• Advantages of Progressive Strengthening After Your Knee Replacement

    Total Knee Replacement

    Many people after a total knee arthroplasty (TKA) never achieve the same level of function as a similarly aged person without knee problems.  However, a recent study published in Physiotherapy Theory and Function indicates that a progressive strengthening program will likely bring their function to higher levels than those who do not receive that type of care.

    Progressive strengthening, in this case, means that the study participants received a number of physical therapy visits after surgery during which strengthening exercises were given. These were progressively increased to maintain maximum effort for 3 sets of 20 for all exercises.  The normal standard of care group focused primarily on range of motion, cycling and straight leg raising exercises without weight.

    The study found that a larger portion of patients who received progressive strengthening exercises achieved normal clinical and functional scores.  This indicates that although all patients may not achieve normal function after a TKA, those receiving this type of treatment have a better chance of returning to normal function.

  • What should I consider before undergoing joint replacement surgery?

    The number of joint replacement surgeries in the United States has grown exponentially in the last several years. And while it is a common surgery there are some things to consider before undergoing the procedure. 

    Conservative treatments and activity modifications should always be the first line of treatment.   These include things such as weight loss, exercise, injections and physical therapy.  Losing excess weight will help to reduce the amount of force applied to your joints.  According to the John Hopkins Arthritis Center being just 10 lbs. overweight can add up to 60 lbs. of force to your knees.  This excessive force causes more wear and tear to the joint and further destruction of cartilage.  Exercise can help to improve muscular strength providing support to the joint and can help to reduce pain.  Regular moderate intensity physical activity can also help with weight loss goals.  Surgeons can also provide steroid injections into the joint which can provide temporary pain relief and reduce the inflammation.  They can also try injections of a gel-like substance that is based on hyaluronic acid which is a naturally occurring substance in our joint fluid.  It helps to lubricate the joint and, in some cases, can provide some pain relief for 6-12 months.   Participating in physical therapy can improve the strength and flexibility of the appropriate muscles to help support the joint and reduce pain and pressure.  By increasing your strength, endurance and function physical therapy could help to postpone or maybe even avoid surgery. 

    But if conservative methods have failed and joint replacement surgery is the appropriate treatment then there are other things to consider.  First is to select the best surgeon.  You want to look for a surgeon who specializes in joint replacements and performs a high volume of surgeries annually.   Check out outcome data if possible, to see the surgeon’s success rate as well as their complication rates.  Next consider undergoing some “prehab” at physical therapy.  A study in the Journal of Bone and Joint Surgery found that 1-2 sessions of pre-operative physical therapy reduced the post-operative care use by 29%.  The physical therapist can provide you with education regarding post-operative expectations in terms of swelling, and mobility challenges.  They can also evaluate your current strength and mobility deficits and provide exercises for you to start performing to help increase muscle activation.  During the prehab visit the therapist can also help you to plan for your post-operative recovery by instructing you on the proper way to use an assistive device such as a walker or cane for ambulation and teaching you how to climb stairs safely after surgery.  Other things to consider before undergoing joint replacement include having a support system in place post-surgery.  You may need to make some modifications to your home such as removing throw rugs and other possible obstacles, obtaining adaptive equipment such as a shower chair or raised toilet seat to make daily activities easier while your mobility is reduced.  Driving is also typically restricted for at least 4-6 weeks post-surgery.  Rehabilitation after joint replacement starts immediately to help initiate muscle contraction and increase early mobility to decrease swelling, improve range of motion and decrease pain.  The rehabilitation process takes commitment in order to achieve the best results. Generally, after 3 months post-surgery individuals have returned to their normal daily activities, but they may still have some mild swelling and weakness for up to a year post surgery. 

    If you have questions or want to pursue physical therapy to help reduce your joint pain and improve your function, contact our office to schedule an evaluation.  For a consumer-friendly guide to joint replacement go to www.moveforwardpt.com.



    Johns Hopkins Arthritis Center: https://www.hopkinsarthritis.org

    Journal of Bone and Joint Surgery: https://www.jbjs.org/


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