1428 Victory Blvd.
Staten Island, NY 10301

Total Knee Replacement


Normal Knee Anatomy
The normal knee consists of lower femur (thigh bone), upper tibia (shin bone), and the patella (knee cap).  The thigh bone moves and rotates an the shin bone to produce knee movement.  Cartilages cover ends of bone to allow smooth movements at the knee joint, releases fluids to lubricate the joint.
Knee ligaments provide stability to the knee and restricting excessive knee movements.  Knee muscles (e.g. the quadriceps) provide strength for active knee movements.
The Purpose of Total Knee Replacement
1. Pain relief
2. Correct knee deformity
3. Increase knee function (resume normal daily activities)
Who needs total Knee Replacement
The normal functioning knee can be disrupted with:
-Osteoarthritis (wear and tear of knee cartilages)
-Post traumatic arthritis (knee cartilage damaged after injury)
-Rheumatoid arthritis (body's immune system destroys its own cartilages)
With the above diseases, the knee cartilages are damaged.  When cartilage loss reaches the limit, the person suffers from pain when he walks or moves around.  It would also cause the knee to deform, and the knee cannot perform normal daily function.
When medication, change of activity level and physical therapy have not been effective enough to solve the problems, total knee replacement becomes an option for the patient.
Expectations for Total Knee Replacement
What you should expect:
-Dramatic reduction of knee pain
-Significant improvement in ability to perform activities of daily living
-Excessive weight and pressure put onto the new joint would cause it to become loosened and painful
-weaker muscles after surgery
-avoidance of certain activities for the rest of your life, like high impact sports and running
-despite the better physical function, you should not expect that the procedure would bring you back to the pre-arthritis stage
-Long lasting of the joint (over 10 years) if used properly
Components of the New Knee
The new knee is composed of the:
1. Femoral component (strong metal)
2. Tibial component (made of durable plastic)
3. Patellar component (plastic)
Physical Therapy for Total Knee Replacement
First Part: Acute Care in Hospital
Main aim: Prevent possible post operative complications:
–Preventing joint infection
     -Keeping the wound clean
–Preventing blood clot formation in leg veins:
     -Frequent lower leg exercises, stockings
–Preventing stiff knee:
    -Continuous passive motion machine to keep joint moving since the day after surgery
–Prevent lung infection
    -Deep breathing exercises and coughing exercises
Second Part:  Subacute Care in Hospital/ Clinic
Main aims:
-Pain relief
-Regain rang of motion
-Regain knee strength and function
Second Part: Components
–Stretching, mobilization and strengthening exercises for regaining flexibility, range of motion and strength at the operated leg
Therapeutic activity:
-Specific therapist instructed training, exercise and/ or manual maneuvers 
1. Aims to regain range of motion and eventually function of knee
2. Ability to stand, transfer, walk, climb, stairs and perform daily activities with your operated leg.
Therapeutic modalities:
–Electrical stimulation, ice and heat
Aims to relieve pain and control inflammation of the knee
Other important Components
Fall prevention is important, it usually includes:
-Strengthening exercises of the legs,
-Balance training
-Home modification
-Walking aid prescription
-Patient education
Wound care and diet are other important factors to address for patients with total knee replacement.
Points to Note
-Patients with TKR should avoid kneeling because of its possibility to displace the new knee parts.
-Patients should notify doctor if the knee is found to be hot, painful and swollen.
-Patients with TKR should not soak their operated part into water until the wound is cleaned and dried, A bandage should be placed on wound for protection before healing is complete.
Home Exercises for Total Knee Replacement
Home exercises for TKR should be prescribed by the physical therapist.  A proper evaluation of the condition should precede.
Strengthening Exercises
1. Quadriceps setting
-Start with lying, with a rolled towel placed under the heal
-Press down onto the towel, so that the upper thigh muscle is tightened
-Hold for 5-10 seconds
2. Terminal knee extension
-Start with lying, with a rolled towel placed under the knee 
-Lift the heel off bed to straighten the knee, have the knee straight as possible
-Hold for 5-10 seconds
Strengthening Exercises (continued)
3. Straight leg raising 
-Start with lying flat on your back
-Hold one leg in straight position and lift it up and away from the supporting surface
-Hold for 5 seconds
Stretching Exercise
1. Self-assisted Knee flexion
-Start with lying face up
-Slide operated knee up towards buttock, use non- operated let to assist the bending
-Hold for 10 seconds when stretch is felt
Mobilization Exercises
1. Knee flexion
-Start with lying on your back, knees bent
-Straighten your operated leg towards the air
-Repeat 10 times
Knee extension
-Start with lying on your back, knees bent
-Straighten your operated leg towards the air
-Repeat 10 times