Health & Exercise Forum

Get the Most Out of Your New Knee: Part 2 of 2

Ted Schoch, PIAA football official from NEPA, has spent the past 9 months preparing for the high school football season with the same vigor and passion as a young athlete. You may have seen him biking through Dalton or running drills on the sports facilities at Abington Heights High School. He has been recovering from a total knee replacement and met his goal of returning to work as a football official in this year’s Dream Game. He learned that it takes much more than traditional home exercises to “get the most out of your knee replacement” and get back in the game!

Total knee replacement surgery is a very successful orthopedic surgery as more than 600,000 are performed in the United States each year. More than 95% of patients with TKR are satisfied with the outcome one year later according to the American Association of Orthopaedic Surgeons. Pain relief with daily activities was the most important factor for most patients. Those dissatisfied are often younger and tended to have a long history of an active lifestyle. Many of these patients may have unrealistic goals and expectations. It is recommended that these patients have better preoperative counseling and longer, more aggressive rehab to meet the goals of a more active lifestyle after surgery. The purpose of this column is to present a more advanced rehab program for “fine tuning” in order to make a full recovery for those hoping to hike, ski, play tennis, golf, etc. AND for those who seek better function in daily activities with their new knee.

Despite advances in knee joint implants (e.g. more durable materials, improved simulation of anatomical knee joint movement), some patients continue to report dissatisfaction with their post-operative function!  Patients often complain about difficulty; entering or exiting a car, descending stairs, bending to the floor, and rising from a commode.  All of these activities have one thing in common…they require the ability to perform a partial squat: controlled lowering of the body weight against gravity, not any easy task!

In order for a replaced knee to perform optimally, the hip and ankle must be challenged with exercises similar to the following:

Gluteus Maximus Strengthening

• HYDRANT
  • Assume hands and knees position.
  • Raise involved knee out to side.
  • Hold for one minute.
  • When able to hold for one minute add yellow Theraband ® tied around knees.
  • Advance to next color (i.e. red→green→blue), when able to hold one minute.
• CLAM
  • Lie on uninvolved side with hips and knees bent. Keeping feet together, raise involved knee toward ceiling. Hold for one minute. Advance as above.
• STANDING HIP EXTENSION WITH THERABAND
  • Tie one end of a yellow Therband ® around involved ankle & other end to stationary object.
  • While standing with involved knee straight, extend hip backwards but do not arch lower back. May hold onto object for stability.
  • Perform 3 sets of 5 reps, advance to 3 sets of 10 to 15 reps.
  • Progress through Theraband ® colors as above.

Gluteus Medius Strengthening

•  SIDE-LYING ABDUCTION
  • Lying on uninvolved side, bend bottom hip & knee, keep top hip & knee straight with foot flexed.
  • Turn top leg slightly outward & raise toward ceiling.
  • Hold for one minute.
  • Progress with Therband ® as above.
• STANDING HIP ABDUCTION WITH THERABAND
  • Tie one end of a yellow Therband ® around involved ankle & other end to stationary object.
  • While standing with involved knee straight, move leg outwards. Keep trunk straight. May hold onto object for stability.
  • Perform 3 sets of 5 reps, advance to 3 sets of 10 to 15 reps.
  • Progress through Theraband ® colors as above.

In addition to adequate ankle/hip mobility and strength, the ability to differentiate between the hips and lower back (i.e. body awareness) requires proprioceptive training:

Functional Proprioceptive Training

•  SQUAT WITH POLE:
  • Stand with feet shoulder width part.
  • To promote proper alignment, hold a pole along spine with one end at back of head & other at tailbone. Maintain these contact points while performing a squat.
  • Ensure that spine is straight, hips and knees are bending, equal weight through both legs, & knees are in line with 3^rd toes.
• STEP UP AND DOWN
  • Step up onto riser with involved foot. Ensure that knee moves from bent to straight & that knee aligns with 3^rd toe.
  • Then step down with uninvolved foot. Ensure that knee moves from straight to bent & that knee aligns with 3^rd toe.
  • Start with a 2” riser and progress by 2” to a total of 8”. Ensure that knee moves from bent to straight & that knee aligns with 3^rd toe.

Get what you want out of your new knee and don’t settle for less!

MODEL: Vanessa Borgia

Guest Columnist: Janet Caputo, PT, DPT, OCS is clinic director at Mackarey & Mackarey Physical Therapy Consultants, LLC in downtown Scranton.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum" in the Scranton Times-Tribune.

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email:drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at The Commonwealth Medical College.