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EPISODE 31: Regaining Function - Total Knee Replacement and Rehabilitation

Updated: Sep 28, 2023

Are you a recreational athlete with severe osteoarthritis and knee pain? Have you been considering a total knee replacement but you are not sure what to do? Maybe you had a total knee replacement and you are struggling to get back to your recreational activities, sports and hobbies. This blog is going to reassure you that if you put in the time and work you can return to whatever activities you want to do and possibly even feel better after having a knee replacement!

The best examples are the real ones. In an effort to really show you that getting back to sports and recreation is possible, I wanted to share a recent case of mine. This client's name is Jose. Jose is a 64-year-old male that came into our clinic in October of 2022 after undergoing a left Total Knee Replacement also known as a Total Knee Arthroscopy (TKA). He has participated in multiple Ironman's within the past decade and his goal after his surgery was to return to long-distance cycling and swimming. I am going to share with you what we worked on in each phase of his rehab and how he was able to get back to cycling and swimming in less than 6 months.

Before we discuss Jose’s case, let's talk about exactly what a Total Knee Replacement is in the first place.

1. Relevant Anatomy:

The knee is a complex synovial “hinge” joint that allows for bending and extending while also allowing for rotation and gliding. The cartilage on the above portion of the tibia (shin bone), the lower portion of the femur (thigh bone), and the deep portion of the patella (knee cap) provide smooth surfaces for the bones to move relative to one another. A Total Knee Replacement involves resecting diseased cartilage in the knee and replacing it with metal and plastic prosthetic pieces.

Knee joint before and after surgery

2. Prognosis:

The prognosis which is the outcome and/or chance of recovery depends on several factors including your prior level of function. Knee replacement surgery has an extremely high success rate. About 90% of Knee Replacements Last 10 Years and 80% Last 20 Years. The first 3 months following the procedure will be focused on regaining your ability to perform daily/normal tasks - if you have a good first 3 months, you will definitely have a great next 3 months and so on. For most people, a successful knee replacement typically leads to a higher quality of life, less pain, and better mobility. After a year, many report significant improvements in: pain, stiffness, strength, and overall function.

Now let's get back to Jose and talk about interventions. These are the things we do to promote healing after a total knee replacement in physical therapy.

3. Intervention : REHABILITATION!

In the early phase of rehabilitation (rehab), we focused on regaining range of motion in his knee while promoting strength and control of the surrounding musculature for everyday tasks like walking.

Exercises we incorporated in this phase included:

  • Cycling

  • Supine Heel Slides or Wall Heel Slides

  • Quad+Hamstring+Glute Sets

  • Short+Long Arc Quads

  • Straight Leg Raises

The middle phase of rehab focused on progressing strength and endurance in his legs to build tolerance to higher-level activities like going up and down steep stairs and going on longer bike rides.

Exercises we incorporated in this phase included:

  • Cycling

  • Regular+Split Squats

  • Step Ups+Downs

  • Double+Single Leg RDLs

  • Hip Thrusters

  • Knee Extensions

  • Hamstring Curls

  • Calf+Toe Raises

The late phase of rehab focused on adding explosive power and plyometric abilities while fine tuning small strength deficits in his legs. We also monitored the progression of his long distance bike rides ensuring he had enough endurance and he was not over exerting himself through excessive exercise. Examples of power and plyometric exercises included:

  • Box+Drop+Continuous Jumps

  • Skipping

  • Lateral Shuffles+Cariocas

  • Pogos

It was important to note that these exercises are not meant to be only performed during one specific phase of rehab; additionally, these phases are not independent of each other but rather are on a time continuum and may blend in with one another.

In Jose’s case, he spent the past 6 months going through the normal ups and downs of post-surgical rehab, but, he was VERY consistent and intentional with his physical therapy program. He reported several times over the course of his treatment that his left knee has felt better in the past few months than it has over the past few years. He is back to cycling with his group of friends and is getting ready to travel to Japan next month to ride with this group! As the weather begins to improve, he plans to get back in the water and start swimming more consistently as well.

Jose’s case is a true testament to hard work, a great surgeon and amazing physical therapy. He serves as a reminder for us to continue our athletic journey as we age and to not give up when our body tries to.

Athletes can come in all shapes and sizes, can come from different backgrounds, and can have various amounts of exercise experience. We want to encourage you! If you have severe osteoarthritis and knee pain; you can have a total knee replacement. With hard work and the right team, you CAN get back to the life you had before! Be like Jose and get the right physical therapist on your team that will guide you through the recovery process and tailor your program to your specific needs.

If you are interested in working with us we work with clients on site and virtually through Telehealth. Click here if you are interested in booking a a session or getting more information!

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Much Love <3 ,

Dr. Sandoval, Dr. Brown, Dr. Bay, & Dr. Daisuke

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