getting on and off the bike. It’s also important that the knee can bend between 95 and 100 degrees. It’s easier to start with a step-through bike due to the low step-over height.

 

How far can I bend my knee?

The prosthesis allows for approximately 130 degrees of flexion. There’s nothing wrong if you can’t achieve this. A minimum flexion of 95 degrees is needed for cycling, as well as for standing up from a chair.

 

Is it normal if my knee clicks?

Yes, this is normal. About 60 to 70% of patients hear this sound.

 

How long should I rehabilitate?

After 3 to 4 months, you should be able to function independently at home. You can continue training if you want to train sport-specific skills (in consultation with your physiotherapist and doctor).

 

Home Exercises

During the clinical phase in the clinic, the physiotherapist went through a number of exercises with you. They are described again below.

 

Exercise 1. Tensing thigh

Goal: Activating thigh muscles and

training and muscle pump to drain fluid.

4 x 20 repetitions. 2 to 3 times a day.

 

Exercise 2. Stretching and bending foot

Goal: Muscle pump to drain fluid in the calf region.

4 x 20 repetitions. 2 to 3 times a day.

 

Exercise 3. Pressing knee hollow into the couch

Goal: increase and maintain passive and active extension

4 x 20 repetitions. 2 to 3 times a day.

 

Exercise 4. Heel slides

Goal: increase passive and active mobility of bending and stretching.

4 x 20 repetitions. 2 to 3 times a day.

 

Exercise 5. Active straight leg raise

Goal: train activation and endurance of thigh muscles.

4×20 repetitions. 2 to 3 times a day.

 

Exercise 6. Hamstring stretch

Goal: Stretching the hamstring for relaxation of the knee hollow and lengthening the hamstring.

4x 20 repetitions. 2 to 3 times a day.

 

Climbing Stairs

Going upstairs

  • Use a handrail if available.
  • First place the non-operated leg on the step.
  • Lift the non-operated leg and the crutch(es) onto the step with one leg.
  • Continue to climb the stairs step by step for the first 6 weeks.

 

Going downstairs

  • Use a handrail if available.
  • First place the operated leg and the crutch(es) on the step below.
  • The non-operated leg lowers the operated leg.

 

For information, call us at +31202090332 or by email: doctors@dhkc.nl