KNEE
REPLACEMENT

EXERCISE PROGRAMME

We have described here a knee replacement exercise programme for before and after surgery.

Your engagement with the recovery process has been shown to make a significant difference to the results you can expect. So we recommend that you work with your healthcare team to carry out your strengthening exercises, before your operation, immediately after it and during your rehabilitation at home.

Exercises to prepare for your operation

To ensure the best possible outcome from your operation, you should work with your healthcare team to prepare for your surgery, carry out your strengthening exercises, and ask questions so that you are well informed and in control of your own experience.

In preparation for your operation, it is recommended that you try to attempt as many of the exercises below prior to your admission to hospital. Please stop any particular ones that cause you pain.

Exercises ideally to be performed three times a day. Attempt as many of these exercises as you can but stop any particular ones that cause pain.

Exercise 1: Calf Pumps Sets: 2 / Repetition:10

Exercise 2: Static Quadriceps Sets: 2 / Repetition:10

Exercise 3: Inner Range Quadriceps Sets: 2 / Repetition:10

Exercise 4: Straight Leg Raise Sets: 2 / Repetition:10

Exercise 5: Knee Flexion Sets: 2 / Repetition:10

Exercise 6: Sitting Knee Flexion Sets: 2 / Repetition:10

Exercise 7: Gluteus Bridging Sets: 2 / Repetition:10

Exercise 8: Static Glutes Sets: 2 / Repetition:10

Exercise 9: Single Leg Stance Sets: 1 / Repetition:5

In hospital

After your surgery, it is important to perform the deep breathing exercises you were shown by the Physiotherapist. This is to keep the lungs clear.

Inhale deeply through your nose, and then slowly exhale through your mouth. Repeat this three times and then huff and cough two times. Perform this exercise hourly while you are awake.

You will be mobilised by your physiotherapist or nurse on the day of surgery once you have returned to the ward and are fully awake. The team will start you on a programme of exercises. You can help your own recovery by carrying these out every 2 hours or as recommended by the physiotherapist.

Exercises when you get home

Please discuss any concerns you might have about returning home with your nurse or physiotherapist.

Before going home, you will practise going up and down stairs, walking independently, getting in and out of a chair, on and off of a toilet and getting in and out of bed safely. The physiotherapy team on the ward will advise on the exercises to carry out daily to aid your rehabilitation.

Exercises ideally to be performed every 2 hours. Attempt as many of these exercises as you can but stop any particular ones that cause pain.

Exercise 1: Calf Pumps Sets: 2 / Repetition:10

Exercise 2: Static Quadriceps Sets: 2 / Repetition:10

Exercise 3: Inner Range Quadriceps Sets:2 / Repetition:10

Exercise 4: Straight Leg Raise Sets: 2 / Repetition: 10

Exercise 5: Knee Flexion Sets: 2 / Repetition:10

Exercise 6: Sitting Knee Flexion Sets: 2 / Repetition:10

Exercise 7: Heel Hangs – Floor Sets: 2 / Repetition: 10

Exercise 8: Heel Hangs – Chair Sets: 2 / Repetition: 10

Exercise 9: Prone Hangs Sets: 2 / Repetition: 10

Exercise 10: Caudal Patella Glides Sets: 2 / Repetition: 10

Exercise 11: Medial Patella Glides Sets: 2 / Repetition: 10

Exercise 12: Lateral Patella Glides Sets: 2 / Repetition: 10

Outpatient physiotherapy

Make sure you have physio support in place for when you get home, or speak to the physio team in hospital about follow up sessions. If you have any queries or would like further information, please contact the Therapy Department on: 020 7460 5749.

Exercise and returning to daily life

A total knee replacement is a major procedure, so it will take several months before you can return to a normal level of activity. Try to go out walking every day and increase the distance you walk each week.

It can take up to three months for the discomfort and swelling to go completely. When this swelling is noticeable, use ice and elevate the leg but keep active and enjoy the benefits of your new knee.

Try to gradually increase your daily walking. Continue to use walking aids as instructed until you are able to walk a good distance without a limp. Your outpatient physiotherapist will be able to advise you on this.

Do not drive a car until you have discussed this with your consultant and insurance company. Do not jump, run or perform other activities that put undue stress on the knee.

