Phyllis Said:

I had knee replacement surgery last year?

We Answered:

The doctor is most likely checking for an underlying infection. If that comes back positive, they only way to stop the fluid is by getting on a course of antibiotics and you may have to have the knee removed. In other words, if the infection is not treated, it will swell no matter what. If it comes back negative, compression to the knee should help...either a compression garment or knee sleeve...ask your surgeon. However, if your pain is getting worse and you are still having to use a cane at this point, I'd be worried about loosening of the prosthesis....you'll need to talk to the surgeon about this further.

Lydia Said:

knee replacement,how long does the pain last during pt?

We Answered:

It depends on the cause of your pain. Is your knee swollen, warm, and red? Are you feeling feverish? It is possible that the knee is infected or you may have a deep vein thrombosis (in which case you need to see the doctor immediately). If this is not the case, there are other ways to relieve post-surgical pain. Ice, heat, anit-inflammatory meds, TENS, stretching, massage, etc are all appropriate methods for you to try. Finally, if the pain is unexplainably high, there is a possibility that something is wrong with the prosthesis - which your doctor should discover when he examines you. In the meantime, try to rest and avoid causing more pain. You probably should continue your physical therapy exercises (the ones that don't cause pain) especially because you want to keep gaining range of motion to get you down those stairs! Good luck!

Casey Said:

what is the physical therapy protocole for total hip and total knee replacement?

We Answered:

Total hip replacement protocol

* Preoperative 1-2 weeks prior to surgery

o Preoperative education of the surgical process and outcomes

o Instruction on a postoperative exercise program

o Instruction on total hip precautions (based on posterior surgical approach to the hip)

+ No hip flexion beyond 90°

+ No crossing of the legs (hip adduction beyond neutral)

+ No hip internal rotation past neutral: With the anterior hip approach, the patient can cross the legs and internally rotate the hip. Positions that involve extreme hip extension and external rotation will dislocate the hip.

o Assessment of the home environment

* Postoperative day 1

o Bedside exercises are initiated (eg, ankle pumps, quadriceps sets, gluteal sets)

o Review of hip precautions and weight-bearing status

o Bed mobility and transfer training (ie, bed to/from chair)

* Postoperative day 2

o Gait training is initiated with use of assistive devices (eg, crutches, walker).

o Continue functional transfer training

* Postoperative day 3-5 (or on discharge to rehabilitation unit)

o Progression of ROM and strengthening exercises to the patient's tolerance

o Progression of ambulation on level surfaces and stairs (if applicable) with the least restrictive device

o Progression of ADL training

* Postoperative day 5 to 4 weeks

o Strengthening exercises (eg, seated leg extension, sidelying/standing hip abduction, standing hip extension and hip abduction, knee bends, bridging)

o Stretching exercises to increase flexibility of hip muscles

o Progression of ambulation distance

o Progression of independence with ADL

Measurement of leg lengths

Leg lengths are measured meticulously during the preoperative phase to prevent postoperative leg-length discrepancy. Measurement is performed radiologically and clinically by measuring the actual leg lengths. However, during the operative process, leg lengths can change, depending on how the prosthesis was fixed or stabilized or depending on how much bone needed to be removed, among other surgical considerations. In the postoperative phase, it is important, therefore, to correct any leg-length discrepancy by using appropriate orthoses or heel lifts. Correction of any discrepancies has a direct impact on the gait pattern, as well as on the development of low back pain (LBP).

Total knee replacement exercise protocol

* Preoperative 1-2 weeks prior to surgery

o Education on the surgical process and outcomes

o Instruction on a postoperative exercise program

o Assessment of the home environment

* Postoperative day 1

o Bedside exercises (eg, ankle pumps, quadriceps sets, gluteal sets)

o Review weight-bearing status

o Bed mobility and transfer training (ie, bed to/from chair)

* Postoperative day 2

o Exercises for active ROM, active-assistive range of motion (AAROM), and terminal knee extension

o Strengthening exercises (eg, ankle pumps, quadriceps sets, gluteal sets, heel slides, straight leg raises, isometric hip adduction)

o Gait training with assistive device and functional transfer training (eg, sit to/from stand, toilet transfers, bed mobility)

* Postoperative day 3-5 (or on discharge to rehabilitation unit)

o Progression of ROM and strengthening exercises to the patient's tolerance

o Progression of ambulation on level surfaces and stairs (if applicable) with the least restrictive device

o Progression of ADL training

* Postoperative day 5 to 4 weeks

o Strengthening exercises (seated leg extensions, standing hip abduction and extension, knee bends, short arc quads)

o Stretching of quadriceps and hamstring muscles

o Progression of ambulation distance

o Progression of independence with ADL

Alexander Said:

My mother has gotten a knee replacement. What do we do to help it heal and get out of pain?

We Answered:

My mother went through the same thing, she had nurses and physical therapists come in the home the first few weeks. It's a very painful and have to have patience and needs team work after this kind of surgery. You need to help her and call her physician that did the surgery and tell them she needs care and physical therapy. Physical Therapy is really needed after a knee replacement, so it heals properly and she can get it moving around. And, make sure your mother is on pain killers, that her doctor should have prescribed, and that she takes them at the recommended dosage. Remember, Doctor's are always on call if you have any questions anytime of the day, just open the yellow pages. Good luck, hun!

Barry Said:

hip replacement physical therapy injury?

We Answered:

Popping in the knee can be something very benign such as a gas bubble popping, or it can be a sign of meniscal injury to the knee. MOST of these things do get better on their own, but if it doesn't get significantly better in a few days, he should see the surgeon...it would be a shame for his knee to delay his recovery of his hip.

Cody Said:

Should I have knee joint replacement at 70 or physical therapy?

We Answered:

Most definitely PT first. And I would only do the surgery after trying PT for 2-3 months if walking was really difficult and painful. I have seen several cases of patients your age and older going in for joint replacement surgery and never making it out of the hospital b/c of contracting pheumonia, or a DVT, etc. That does not mean it will happen to you but understand than any surgery is a serious thing and should only be considered if you are having real difficulty with daily necessary activities. The rehab is long and much harder than PT is wthout a surgery. Granted there are many more cases where patients do quite well after surgery.