The operation of a complete knee replacement (the so-called full arthroplasty of the knee joint) is a method of treating osteoarthritis, inflammatory arthritis, as well as (in case of chronic injuries) pain associated with traumatic arthritis, and not to mention joint stiffness, edema and other pathologies leading to limited joint mobility and a deterioration in the quality of life of the patient. Having decided on the operation, you can forget about the pain and discomfort ... unless, of course, you agree with the risks that such an operation carries, as well as with the long recovery period that is necessary to again feel all the joy of movement. However, even if the rehabilitation process takes place in each country according to special methods, this article will help you and tell you what to expect.
Who is to blame for the lack of progress?
The incomplete functional restoration of the lower limb is unfoundedly blamed on the surgeon who incorrectly performed the operation. Patients complain that their knee does not bend like a healthy leg. Incomplete extension of the knee joint is a fairly common complaint of people.
Knee joint contracture - the leg cannot straighten up to the end.
There are cases when, even with an excellently planned and implemented system of rehabilitation therapy, the healing process is delayed or complicated by negative pathogenesis. As you understand, here we are most often talking about an individual factor.
Do not neglect the services of rehabilitologists during rehabilitation of the operated limb. And do not violate the rehabilitation periods: how much you were told to adhere to a special regime of physical activity, just as much you are required to observe it. Your future quality of life will depend on all this.
Surgical wounds after arthroscopy of the knee joint.
Postoperative problems and solutions
In the postoperative period, due to trauma during the operation of the periarticular and intraarticular structures, fluid accumulates in the knee and pain is felt. These are normal phenomena, and are not considered complications if the accumulation of effusion, accompanied by swelling of the tissues around the patella, as well as the manifestation of painful symptoms did not last longer than expected. These symptoms should subside after 3 days, and by the second week they usually disappear. In the early period, to eliminate puffiness and pain, doctors conduct drainage and antiseptic treatment of the wound. Additionally appointed:
- limb immobilization with orthopedic drugs,
- the position of the leg in an elevated position when the patient is lying in bed,
- applying cold dry compresses,
- anti-inflammatory drugs
- antibacterial drugs
- pain medication.
Arthromot - a means for passive development of the knee joint.
Long-lasting edema testifies to the progression of inflammation, and, possibly, to the local infectious pathogenesis that appears, which is fraught not only with the absence of the effect of restoring mobility, but also with much more complex consequences. For example, if you have an endoprosthesis installed, an infectious lesion leads to rejection and damage to the prosthetic structure, which requires repeated surgery (removal of the implant) and prolonged antibiotic therapy. If severe edema is associated with excessively excessive accumulation of synovial fluid and blood, you will need to perform a joint puncture to remove the pathological formation.
Gradually, the temperature in the knee joint should decrease, it is recommended to apply ice packs for a week or two.
The volume of movements should gradually increase, and by the end of the 6th week to reach normal values. If the amplitude of flexion / extension of the knee is not restored, then it can be argued that physical rehabilitation is performed or was performed incorrectly. If the leg does not bend or straighten completely, then the reason for this is contracture of the joint, which developed as a result of the formation of coarse adhesions between the tendons and nearby tissues. The unreleased problem is solved by manual redress and long and intensive work on the development of a stiff joint for exercise therapy, mechanotherapy, physiotherapy, etc. In severe pathology, an operation is performed to mobilize and excise cicatricial fusion with subsequent rehabilitation.
Such simulators allow gradually, with minimal unpleasant sensations, to increase the amplitude of movement of the knee joint. The patient pumps the cuff around the knee with air and, due to the pressure exerted, the leg straightens.
Regardless of the type of operation, the risk of the formation of pathological formations in the form of coarse adhesions and scars is considerable. After surgery, the lower limb is in a state of low physical activity. To resist the development of a severe adhesive process, doctors recommend starting from the next day after the intervention a complex of physiotherapy exercises that will not interfere with the healing of the knee, and at the same time will prevent contractures and muscle atrophy.
In advanced cases, surgeons are included in the solution to the problem.
After surgery in the long-term recovery period, such an excess can also happen: the lateral ligament of the knee does not hold, which is expressed by lateral instability of the joint, mowing of the leg during rotational movement. If a torn fibular or tibial collateral ligament was reconstructed, PKS, it is possible that due to irrational loads, the integrity of the fragile ligament structure stabilizing and strengthening the joint apparatus again occurred. With this symptom, an orthopedic surgeon should examine you! Only after identifying a reliable cause of instability does a specialist, having selected an effective complex of therapeutic measures, be able to direct the therapy in the right direction.