Ice application

Resting your leg with a rolled up towel under the heel to encourage a straight knee. Apply crushed ice/bag of frozen peas directly on the skin over the knee joint then compressed with a towel wrapped around the knee joint and the leg elevated with the knee straight. (N.B. Check your skin after ice treatment – if it stays red for more than 20 minutes after icing then apply a thin damp towel between the crushed ice/bag of frozen peas and your skin to prevent ice burn). Aim for 15 minutes every 1– 2 hours as swelling persists.

The exercises illustrated

CALF PUMPS Sets: 2 / Repetition:10
Lying on your back or sitting, bend and straighten your ankles briskly, contracting your calf muscles. Repeat regularly.

STATIC QUADRICEPS Sets: 2 / Repetition:10
Lie on your back with your operated leg straight. Bend your ankle and straighten your operated leg. Feel your quadriceps muscle (thigh muscle) contract. Hold this contraction as if you were about to initiate a leg raise but without lifting the leg off the bed. Hold for 5 seconds, and slowly relax.

INNER RANGE QUADRICEPS Sets: 2 / Repetition:10
Place a pillow or a rolled up towel under your knee. Activate your thigh muscle, straightening your knee and lifting the heel off the bed/ floor. Your knee should remain in contact with the pillow/ towel. Lock your knee, holding it straight for 5 seconds then slowly lower.

STRAIGHT LEG RAISE Sets: 2 / Repetition:10
Lying on your back with operated leg straight and the other leg bent (to protect your lower back). Exercise your operated leg by pulling the toes up, straightening the knee and lifting the leg 20cm off the bed. Hold approx. 5-10 seconds, slowly lower.

KNEE FLEXION Sets: 2 / Repetition:10
Lying on your back, bend and straighten your operated leg by sliding your heel up and down the bed/floor. Ensure you bend within pain limits only.

SITTING KNEE FLEXION Sets: 2 / Repetition:10
Sit on a chair with your feet on the floor. Bend your operated knee keeping your heel in contact with the floor. Ensure you bend within pain limits, you can use your non-operated leg to assist.

GLUTEUS BRIDGING Sets: 2 / Repetition:10
Lie on your back with your knees bent. Draw your tummy button in towards your spine. Contract your buttocks while lifting your buttocks off the ground until your trunk is aligned with your legs. Hold for 5-10 seconds and then slowly return to initial position and repeat.

STATIC GLUTES Sets: 2 / Repetition:10
Lay on your back and tighten your buttocks as hard as you can. Hold for five seconds and repeat.

SINGLE LEG STANCE Sets: 1 / Repetition: 5 / Frequency: 3 / Duration: 1 minute
Stand straight with your feet close together and lift operated leg off of the floor. Hold this position for 1 minute, lower your leg and lift the opposite leg and repeat the exercise if you are able to.

HEEL HANGS – FLOOR Sets: 2 / Repetition: 10 / Frequency: 3
Place a rolled towel or a small pillow under your ankle. Let the knee straighten in this position to get full extension/straightening. You can apply your ice in this position for 10-15 minutes.

HEEL HANGS – CHAIR Sets: 2 / Repetition: 10 / Frequency: 3
Sit on a chair with the operated leg supported on the chair as shown. Rest your leg so that it is encouraged to straighten in this position. You can combine this with ice treatment.

PRONE HANGS  Sets: 2 / Repetition: 10 / Frequency: 3
Lying on your front with your lower leg hanging off the end of the bed. Let gravity straighten your leg. Rest in this position for 2 minutes at a time, or as pain allows.

CAUDAL PATELLA GLIDES  Sets: 2 / Repetition: 10 / Frequency: 3
Sit with a small rolled towel under your knee, push your knee cap down towards your foot.
Continue to hold for 5-10 seconds.

MEDIAL PATELLA GLIDES  Sets: 2 / Repetition: 10 / Frequency: 3
Sit with your leg straight and relax your thigh muscle. Push your knee cap in towards your opposite leg (medially) then hold for approximately 5-10 seconds.

LATERAL PATELLA GLIDES  Sets: 2 / Repetition: 10 / Frequency: 3
Sit with your leg straight, relaxing your thigh muscle. Push your knee cap outwards (laterally) and hold for approximately 5-10 seconds.

Fortius Joint Replacement Centre
at Bupa Cromwell Hospital

164 -178 Cromwell Road
Kensington
London
SW5 0TU


E: info@fortiusclinic.com

Appointments: +44 (0)203 693 2119

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