Role of physiotherapy in Total Knee Replacement.pptx

Explore the vital role physiotherapy plays in the successful recovery from Total Knee Replacement (TKR) surgery. This presentation offers an in-depth look at rehabilitation protocols, exercises for strength and mobility, pain management strategies, and patient education tips to facilitate optimal post-operative outcomes. Designed for healthcare professionals, physiotherapists, and patients, this slide deck provides evidence-based techniques to improve knee function, reduce complications, and enhance quality of life after surgery.

1. ROLE OF PHYSIOTHERAPY IN TOTAL KNEE REPLACEMENT (TKR) Dr. Peteti Sairam , MPT Asst. Professor KVG Institute of Physiotherapy

2. What is Total Knee Replacement? Total Knee Replacement (TKR), also known as Total Knee Arthroplasty, is a surgical procedure in which a damaged or diseased knee joint is replaced with artificial components (prosthesis) to relieve pain and restore function. TKR has been performed since the 1960s and has become one of the most successful orthopedic surgeries, with advancements in prosthetic design and surgical techniques. [email protected] 2

3. Why is TKR Performed? To relieve severe knee pain and improve the quality of life for individuals suffering from knee joint conditions that limit daily activities. CRITERIA FOR TKR: Severe pain limiting activities of daily living Significant knee deformity (e.g., varus or valgus) Failure of non-surgical treatment (medications, physical therapy, injections) [email protected] 3

4. Benefits of TKR Pain Relief: Substantial reduction or elimination of knee pain. Improved Mobility: Increased ability to walk, perform daily tasks, and engage in recreational activities. Corrects Deformity: Addresses knee deformities (e.g., bow-legged or knock-kneed alignment). Long-Term Durability: The modern prosthesis can last 15-20 years or longer, providing lasting benefits. [email protected] 4

5. Who Typically Needs TKR? Typically adults aged 60 and above , but can be considered for younger individuals with significant disability. Patients with severe knee pain affecting activities of daily living, sleep, and overall mobility. Those whose knee joint is damaged due to OA, RA, or other joint conditions. [email protected] 5

6. Indications for Total Knee Replacement Osteoarthritis (OA): Most common reason, characterized by degeneration of cartilage and narrowing of joint space. Rheumatoid Arthritis (RA): Chronic inflammatory disorder leading to joint damage Post-Traumatic Arthritis: Arthritis due to an injury affecting the knee joint Other Conditions: Avascular necrosis, severe deformities, and persistent pain unrelieved by conservative management [email protected] 6

7. Contraindications of TKR ABSOLUTE CONTRAINDICATIONS: Active knee infection Severe peripheral vascular disease Uncontrolled medical comorbidities RELATIVE CONTRAINDICATIONS: Morbid obesity (due to increased risk of complications) Limited bone stock or significant neuromuscular disease Young age (due to possible implant wear over time) [email protected] 7

8. Total Knee Replacement Procedure [email protected] 8

9. Types of TKR [email protected] 9

10. ROLE OF PHYSIOTHERAPY [email protected] 10

11. Purpose of Physiotherapy in TKR: Facilitate recovery, restore mobility, enhance muscle strength, prevent complications, and improve the patient's quality of life. Goals : pain management, range of motion (rom), and functional independence. [email protected] 11

12. Phases of Physiotherapy in TKR Preoperative Phase ( Prehabilitation ) Immediate Postoperative Phase (First Week Post-Surgery) Early Rehabilitation Phase (Weeks 1-6) Advanced Rehabilitation Phase (Weeks 6-12) Long-Term Recovery and Maintenance (Beyond Week 12) [email protected] 12

13. Preoperative Physiotherapy ( Prehabilitation ) Goals : Improve muscle strength, especially quadriceps and hamstrings. Educate on post-surgical exercises and use of assistive devices. Reduce anxiety by familiarizing patients with the rehabilitation process. Components: Strengthening Exercises: Quadriceps setting, straight leg raises. Range of Motion: Gentle knee flexion and extension exercises. Patient Education: Information on the surgery, use of walkers/crutches, and breathing exercises. Benefits: Patients with preoperative physiotherapy have demonstrated faster recovery, improved outcomes, and reduced length of hospital stays. [email protected] 13

