You are about to have Knee Replacement Surgery (TKR). A lot of the long-term results of knee replacements depend on how much work you put into it following your knee surgery.
After a knee replacement surgery, chances are very high that you’ll feel far less pain and can move around much better than before. Physiotherapy after knee surgery is an important part of that recovery. Patients who prepare for surgery and actively take part in their care can recover in less time and with less knee pain. Knee Rehab exercises will help you walk, climb stairs, and return to other normal activities more quickly.
This knee pain treatment guide has general information along with tips for things to do before and after knee replacement to help you make it a success.
You may get different instructions from your surgeon, doctor or physiotherapist. Always follow the directions of your care team. This guide is meant to be used under the direction of your physiotherapist.

Caution: If you have too much knee pain to exercise, or if any of the exercises cause more pain or knee swelling, stop. Tell your physiotherapist or doctor. If your whole leg becomes swollen or hot, tell your doctor right away!

Why do I need to exercise before Knee Replacement Surgery?
If you exercise before knee surgery you can have a faster and easier recovery. Exercise helps to:

• Maintain the range of movement of your knee
• Make your muscles strong
• Control your pain
• Build your knowledge of how to exercise after surgery
• Improve your sleep

Do activities that put less stress on your knee. It is best to do specific knee movements; your physiotherapist will help you do specific knee strengthening exercises after a thorough assessment of your knee joint and associated pain.

• Try cycling on a stationary bike (upright or seated) for 5-10 minutes,
• Walking in water (water level should be at least thigh deep).
• Always warm-up before exercising.
• Your physiotherapist may tell you to apply moist heat to the front and back of your knee for 5-10 minutes OR Have a warm shower/bath.

When should I see a physiotherapist for TKR recovery?
Well, in order to maximize your functional mobility and recovery after total knee replacement, you may want to consider physiotherapy throughout the process.
Phase 1 – Preparing for Knee Replacement Surgery
RehabMax physiotherapist can begin to assist you as soon as you decide to have knee replacement surgery – take pre-surgery knee strengthening exercises at a clinic near you.

Phase 2 – Inpatient Physiotherapy after knee replacement surgery
Rehabilitation begins as soon as possible after your operation. If you return to the ward in the afternoon, you will be assessed by a physiotherapist to see if you are able to stand and take a few steps with your new knee with their help. (Did You Know, RehabMax is the outsourced physiotherapy partner for several leading hospitals, in which case ReLiva Physiotherapist will continue to help you with In-patient physiotherapy in the hospital.)

Phase 3 – Physiotherapy at home for Knee Rehab
Your knee may still be painful, once you have left the hospital. Well, in order to maximize your functional mobility after total knee replacement, you should consider physiotherapy at home. ReLiva home physiotherapist will initially teach you exercises to:

• Reduce swelling
• Control your pain
• Recover your knee movement

How long do I need to do physiotherapy after a knee replacement?

A follow-up physiotherapy outpatient appointment will ideally be arranged within a week after you leave the hospital. Physiotherapy at this stage is aimed to help you develop your strength, knee movement, and walking ability.
It usually takes 6-8 weeks after surgery for one to resume normal unassisted activity. The recovery may vary from person to person. You may still need to continue to do your knee exercises for a longer time based on your goals. Ask your physiotherapist about returning to active or sporting hobbies. Gardening, swimming (once stitches/clips are removed and the wound is dry), cycling, golf, and walking are highly recommended.

Is physiotherapy necessary after total knee replacement surgery?
Exercise after surgery will help you recover and regain the movement and strength of your knee. Exercise also helps to:

• Reduce swelling
• Prevent blood clots (Thrombosis)
• Control your pain
• Prevent constipation
• Improve your sleep
• Your physiotherapist, who is an expert in muscle and movement, will initially assess your knee recovery and teach you the appropriate knee exercises.

What should I do to make the most of Knee surgery?
RehabMax Physiotherapists who regularly work with orthopedic surgeons to aid recovery of patients after knee surgery suggest these Dos and Don’ts to make the most of your Knee replacement surgery.

