Therapy Guide following Knee Replacement Surgery

Information for patients and visitors
Therapy Guide following Knee
Replacement Surgery
Occupational Therapy & Physiotherapy
Community & Therapy Services
This leaflet has been designed to
give you important information
about your knee replacement
surgery and help you prepare for
coming in and going home from
your surgery.
Information for patients and visitors
Following your Operation
After being in the recovery room, you will return to the ward and be on your bed. Your knee will
be bandaged, you will have the intravenous line still in your arm and an oxygen mask or nasal
cannula in place. You may also have a PCAS (patient controlled analgesic system) for pain
control. You will be able to sit up and start eating and drinking as you feel more comfortable.
Moving after the operation is important to reduce complications. Perform the following
exercises hourly when awake:
Deep breathing - Take nice deep, slow breaths in through your nose and out through your
mouth. Do at least 2 or 3 before having a strong cough to keep your chest clear.
Ankle Exercises – Pump your feet up and down and
make circles with your ankles 5-10 times to keep the blood
moving in your legs.
Muscle contractions – With legs straight. Pull your toes
towards you, push your knees down into the bed and
tighten your thigh muscle. Hold for 5 seconds then relax.
Repeat 10 times.
You will likely have some discomfort around your knee. If your pain is not controlled, please tell
someone sooner rather than later.
You will be encouraged to get out of bed and begin mobilising as soon as possible following
your operation. You will be helped out of bed initially by one of the therapists or nursing staff.
A member of the therapy team will show you the best way to walk and ward staff will help you
until you feel confident. Initially you will have a walking frame, but will be progressed to crutches
or sticks as appropriate. You should try to walk as normally as possible using your knee bend.
Swelling often causes your knee to be stiff and painful. To help reduce this swelling, elevate
your leg and use an ice pack on your knee. Continue with this at home. If you don’t have an
ice pack, a bag of frozen peas or crushed ice can be used. Ice should always be wrapped in a
towel to prevent ice burns to the skin.
Apply for 20 minutes at a time. This can be done every 2 hours after your exercises if advised.
Information for patients and visitors
Your Basic Knee Exercises
Below are the basic exercises you need to do to improve the mobility and strength of your knee.
A member of the therapy team will teach you these exercises. It is important you keep doing
them regularly.
Your thigh muscles and knee may feel tired or sore after your exercises. This is all normal.
Do each exercise 5 times each and repeat them 5 times a day or every 2 hours unless you are
told otherwise.
1)
Ankle Exercises & Muscle Contractions / Knee Straightening – See previous pages for
these exercises
2)
Straight leg raise – Tighten your thigh muscle and
lift your leg off the bed, keeping your knee as
straight as possible. When lowering try to get your
calf to touch the bed before your heel does. This
keeps your knee straight
3)
Knee Bending in Lying – Bend your knee as far as
possible. Use your hands behind your knee or a
band round your foot as shown and gently pull up
to stretch the bend further. Hold for 5 seconds
4)
Knee Bending and Straightening in Sitting – Bend
your knee in the chair by sliding your foot back
along the floor. Hook your un-operated leg in front
of it to stretch it back a little further. Hold for 5
seconds, before sliding your foot forward and
lifting your foot off the floor. Straighten your knee
fully and hold for 5 seconds then slowly relax your
leg back down
5)
Knee Straightening Over a Roll – Put a rolled
up towel under your knee. Keeping your knee
on the roll, lift your foot off the bed and
straighten your knee. Hold 5 seconds
Information for patients and visitors
Occupational Therapy
If required, a member of the Occupational Therapy team may assess you and provide you with
advice/education on how to perform everyday activities safely and independently when at home.
The following information will help you in preparing for coming into hospital and returning home,
whether you live alone or not.
Washing and Dressing:

On the ward you will either strip wash or shower. This can be continued at home

You will be encouraged to perform all personal care activities as independently as possible
and there is usually no need to use dressing aids

Please ensure your bring in comfortable, loose fitting clothes and suitable footwear.
Women find skirts or shorts, and men find shorts, most practical to wear while on the ward

Gradually return to your normal bathing routine. Take all usual safety precautions, for
example, use a non-slip mat in a bath and/or shower cubicle

You should not have a bath until your wound is healed and you may find it difficult getting in
and out of a bath until you have gained better movement and control of your knee

