Attending the Total Knee Replacement (TKR) Class

Transcription

1 Attending the Total Knee Replacement (TKR) Class Page 16 Patient Information

2 This leaflet explains more about the total knee replacement (TKR) Class at Ashford and St Peter s Hospitals NHS Foundation Trust Page 2 Page 15

3 6. What if I am unable to attend? Contents Page Number If you are unable to attend your class, then please inform the physiotherapy department on: (Ashford Hospital) or (St Peter s Hospital) If you miss a class without notifying the department then you may be discharged from the class. 1. What is the TKR class? What does the TKR class involve? How to look after your new knee Exercises Getting back to normal What if I am unable to attend? Page 14 Page 3

4 1. What is the TKR class? The Total Knee Replacement (TKR) class is a physiotherapy-led exercise class specifically designed for people who have recently had a TKR. The class aims to improve your knee strength, range of movement, balance, knee control and function. The TKR class runs for a period of 4 weeks, with each class lasting one hour. You will attend the class once a week for the duration of the 4 weeks. You are expected to attend all 4 classes. If you miss one of the classes this will be counted as part of your four week allocation and will not result in an additional class being added on. At the beginning of your first class we will ask you to complete a questionnaire called The Oxford Knee Scale, which will help us measure your progress over time. We will ask you to repeat the questionnaire on your last class to assess the progress you have made. We will also measure the range of movement of your operated knee on your first and last class. 5. Getting back to normal Keeping up with your exercises even after the class will make a big difference to your recovery time. Gradually you will be able to build up the exercises to strengthen your muscles so that you can move around more easily. Walking aids: crutches are useful at first because your quadriceps (thigh muscles) will be weak after the operation. You can begin to wean yourself off the walking aids as your swelling and pain improves. Sleeping: you don t need to sleep in a certain position with your knee after surgery. However, you should avoid sleeping with a pillow underneath your knee, although this may feel comfortable it can affect your muscle length, resulting in a permanently bent knee. Kneeling: you can try kneeling on a soft surface after 3 months when the scar tissue has healed sufficiently. Kneeling may never be completely comfortable but should become easier as the scar tissue hardens. Driving: you should be able to drive again after about 6 weeks. You ll be able to drive after your joint replacement as long as you can safely control the vehicle and complete an emergency stop. It s important to check with your insurance company whether you are covered during your recovery, and you need to be confident that you can adequately control the vehicle in all circumstances. Page 4 Page 13

5 2. What does the TKR class involve? The class begins with a gentle warm up. After the warm up you will complete an exercise circuit, spending 2 minutes on each circuit station where you can exercise at your own pace. The class finishes with a gentle cool down and some stretches. What if I am still lacking movement of my knee on my last class? If you are still lacking movement of your knee, then we can refer you back to the physiotherapist who referred you into the class for another one to one session. You may have some increased swelling and soreness after your first few classes- this is normal after a TKR operation when exercising. You may find it useful to take some of your prescribed pain killers following your session. The physiotherapist will then re-assess your knee and decide on your treatment and progression of exercises. 3. How to look after your new knee Page 12 Page 5

6 Your new knee will continue to improve for as much as 2 years after your operation as the scar tissue heals and the muscles are restored by exercise. However, with structured rehabilitation most people can get back to 90% of their daily activities within a 3 month period. During this time you need to look after yourself and pay attention to any problems such as pain or swelling. Whilst this can be unpleasant it is not a cause for concern and should not stop you from building up your activity levels. Pain- pain caused by bruising during the operation should reduce after about 4 weeks, although some pain is likely to last for as long as 6 months. It is important to keep your pain well controlled as this will allow you to move your knee and complete your exercises. 4. In standing (hold a stable support if needed) with your weight evenly on both feet, use your thigh muscles to straighten the operated knee (or both together). Hold for 5 seconds. If your pain is not well controlled, it may delay your progress and recovery. If you need to, please continue to take your pain medication, or seek advice from your GP if your pain relief is not working for you. Swelling- this is a very common problem after a TKR, particularly affecting the ankle and foot and may last for months after the operation. 5. Sitting in a chair, bend your ankle to bring your toes upwards then try to straighten the operated knee keeping the foot pointing up. Try to achieve the foot level with your hip with a straight knee. Hold for 5 seconds. The swelling usually settles as your walking ability improves. Page 6 Page 11

7 Ask the physiotherapist if you are unsure. Exercises to be performed 4 times a day repeating each exercise 10 times. 1. With your leg supported on a stool/sofa or in bed: use your thigh muscles to straighten the operated knee down flat onto the surface with your toes pointing up. Hold for 5 seconds. To reduce the swelling in your knee, you should rest with your leg elevated for 20 minutes at a time as often as needed throughout the day. Raising your foot above the level of your heart is another good way to reduce swelling. Applying cold can be very helpful for a swollen joint, but make sure that you protect the skin from direct contact with ice to prevent ice burns. An alternative is to use fridge temperature cold pack, such as a cold water bottle. 2. Slide your foot up the bed to bend your operated knee as far as possible. 3. Sitting in a chair, slide the foot of your operated leg backwards to bend your knee as much as possible. Now cross your other foot over your ankle and nudge to bend the knee further. Looking after your wound It is important to look after your wound and be aware of any signs of infection such as excessive swelling, redness, weeping fluid, heat or excessive pain. If any of these signs appear please contact your GP. Page 10 Page 7

8 Why does my knee feel tight? Your knee range of movement will be limited if your knee is still swollen. As your wound heals scar tissue is formed, scar tissue has different properties to normal tissue and is not as flexible as normal tissue, making your knee feel tight as you move it. Why does my knee still feel numb? As your wound is healing it often feels hard and itchy, this is normal and settles with time. You may find the skin is numb on one side of the wound; this normally improves with time but sometimes it may not improve. It tends not to cause any long term problems. 4. Exercises Do I carry out the exercises at home? To get the maximum benefit from the class, it is important that you also complete the exercises at home. The exercises in the class are designed to make this possible; your physiotherapist can provide you with a copy of the exercises. Importance of the exercises After the operation you will have weak quadriceps (thigh muscles) around your knee. This is because some muscles may have been cut in order to perform the operation. They may have also been weak before surgery as you have been suffering with pain It is important to complete the exercises given to you by your physiotherapist in order to improve the strength of the muscles and to regain the range of motion of the knee. The primary focus of the exercises is to achieve a knee bend- at least 100 degrees and to achieve a straight knee- as straight as the other knee. Exercises Page 8 Page 9