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Tibio-Femoral Partial Knee Replacement (OXFORD)

We have divided the post operative period into:

  • Early post op:  0 – 2 weeks
  • Mid stage:  2 – 6 weeks
  • Mid to late stage:  6 – 12 weeks and beyond

Remember … “Every knee is different and every person is different”. The rate at which your knee recovers may differ from someone else’s.  If you find you are doing really well (pain and swelling good, range of motion improving) and feel you would like to do more, then slowly increase your activity levels. Large jumps in volume of activity or consistently “big days” on your knee may cause an increase in pain and swelling.  We generally recommend that the exercises be performed twice a day and you should have a “day off” your exercises once a week.

Early Post op (0 – 2 weeks)

Aims:

  • Swelling control
  • Range of motion (ROM) – 0-100°, focusing especially on getting the knee out straight, ie terminal extension
  • Safe mobilising – may have 2 or 1 crutches or may be unaided depending on quads control and confidence

Advice:

  • Take it easy – gentle exercise and short walks. As a general guide, walk to the toilet and meals and a couple of 5 minute walks around the house per day
  • Ice regularly – up to 6x/day for 20 minutes
  • Use a compression bandage to help with swelling
  • If pain or swelling increase with exercises or activity then BACK OFF

Exercises – twice a day:

  • Circulation drills – foot pumping, static quads and gluteals (these should be performed more regularly than twice a day ie. every time the ads come on the television)
  • Calf and hamstring stretches
  • Static quads with small rolled towel working on terminal extension (this should be performed regularly ie. 30 – 40/hour. These can also be done in sitting and standing). This is the most important exercise to get your knee straight and activate your thigh muscles.
  • Straight leg raising and or inner range quads over roll
  • Calf raises
  • Bending drills – usually sitting in a chair and shuffling your bottom forward
  • Walk as well as you can. You can wean from crutches when safe and confident.

Review by Dr Gallagher and Robert Godbolt at 2 weeks

Mid stage (2 – 6 weeks)

Aims:

  • Dressing change
  • Swelling reduction
  • A straight knee (terminal extension)
  • ROM 0-120° (by the end of 6 weeks)
  • Walking well
  • Don’t overdo it

Advice:

  • Build your activity to “What you NEED to do” over this period (2 – 6 weeks)
  • Continue regular icing- still up to 6x/day for 20 minutes
  • If pain or swelling increase with exercises or activity then BACK OFF
  • We recommend that you see a physiotherapist once a week to monitor your progress

Exercises:

  • Calf / hamstring stretches
  • Static quads with small roll
  • Straight leg raise or Inner range quads over roll
  • Standing 3 way leg swing
  • Calf raise
  • Bending (flexion) drills- in chair or with band or over the edge of a table. Use the ones that work!
  • Early balance work- single leg stance with reducing hand support.
  • Practice walking with a good pattern. Try to eliminate limp.

Please note. This is an important period in your recovery. The priority is to settle the knee down and work on the range of motion ie. get it to straighten and bend. If you are too active or push your strength work in this stage, then pain and swelling may slow this process.

Mid to late stage  (6-12 weeks and beyond)

Aims:

  • Strengthening
  • Return to function. Mobilising normally on stairs etc.
  • Continue to work on range of motion (if required)
  • ROM 0-130° or greater (by the end of 12 weeks)

Advice:

  • Progression of activity – “Build to what you WANT to do”
  • You will be back to most activities at 3-4 months but you will still notice that your knee may get warm or swell or feels a little stiff afterwards. In the majority of people their knees have “settled” between the 6th and 9th month following surgery.

Exercises:

  • Strengthening and functional retraining- Bridging, Squats, step ups, sit-stand
  • Gait re-education and balance training
  • Bike or hydrotherapy (hydrotherapy may be commenced earlier if your wound is dry and healed)
  • Walking program – a progressive walking program can usually be commenced after 6 weeks