You may find it easier to dress your operated leg first and undress it last, but try to use it as
normally as possible. Sit on the side of the bed or chair initially when getting dressed to
reduce the risk of falls
Transfers:

Sitting down and standing up – A member of the therapy team will discuss and demonstrate
with you how to safely transfer on/off a bed and chair
Using the toilet – there is usually no need to use equipment such as a raised toilet seat. Whilst
on the ward you will have the support of hand rails around the toilet. You may not have this
help once you are home so practice getting on/off the toilet without this extra support. A
member of the therapy team will ensure you can manage a toilet transfer safely and
independently
Information for patients and visitors
Household Tasks:

If you live alone it may be helpful to have somebody stay with you for a few days until you
gain confidence to do things. You may require help with activities involving carrying items
as you will be using a walking aid

Make sure your meals are organised or pre-cooked and you have stocked up on groceries
prior to hospital admission

Make sure items in the kitchen are located so you do not have to over bend/over reach

Avoid tasks involving kneeling, such as cleaning floors
Other things to consider in the Home:

Ensure banisters and handrails are secure on steps and stairs

Make sure all rooms, hallways and doorways are clear of clutter and any loose rugs
removed. You may also need to ensure carpet edges and loose cables are secure to
prevent any risk of falls

It may be useful to have table lamps or nightlights set up in dark hallways, to ensure good
visibility at night

Have a phone in areas you spend most of your time (such as sitting room, kitchen) and
keep emergency phone numbers at hand
Driving:

Driving is not recommended in the first 6 weeks after your surgery, unless you have been
told you can. This will be based on your surgery and individual circumstances (for example
having a left knee replacement, but an automatic transmission in your car)
There is no reason why you cannot be a passenger in a car to get out of the house. If you
struggle to get into the car, you may need to move the seat back or even use a plastic bag on
the seat to help slide round until you get more mobile
Information for patients and visitors
Steps and stairs
Before discharge a member of the therapy team will show you how to go up and down the
stairs, or a step if you are unlikely to be using stairs. The sequence is the same for both.
Walking up and down stairs
One step at a time – Stand close to the stairs and handrail. Hold handrail with one hand and
crutches / sticks in the other hand.
Going Up
Going Down
Step up with the un-operated leg
Place crutch or stick down
Then bring up your operated leg
Then step down your operated leg
Finally bring up your crutches or sticks
Finally step down the un-operated leg
Your therapist may adjust this technique to suit your own needs.
Information for patients and visitors
At Home:
Once you are home, it is important to continue with your exercises little and often and increase
your walking distances. Aim to return to normal levels of activity gradually.
Follow up Physiotherapy may be arranged for you to progress your mobility and exercises, but it
is your responsibility to do your therapy programme regularly to get the best outcome.
Please discuss any hobbies or pastimes you have with your Physiotherapist, who will be able to
advise you when to restart them.
Pain and Swelling Control
Keep taking your medications and using ice packs, as
needed.
Use the ice for 20 minutes, while elevating your leg as
shown. If your knee is still stiff after a few weeks, you
may benefit from using heat on your knee before your
exercises. This may help you to stretch your knee
more easily. Do not put the heat or ice directly on your
skin.
Infections & Blood Clots
There is greatest risk of infection and blood clots in the first 6 weeks after surgery. Things to
look out for include:

New excessive swelling and pain (pain not from your exercises)