Do’s after Knee Replacement Surgery

• Take your recovery and rehab seriously. Exercise regularly as per the program charted by your physiotherapist.
• Continue with your knee replacement rehab program for at least 3 weeks after surgery, probably 3 months of physiotherapy-guided knee exercises to get the best result from your knee replacement.
• Follow-up regularly with your surgeon, to monitor internal recovery.
• Walker or crutches should be used until discontinued by a Doctor or Physiotherapist.
• Change knee position at least once an hour, while awake, to avoid stiffness.
• Home exercises should be performed 3 times every day unless advised differently by your Physiotherapist.
• Walking, Swimming, or walking inside a swimming pool (where the water level is at least till your thigh) is a very good strengthening exercise that prevents jerks and unnecessary strain on the knee.
• Stay positive and committed. Don’t give up, and do what you can to keep a good attitude.

Don’ts after Knee Replacement Surgery
For 6-8 weeks after knee surgery, avoid:

• Any pivoting (twisting) on your knee
• Avoid kneeling down & squatting
• Avoid high-impact activities that cause jerk and stress on the knee joint, for example running, jogging, rock climbing etc.
• Avoid unnecessary stress on your knee by lifting very heavy objects. This can cause damage to your new knee.
• Avoid using Indian traditional toilet, instead, use a Western Commode (WC) or toilet chair.

Is walking good after knee replacement?
Walking is an excellent activity and you are strongly encouraged to gradually increase your walking distance after you leave the hospital. It is important that pain does not restrict your walking or exercise. If you are in pain, tell your doctor. They can check your pain relief and see whether you need different or stronger painkillers.
Walk outdoors as long as sidewalks are dry. Consider going to a mall to walk when the sidewalks are wet and slippery.
You may also consider walking inside a pool once the stitches/clips are removed and the knee wound is dry and healed. Water absorbs any sort of a jerk, making it safe for your knees. Ensure the water is thigh deep in the pool.

How often should you exercise after knee replacement surgery?
For the first three weeks, you should do your exercises at least three times throughout the day. You do not have to do them all at the same time. After three weeks you can do all the exercises for the suggested number of repetitions or holding time, at least three days a week.
This will help to maintain and improve the movement and strength you have gained.

What are the best exercises after knee replacement?
A. Exercises in bed, after Knee surgery
Immediately after surgery, you can continue to do the following in bed:

• Deep Breathing and Coughing Exercises
  Until you are up and moving well, take at least 10 deep breaths, followed by a cough, every hour that you are awake.

• Pump Your Ankles
  When lying down, move feet up and down and in circles. Repeat 10 -15 times every hour you are awake.
• Buttock Contractions
  Tighten your buttock muscle and hold for a count of 5 seconds. Repeat five to ten times, three to four times each day
• Moving your new knee
  It is important to move your knee soon after the operation unless your surgeon or physiotherapist tells you not to. This will minimize stiffness, pain and swelling, and reduce the formation of scar tissue. Check with your physiotherapist for guidance about the best way to warm up your new joint.

B. Knee Exercises, once you are home after knee surgery
To Keep Pain and Swelling under control, once you are home here is what you should do:
Rest Your Joint after knee surgery

• Change positions often (every 20 minutes) when you are awake. Try sitting, standing, and walking.
• Pace yourself. Take things easy and slow.
• Lie down 3 times a day for 30 minutes on your bed.
• Put your leg up and support it with a rolled towel or with pillows (as shown).

2. Use Ice after knee replacement surgery
Ice your knee when it is hot and red, painful, and after exercises. (If your knee is very stiff and painful, check with your physiotherapist before icing.Follow these steps:

• If your scar is not healed, cover it with a clean bandage and clean plastic wrap
• Put a damp hand towel over your knee
• Put a flexible gel pack or plastic bag with crushed ice on your knee
• Leave the ice ON for 10 minutes. Take it OFF for 10 minutes. Put it back ON for 10 minutes. Repeat 4-6 times a day.
• DO NOT use ice if your doctor has told you that the circulation to your legs is poor and that you should avoid using ice or heat

3. Use Pain Medicine
Use your pain medicines as prescribed by your doctor. Tell your doctor if the pain is too much or not improving.
4. Use Walking Aids
Use the walking aid that your physiotherapist has measured and recommended. Do not change or stop using the walking aid until your physiotherapist or surgeon tells you to. Walkers, crutches, and canes help to:

• If your scar is not healed, cover it with a clean bandage and clean plastic wrap
• Reduce the stress on your knee Reduce pain Improve your balance and reduce falls
• Remember it is better to have a good walking pattern using two crutches than to limp and risk losing balance.

Sleep
It helps with rest and recovery. It is normal to have some sleepless nights up to 12 weeks after your knee surgery.