Osteoarthritis (OA) is one of the main causes of functional disability and chronic pain in older people. OA is related to environmental factors, aging, lifestyle changes, and genetic predisposition. When the knee is affected by arthritis, many people undergo knee replacement procedures.
The goal of total knee replacement is to improve overall quality of life and return patients to a higher level of functioning than before surgery. Most people will heal well without problems if they follow their rehabilitation program. Some activities are permitted and others are not:
- Permitted: Swimming, golf, dancing, water aerobics, cross-country skiing, cycling, hiking, light labor (involves standing and walking), and sedentary occupations.
- Not permitted: Jogging, running, impact exercises, contact sports, sports that require pivoting and twisting, and heavy labor.
Post-operative exercise may be detrimental to the success in recovery after a total knee arthroplasty (TKA). You will begin to receive physical therapy in the hospital, and will continue at home, outpatient, or in a skilled nursing facility. A home exercise program is provided before hospital discharge.
Weeks 1-2: Anticipate discharge from the hospital after 3-5 days. Continue using walker with instructions from the therapist. At this time, you will start walking 300 feet, begin to straighten the knee, dress independently, and perform simple homemaking tasks. Home exercises will be advanced with your therapist.
Weeks 2-4: During this time, you will gradually increase independence. The home exercise program involves progressive ambulation using the cane, resuming driving if you had a left knee replacement, independent showering, and walking around ¼ mile.
Weeks 4-6: During this time, your physical therapist will have you bending the knee to 90 degrees, using a cane as needed, walking up stairs, and straightening the knee completely.
Weeks 6-12: You will continue home exercises. During this time, you will progress to walking one mile, climb stairs, and resume usual activities, such as swimming and bowling.
Many clinical studies regarding total knee replacement have studied quality of life after surgery. Considered a highly successful operation, technical outcomes from total knee replacement are excellent. In a recent study evaluating intermediate and long-term quality of life following surgery, researchers conducted a large review of studies. They found that both intermediate and long-term post-operative quality of life were superior to the pre-operative level in analyses.
In the review of clinical reports, researchers found that most patients were satisfied with the knee replacement surgery and reported substantial improvement in daily functional activities. In addition, the benefits were related to health-related quality of life as well as disease-specific quality of life. Four validated measurement tools were used to assess quality of life: the Western Ontario and McMaster’s Universities Osteoarthritis Index, the Knee Society Score, the Center for Epidemiological Studies Depression Scale, and the visual analogue scale for pain.
Another study evaluated self-reported outcomes in the first year after total knee replacement and attempted to determine which factors influenced patient quality of life. The results showed that after 6 weeks, all patients reported significant improvement for all measured parameters in relation to quality of life.
To examine health-related quality of life after total knee arthroplasty, researchers in a Singapore hospital interviewed patients. Data were collected from almost 5,000 patients. The patients who had total knee replacement all had improved pain scores. In addition, two years after surgery, the majority of patients showed improved physical functioning scores.
Ko Y, Narayanasamy S, Wee HL, et al. (2011). Health-related quality of life after total knee replacement or unicompartmental knee arthroplasty in an urban asian population. Value Health, 14(2), 322-328.
Papakostidou I, Dailiana ZH, Papalychroniou T, et al. (2012). Factors affecting the quality of life after total knee arthroplasties: a prospective study. BMC Musculoskel Dis, 13, 116.
Shan L, Shan B, Suzuki A, et al. (2015). Intermediate and long-term quality of life after total knee replacement: a systematic review and meta-analysis. J Bone Joint Surg Am, 97(2), 156-168.