Increased redness, heat or leakage from your wound

Generally feeling unwell or having a raised temperature

Swelling and pain in the thigh or calf, especially if red and hot
If concerned contact your GP or practice nurse.
Information for patients and visitors
Walking and Steps / Stairs
Continue to walk regularly and increase the distance you walk as tolerated. It is important you
walk outdoors. Gradually stop using your sticks or crutches as able or as advised by your
Physiotherapist. When using one stick or crutch, use it in the opposite hand to your knee
replacement.
In addition to walking normally, try walking sideways and backwards to help your balance.
Using a mirror to look at how you are walking will help you see if you are using your knee bend
properly and allow you to correct it. After 6 weeks, progress to walking on uneven ground such
as walking in the park or on the beach.
Don’t be surprised if you cannot climb stairs normally until 6-10 weeks after the surgery. You
may need to practice stepping up and down with your operated leg to improve confidence in
using it.
The following exercises will help with your walking, balance and stairs. You can try any of them
you feel capable of doing, but your Physiotherapist may ask you to work on specific ones.
Additional Straightening Exercises
Hold the stretches for 30 seconds to a minute and increase the time as you are able. Try to
stretch a few times during the day.
Passive Knee Stretches
Place a soft weight on the front of the knee while resting with the leg on a stool or roll.
Lay on your tummy with your foot and lower leg hanging off the edge of the bed. Put a weight
on your ankle, or press the other leg on top of your operated leg to increase the stretch.
Information for patients and visitors
Additional Bending Exercises
Hold these stretches 10 to 30 seconds and do at least 5 repetitions 2-3 times a day increasing
as you are able.
Stairs Stretch
Stand at the bottom of the stairs and lift your operated leg on to the second step. Keep your
back straight, your hip down and your good foot on the floor, lean forward into the stairs. This
will stretch your knee bend.
Towel Stretch
Slide Forward in Chair Knee Bend
Use a towel to help stretch your
knee bend as the picture
shows.
Start sat in the chair with your feet flat on the
floor. Slide your bottom forward in the chair
without moving your feet. Block your foot
against something solid to help if required.
Information for patients and visitors
Additional Strengthening Exercises
Start with 10 repetitions 2-3 times a day increasing the repetitions as you are able.
Bridging
Lift your bottom up as shown by pushing down on your feet. Hold 10 seconds.
Sit To Stand
Stand up without using your hands. Slowly sit back down again, but try just to touch your
bottom to the chair or bed before standing up again. Use a lower surface to progress the
exercise.
Squats
Stand with support. Bend your knees to squat. Hold for 10 seconds. Try to reduce the amount
of support you have and increase the depth of the squat.
Information for patients and visitors
New Balance and Control Exercises
Start these after a few weeks or when you feel you can fully weight bear without a stick for
support.
Balance
With support, stand on your operated leg by itself. Hold for as long as possible (aim for 30
seconds) and repeat 5 times. Progress this by using less support.
Step Ups and Downs
Practice stepping up and down using your operated leg. Control the movement and don’t jump
up and down on the step. Increase the repetitions you can do aiming for 20, if possible.
Toe and Heel Walking
Try walking on your toes and heels as shown. Use support if needed initially. Even try
changing directions on your toes and heels. This works your balance control and leg muscles
harder.
Information for patients and visitors
Heel to Toe Walking or Walking On A Line
Practice walking in a straight line placing one foot directly in front of the other, heel to toe.
Again this will help with your balance.
Exercise Bike
An Exercise bike can be very good for both increasing your knee bend and for general fitness.
The seat height may need to be higher than you would normally have it until your knee bend
improves.
If you are using it to increase your knee bend, make sure the operated leg is secured to the
pedal. Then by doing half circles forwards and backwards, you can stretch the knee bend in
both directions. Eventually you should be able to do a full circle and pedal normally. Gradually
lower the seat if you want to improve your knee bend or until it is at a comfortable height for
pedalling. Start with up to 5 minutes on the bike and increase as you wish.
Pool Exercises / Swimming
Once your stitches are out and your wound is healed and dry, there is no reason why you
cannot go to a pool to swim or do exercises in the water. Please speak with the Physiotherapist
if you need specific advice about exercises. Initially you will need to swim using the flutter or
scissor kick leg action, but gradually you can start doing breast stroke leg action as long as it is
comfortable.
Massage
Once your wound is healed, if your scar is tight or bumpy gentle massage down and around the
scar for 5 minutes 2-3 times per day, may help. Speak to the Physiotherapist for instruction on
the specific techniques and make sure you wash your hands well before massaging.
Information for patients and visitors
Getting Up and Down from the Floor
After 3-4 weeks getting up and down off the floor can be done as shown in the pictures below, if
needed. Use the support of a chair to help with the lowering and standing. Your stronger leg
should be used in front for the lifting and lowering. Getting up is the reverse of the pictures
shown of getting down.
Before your 6 week follow up appointment with the Hospital Doctor
You may still need to avoid:

Kneeling on your operated knee until your wound is healed

Twisting or pivoting on the operated knee

Resting with a pillow under your knee

Driving (unless your doctor or physiotherapist has said you may drive)
You may try:

House work and domestic activities. Some things may need to be done sitting down or
modified, especially if you still need to use your walking aids, or find standing for periods of
time difficult

Returning to work, if you have a fairly sedentary or desk type job. More physical jobs
should be avoided until after the first 6 weeks from surgery. If you require a medical
certificate for work, please ask while on the ward and then speak to your GP (family doctor)
for additional ones

Doing stairs normally. Don’t be surprised if you cannot do stairs normally until 6-10 weeks
after the surgery

Swimming (see the previous page)

Low Impact Exercise Machines (Stationary Bikes, Cross-trainers, Elliptical Trainers,
Steppers and Rowers) under guidance by your Physiotherapist
Golf (starting with pitching and putting and only mid-swing strokes) under guidance by your
Physiotherapist
Information for patients and visitors
After your 6 week follow up appointment
You should continue to avoid:

High impact activities such as running and jumping.

