The first 12 weeks after surgery are critical to ensuring you get the best function possible with your new knee. Getting right back on your feet after surgery helps you recover faster, improves your long-term outcome, and avoids complications. The following video series will take you through the activities and exercises you need to do to make that happen.
Congratulations! You’ve completed your total knee replacement. The first 12 weeks after surgery are critical to ensuring you get the best function possible with your new knee. This video series will take you through the activities and exercises you need to do to make that happen.
This video series is led by Dr. Amy Cannatta, DC, and Ashley Baratko. Dr. Amy received her Bachelor of Science and Doctor of Chiropractic degrees at the University of Bridgeport College of Chiropractic in 2005. She was specialty certified in Neurodiagnostics at the Palmer College of Chiropractics in Port Orange, Florida in 2018. Dr. Amy has practiced chiropractic medicine in Connecticut as well as Arizona. She joined Phoenix Spine and Joint in 2017. Ashley Baratko has worked for five years as a physical therapy assistant and is applying to enter physical therapy college to study for her doctorate.
Week 1 After Total Knee Replacement Surgery:
First, a little reminder. Your surgery was done in a minimally invasive fashion to help you make a rapid recovery. In addition, robotic guidance with artificial intelligence was used to create a model of your knee joint that was used to pick the perfect implants to give you the best possible range of motion. In the bad old days when legacy surgeons took down muscles and the implants were not the perfect fit recovery required extensive physical therapy and strengthening for six to twelve months. Times have changed. You may choose to engage in physical therapy, but many of our patients have achieved excellent recoveries without it. You should expect to make a complete recovery from surgery in 1-2 weeks, and fully strengthen and “on board” your new knee within 8-12 weeks after the day of surgery.
You have three goals for the first week of recovery after your minimally invasive robotic-assisted knee replacement surgery. The first goal is to walk one hundred feet without a walker. You were given a walker when you left Phoenix Spine Surgery Center. The purpose of the walker is to ensure that you do not fall! Most people feel stable walking without the walker after the first day or two; some require the walk through the first week. Regardless, by the end of the week, you should be able to walk 100 feet.
The second goal is to regain 80 degrees range of motion in your new knee. This is best done sitting and standing out of a chair. In the video, Dr. Amy and Ashley will coach you on how to safely reach your goal.
The third and final goal is to regain extension (straightening) of your knee. When standing the knee bends forward beyond straight up and down. The exercises in the video will enable you to reach the –10 degrees (ten beyond straight) needed for proper gait.
The first exercise is done on a chair. Sit down comfortably, then scoot yourself forward on the chair so that your knee is at a 90-degree angle to the ground. Hold this position for two minutes. Some discomfort is normal, and this should decrease as you progress through the week as your recovery progresses. Release your knee by straightening your leg, then repeat. You should do this exercise for at least two hours throughout the day.
The second exercise for your total knee recovery ensures you regain full extension of your new knee. This is crucial to having walking normally without any limp after your full recovery. The second exercise is also done sitting on a chair. Place your heel on a second chair in front of you with your toes pointed to the ceiling. Take care not to let your hip rotate inward or outward.
Complications such as blood clots, infection (urinary tract, pneumonia, surgical site), heart problems or dislocation almost never happen; however, we are always on the lookout for them. It is always better to be safe than sorry. Let your surgeon know if you experience any of the following:
- bleeding or drainage from your incision site
- Skin redness around the incision that is getting larger
- Painful urination
- Chest pain
- Shortness of breath
- Swelling that does not respond to elevation and compression
- Temperature greater than 100.4 sustained over 24 hours
In addition, let your surgeon know if you are unable to do the exercises shown in the video.
At Phoenix Spine and Joint, we’ve seen how minimally invasive robotic-assisted total knee replacement changes lives. We’re excited for you as you begin your journey and get BACK IN THE GAME!
Weeks 2-4 After Total Knee Replacement Surgery:
Your first goal for this period of recovery, and from here on out, it to increase your range of motion. The second goal is to increase your daily activity and endurance. And the third and final goal is to manage swelling.
The first exercise is an isometric contraction. While sitting down in a chair press your heel back into the chair. This helps strengthen your hamstring muscle. Hold the pressure for 2 minutes. Keep your toes pointed straight out and avoid rotating your knee or hip inward or outward as you contract your hamstring muscle.
The second exercise for your total knee recovery is also done sitting on a chair. Straighten your knee as far as you can up in the air. This exercise strengthens the quadriceps muscles on the front of your leg. Hold the extended position for 2 minutes. Again, avoid rotating your hip or knee by keeping your toes pointed straight up in the air.
The third exercise is a heel slide. Sit with your legs straight in front of you and put your heel on a towel. Bend your knee by bringing it toward you so that your heel slides on the towel across the ground. Repeat ten times as you tolerate. Rest. Then repeat ten times more, and ten more times after that.
If you are in physical therapy expect your therapist to do patellar mobilization (moving the kneecap across the joint) and passive range of motion in this phase. If you’re not in therapy, you can do these things with the help of a family member as shown in the video.
The last exercise is a straight leg raise which is done in four planes. Watch the video to learn how to do each.
Weeks 4-6 After Total Knee Replacement Surgery:
People vary in the speed at which they progress. Some people may feel ready to move on in week 4, others in week 5. We left some overlap in the videos to account for these differences. The first 12 weeks after surgery are critical to ensuring you get the best function possible with your new knee.
Your first three goals for this period are the same as the last one: increase your range of motion, hamstring and quadriceps strength, and daily function. A new goal of this period is to become aware of your proprioception, your sense of where your knee is in space. Proprioception is key to normal use of your knee, a full recovery, and walking in particular.
Please note that these exercises are added to the ones you learned in the previous videos. Keep doing all of the exercises from week 1 as well as weeks 2-4.
The first additional exercise for this period is standing on one foot. Take off your show on the side of your operated knee so that you are barefoot or wearing only a sock. Stand somewhere you can support yourself with your arm and raise your unoperated leg with your operated knee slightly bent.
The second exercise for your total knee recovery is a step up. The purpose of this exercise is to practice so you are confident going up and down stairs. Just take a step up, rest, and repeat. Make sure you have a rail to hold onto for stability.
The third exercise is a squat. At this point you should be able to do some form of a squat. Follow the cues in the video to be sure you are using proper form.
The fourth exercise is a resisted march. Place a wide elastic band around your feet and march in place. Try to keep your torso still. Do ten on each side and repeat the ten twice for three set of ten reps of the marches. The first exercise is a lateral band walk. Place the band on your legs above your ankles and walk to the side.
Note that you should be walking unassisted — without a walker or cane — at the very latest by week 4. If you still require a walker or cane, please contact your surgeon.
Weeks 7-12 After Total Knee Replacement Surgery:
You’re almost there! The first 12 weeks after surgery are critical to ensuring you get the best function possible with your new knee.
The goals for this period of your recovery are first to start returning to light recreational activities such as swimming, brisk walking, light hiking; for golfers this is the time to start chipping and putting. These activities are the last transition before you resume the sports and exercises you liked to do before your knee pain took you out of the game. The second goal is to ensure you have 120 degrees of flexion. Last, it’s important you have good range of motion of your kneecap (patella).
There are no new exercises for this period, but you should raise the difficulty on the exercises you are already doing. Increase the strength of the bands. Work harder and bring greater repetition and intensity to your movements.
How do you know when you should be done with physical therapy after total knee replacement? Not everyone does PT, but if you did, you know you’re done when you’ve reached full strength, have normal range of motion as described in the video, walk without a limp, are free of limiting pain, and can do your own home exercise program.