If the reconstruction operation of the ligaments is performed well, they become no less durable than before the operation.
Muscular structures launch the bone joint into working condition. Postoperative rehabilitation of the knee joint strengthens and increases the endurance of the musculo-ligamentous apparatus.
Principles of rehabilitation after knee surgery
Rehabilitation treatment includes:
- careful planning of rehabilitation taking into account a specific medical problem and body criteria,
- a developed daily schedule, including medical, procedural, and physical rehabilitation,
- the principle of balance, gradualness and dosing of physical activity,
- careful control over the patient’s performance of all medical recovery procedures.
Each individual patient needs his own recovery program after surgery on his knee, specially developed for him by a team of specialists (surgeon, rehabilitologist, neurologist, physiotherapist, exercise therapy methodologist, etc.). Therefore, a single rehabilitation scheme for all patients does not exist. Recovery Goals:
- early activation of the patient,
- prevention of congestion in the respiratory system,
- stimulation of regional blood circulation and lymph outflow in the lower extremities,
- reduction in the release of pathological fluid in the knee,
- rapid elimination of pain
- active prevention of muscle wasting, contractures and adhesions,
- stimulation of metabolic metabolism and tissue regeneration,
- prevention of the emergence of an infectious environment in the operated tissues,
- the resumption of lost limb functions.
A doctor will tell you how to develop a knee after surgery. Do not self-medicate! Incompetent tactics will prevent a favorable prognosis. Take this fact into account if you do not want, having undergone a serious operation, the knee does not bend and hurt.
Physiotherapeutic procedures will be prescribed for you:
- laser treatment
- UHF treatment
- extracorporeal shock wave therapy (shock wave therapy),
- ion galvanization
- hot paraffin treatment (only in the late stages!).
Electrical stimulation is one of the options for physiotherapy.
Exercise therapy and physiotherapy will help:
- relieve spasms from tense muscle structures and increase the tone of weakened and atrophied muscles,
- activation of microcirculation and blood flow in the lower limb,
- stimulate metabolism in articular structures,
- relief of painful manifestations and edema.
For 6 weeks after the operation, there is a risk of blood clots and swelling. Therefore, a specialist in the early period is prescribed elastic bandaging, in a later period - compression stockings. The orthopedist selects the degree of compression of these medical devices, taking into account the volume of intervention and the factor of predisposition to thrombosis. The application of an elastic bandage and wearing compression underwear prevent the development of deep vein thrombosis.
Bandages are used less and less; they are very poorly kept during movement. More often used such compression hosiery.
The technique of bandaging your leg will be taught in a hospital. First, bandaging is carried out by the doctor, and upon returning home you will have to do it yourself. Be attentive to everything that the medical staff says and teaches you while you are still in the clinic or rehabilitation center.
No knee rehabilitation is complete without medication. After any type of orthopedic surgery, three main types of drugs are prescribed:
- antibiotic against localized infection,
- blood thinning anticoagulant and antithrombotic effect,
- non-steroidal anti-inflammatory drug.
Perhaps there will be a need for the appointment of biologically active additives or agents from a series of chondroprotectors to replenish articular tissues with valuable nutrients, which will help activate reparative-regenerative reactions.
Taking antibiotics is critically important, without which very unpleasant consequences in the form of an infectious complication can occur.
Against pain, drugs should be used only as necessary, and do not abuse them if the discomfort in the knee is not very pronounced. In the first 3 days, so as not to be frustrated with harmful drugs, doctors advise applying an ice bag to the knee joint every 30-40 minutes. Cold dry compresses are quite effective and soothe the pain, and swelling is reduced to nothing. Funds from the NSAID category can not be used immediately before classes, so that you can feel your leg well at the time of training. If the pain is dulled by the medication, there is a danger of making the wrong movement and causing undesirable injury to the still vulnerable limb.
Is it painful to develop an operated knee without prior anesthesia? Of course, what to hide, at first it will not be easy, what to do exercises, what to move. But soreness is not going anywhere, this is a normal reaction of the body to the intervention temporary. Every day it will become easier and easier for you, and after about 7-10 days, unpleasant sensations will cease to bring you such suffering. The main thing is not to give up! Do not stop following the instructions given by the specialist. Naturally, about all your sensations, especially if the unpleasant symptoms began to intensify, immediately notify your observing physician or physical therapy trainer.
When are surgical sutures removed?