Activities which will force the bend of your knee too far (although rare, dislocation of a knee
replacement can happen in some cases, if you bend your knee too far).
You may try:

All domestic tasks you would normally do

Driving, if you haven’t already been told you can

Dancing

Bowls

Exercise classes (let your instructor know you have had a knee replacement)

Speed walking, Cycling and Horse Riding

Skating

Tennis or other court sports (not high impact, but gentle movements using the arms rather
than jumping)
Other Advice

If you need to see your dentist, inform them you have had a knee replacement in the last 6
months.
There will continue to be some variance even between the specialists in what activities you can
and cannot do following your knee replacement. One medical study found a knee replacement
allowed a significant increase of sporting activities at a 5 year follow up of patients, yet some
doctors don’t encourage this level of activity.
The most important thing to remind yourself is you have had the operation to decrease your
pain and improve the quality of your life. It is important you make the most of this improved
quality of life, balancing it with a current accepted life of joint replacement being up to 20 years.
Information for patients and visitors
Concerns and Queries
If you have any concerns / queries about any of the services offered by the Trust, in the first
instance, please speak to the person providing your care.
For Diana, Princess of Wales Hospital
Alternatively you can contact the Patient Advice and Liaison Service (PALS) on (01472) 875403
or at the PALS office which is situated near the main entrance.
For Scunthorpe General Hospital
Alternatively you can contact the Patient Advice and Liaison Service (PALS) on (01724) 290132
or at the PALS office which situated on C Floor.
Alternatively you can email:
[email protected]
Confidentiality
Information on NHS patients is collected in a variety of ways and for a variety of reasons (e.g.
providing care and treatment, managing and planning the NHS, training and educating staff,
research etc.).
Everyone working for the NHS has a legal duty to keep information about you confidential.
Information will only ever be shared with people who have a genuine need for it (e.g. your GP or
other professionals from whom you have been receiving care) or if the law requires it, for
example, to notify a birth.
Please be assured however that anyone who receives information from us is also under a legal
duty to keep it confidential.
Zero Tolerance - Violent, Threatening and Abusive Behaviour
The Trust and its staff are committed to providing high quality care to patients within the
department. However, we wish to advise all patients / visitors that the following inappropriate
behaviour will not be tolerated:

Swearing

Threatening / abusive behaviour

Verbal / physical abuse
The Trust reserves the right to withdraw from treating patients whom are threatening / abusive /
violent and ensuring the removal of those persons from the premises.
All acts of criminal violence and aggression will be notified to the Police immediately.
Information for patients and visitors
Risk Management Strategy
The Trust welcomes comments and suggestions from patients and visitors that could help to
reduce risk.
Perhaps you have experienced something whilst in hospital, whilst attending as an outpatient or
as a visitor and you felt at risk.
Please tell a member of staff on the ward or in the department you are attending / visiting.
Moving & Handling
The Trust operates a Minimal Lifting Policy, which in essence means patients are only ever
lifted by nursing staff in an emergency situation.
Patients are always encouraged to help themselves as much as possible when mobilising, and
if unable to do so, equipment may be used to assist in their safe transfer.
If you have any questions regarding moving and handling of patients within the Trust, please
speak to a member of staff in the ward or department you are visiting.
Northern Lincolnshire and Goole NHS Foundation Trust
Diana Princess of Wales Hospital
Scartho Road
Grimsby
01472 874111
Scunthorpe General Hospital
Cliff Gardens
Scunthorpe
01724 282282
Goole & District Hospital
Woodland Avenue
Goole
01405 720720
www.nlg.nhs.uk
Date of issue: December, 2015
Review Period: December, 2018
Author: Service Lead for NL/NEL, Goole Acute ＆ NEL C＆T's
IFP-893
© NLGFT 2015