14. Immediate Postoperative Phase (Day 1 to Week 1) Goals : Pain control, prevention of complications (e.g., deep vein thrombosis). Start early mobilization to prevent stiffness. Pain Management Techniques : Cryotherapy : Application of ice packs to reduce swelling. Positioning : Elevation and use of knee supports. Exercises : Ankle Pumps : To improve blood flow and prevent clots. Isometric Quadriceps and Gluteal Sets : Promote muscle engagement. Active Assisted ROM : Gently increasing knee flexion and extension. Gait Training : Walking with assistive devices such as walkers. [email protected] 14

15. Early Rehabilitation Phase (Weeks 1-6) Goals : Improve knee ROM (aim for at least 90° flexion). Increase muscle strength and stability. Promote functional independence. Exercises : ROM Exercises: Heel slides, assisted knee flexion. Strengthening: Straight leg raises, quadriceps strengthening with light resistance. Balance and Coordination: Supported standing exercises for balance. Functional Activities: Stair Climbing: Techniques for going up and down stairs. Transfers: Getting in and out of chairs or beds safely. Pain Management: Gradual reduction of analgesics. Modalities like electrical stimulation, if needed. [email protected] 15

16. Advanced Rehabilitation Phase (Weeks 6-12) Goals : Improve strength, ROM (target 120° or more), and functional activities. Transition to normal walking without assistive devices. Exercises: Advanced Strengthening: Resistance bands for quadriceps, hamstrings, calf raises. Weight-Bearing Activities: Partial squats, step-ups. Functional Mobility: Walking on uneven surfaces, balance drills. Gait Training: Correct gait deviations (e.g., improper stride length, limping). Weaning off assistive devices and improving gait quality. Endurance Training: Cycling (stationary bike), walking longer distances. [email protected] 16

17. Long-Term Recovery and Maintenance (Beyond 12 Weeks) Goals: Continue improving knee function and overall strength. Maintain ROM and prevent weight gain. Exercises: Advanced Balance and Strengthening: Use of gym equipment like leg presses. Low-Impact Aerobic Activities: Swimming, cycling. Functional Activities: Gradual return to daily activities like gardening. Patient Education: Importance of long-term maintenance, avoiding high-impact activities. Key Points: Encouragement to continue exercises independently at home to maintain functional gains. [email protected] 17

18. Complications Addressed by Physiotherapy Joint Stiffness : ROM exercises and manual stretching. Muscle Weakness : Progressive resistance training. Gait Deviations : Gait correction and retraining. Swelling : Cryotherapy, elevation, compression garments. [email protected] 18

19. Key Techniques in Physiotherapy for TKR Manual Therapy : Gentle mobilization for soft tissue and joint flexibility. Neuromuscular Electrical Stimulation (NMES) : To assist with muscle activation, especially in the quadriceps. Hydrotherapy : Water-based exercises to reduce weight-bearing stress, particularly helpful for patients with pain or obesity. [email protected] 19

20. Role of Patient Compliance Importance of Adherence : Consistent exercise is critical for optimal outcomes. The success of physiotherapy depends largely on patient engagement and adherence to home exercise programs. Motivational Strategies : Setting realistic goals and milestones. Regular follow-up and encouragement. [email protected] 20

21. References Mizner , R.L., Petterson , S.C., Snyder- Mackler , L. (2005). "Quadriceps Strength and the Time Course of Functional Recovery After Total Knee Arthroplasty." Journal of Orthopaedic & Sports Physical Therapy, 35(7), 424-436. American Physical Therapy Association. (2023). Total Knee Replacement Guide for Patients. Papalia , R., Zampogna , B., Torre, G., et al. (2018). "Role of Physiotherapy in Rehabilitation Following Total Knee Arthroplasty." Journal of Clinical Orthopaedics and Trauma, 9(1), 30-35. [email protected] 21

22. Thank you… [email protected] 22