Sutures on the knee after surgery are usually removed on the 10th day. During this time, the final fusion of the edges of the wound, fixed with surgical threads, should occur. If the incision is small and quickly healed, the stitches will be removed on the 7th day. In general, the ability to regenerate soft tissues that were dissected at the time of surgery is different for all people. In the elderly category of patients or people with diabetes, the final healing can take place only on 12-14 days.
Judging by the scars in this patient, a non-left knee joint was partially replaced and arthroscopy. The seams look good.
Exercise for the knee after surgery
Only under the condition of a complex combination of exercise therapy with other health-improving tactics prescribed by the doctor, you will achieve results in normalizing the motor-supporting potential of the leg.
How long recovery takes has been indicated in previous chapters. Again, 2-6 months. The duration of the recovery process is affected by 3 criteria: operational tactics, degree of surgical aggression, and personal characteristics of the patient.
The fundamental goals of exercise therapy after replacing the knee joint, arthroscopy for restoration of ligaments, meniscectomy of the knee and other surgical methods of treatment are to increase muscle tone and endurance, to develop the knee section to the fullest recovery. A competent physical regime in stages can be recommended by a purely competent doctor - operated by an orthopedic surgeon, rehabilitation specialist or exercise therapy specialist.
How to develop a knee after surgery: methods
Immediately after 12-24 hours after surgery for 3-7 days, you will be advised to perform a lightweight workout when lying down. The repetition rate and daily number of classes is determined by a specialist.
- Carefully tear the problem leg off the bed by lifting it to a distance of 20 cm from the surface. A healthy leg at this time is bent at the knee. Hold the position of the raised leg for 5 seconds, then carefully return the limb to its original position.
- Bending both legs slightly (resting on the heels), produce tension in the thigh muscles. At the count of ten, relax.
Hands along the body, torso relaxed.
- Perform isometric contraction of the gluteal muscles with retention of tension up to 5-8 seconds.
Perform until light burning.
- Lying on your back, placing a roller made of a towel under your foot, apply pressure on it, trying to bend your leg. After 5 seconds, relax. The ligaments of the popliteal zone and the muscular structures of the lower leg will strain.
The main thing is not effort, but the smoothness of increasing the load.
- Legs lie flat on the bed. Make footsteps to and from you, while keeping your heel on the surface. It is useful to alternately spread your legs to the sides, sliding on the sheet.
Perform very slowly.
Gentle exercises are gradually supplemented by more complex exercises. We give examples of some of them.
- To stand against a wall or near a chair to insure yourself. Slowly raise the affected limb in a straightened state forward. Having reached an angle of 45 degrees, keep your straight leg on the weight of 5 seconds, just as smoothly return it to its original position.
Do not forget about the palm rest.
Keep track of the balance.
Smooth execution is the key to no injuries.
After 2-3 weeks, they switch to active training, where classes of the following type will already be present:
- half-squats near the chair (the angle of bending of the knees does not exceed 90 degrees),
Try to lean on the entire foot area.
If the pelvis is moved forward, the stretching effect will increase.
You can think of many exercises with a harness.
Alternate your legs while doing this exercise.
This is the best projectile for rehabilitation.
We recommend to work out in the pool for life.
When realizing physical tasks, listen to your own feelings: you must control the threshold of acceptable pain, not allowing it to intensify. Overloading is not permissible! Non-optimized loads will provoke painful swelling, how long it lasts depends on the degree of damage to vulnerable knee structures. But the saddest thing, puffiness and pain will slow down the recovery process, interfere with the normal development of the joint, increase the time until your final recovery.
Artusmed - Consultant:
05/09/2019 at 9:31 am
Hello Inna. It is impossible to answer such questions. We do not know what the operation was, but this is very important. We don’t know what it means to go backwards. But in general, it is impossible to give an answer remotely better than it was done by doctors who personally saw and operated on the patient.
05/27/2019 at 3:37 pm
Irina, hello. How's your son’s leg? I have the same story after the operation. The lateral and anterior cruciate ligaments were sutured to me.
03/25/2019 at 4:03 pm
After arthroscopy, after how long should the leg bend normally?
03/25/2019 at 8:10 am
Operation 12/27/1918. After exercise and exercise therapy, pain in the thigh or below the knee. It is felt only when walking. At rest it does not hurt. What to do? According to the recommendations, the load should be increased, and the pain is not allowed to go, although 3 months have passed
I try to walk, but I can’t get normal on the operated leg, I limp
Is it normal or is it already necessary to look for specialists
There are no rehabilitation centers in the city
Look for them only in the area 120 km from us