At Queen West Physiotherapy, we work closely with the surgeon to ensure that their post-surgery rehab protocol is strictly followed. We treat many post surgical conditions, including Total Hip Replacements, Knee Arthroscopes, Shoulder Surgeries, Fractures, and Back Surgeries and Foot & Ankle Surgeries.
We also work with many Total Knee Replacements and ACL Surgeries. More information on these types of surgeries can be found below.
Total Knee Replacements (TKR) and Physiotherapy
Knee replacement surgery can be performed using a variety of techniques, including standard and mini-incisions. In addition, your new knee may be implanted with or without bone cement. Postoperative instructions will depend on your surgeon and the type of technique performed.
Your physiotherapist may see you on the day of or the day following surgery. During the first visit your physiotherapist will perform a thorough examination to gather as much information as possible about the history of your condition. Quick screening examinations of your heart rate, blood pressure, breathing rate, skin integrity, range of motion of other joints of the body, functional strength of other areas of the body, and your overall ability to move may be done during this phase. Your pain and use of a walking aid may also be addressed.
Initially ice may be used to help reduce the pain and swelling. Ice makes the blood vessels become more narrow, called vasoconstriction, which helps control inflammation. Elastic stockings may also help to prevent vein problems in the lower leg. Foot cradles or soft heel cups may also be used to prevent sores from developing on the heels.
While in the hospital, your knee may also be placed in a machine that allows continuous passive movement of bending and straightening of your knee.
Your therapist will discuss the knee precautions for you to follow after surgery which include:
- Do not twist your knee.
- Turn your entire body avoiding stress on the knee.
- Do not impose any jarring forces on your knee.
Exercises should be done only at the direction of your physiotherapist. The choice of exercises used after surgery will depend upon the type of surgical technique used. Exercises are used to help control pain and help with movement in the knee, hip, and ankle. You may be given gentle passive movements of your knee and lower leg, as well as, active movements of your knee, hip, ankle, and foot. Some of the following exercises may be incorporated in your treatment plan.
The goals prior to discharge from the hospital will often be to have close to full straightening and approximately 90 degrees of bending of your new knee, the necessary range for stair climbing. After discharge from the hospital, you may require additional physiotherapy in an outpatient clinic. Please consult your doctor about this and contact us to make an appointment.
Exercises that will likely be taught to you include:
Leg Exercises: bending and straightening of your ankle, and a variety of specific exercises for the knee and thigh muscles.
Arm exercises may also be included in your post-operative physiotherapy program to assure you have adequate strength in your arms for moving around in bed, for standing up from a chair, and for walking when using your walking aid.
Breathing exercises may be incorporated into your post-operative program to help prevent pneumonia from developing. Deep breathing is the simplest form of breathing exercise. In addition, you may be given an incentive spirometer, a device requiring you to take in as deep a breath as you can, hold it for a few seconds, and then blow it out. An indicator on the incentive spirometer will enable you to track your deep breathing progress as you attempt to take in deeper and deeper breaths each time you use the device.
Trunk strengthening exercises are included in your postoperative program to keep your trunk muscles strong, which may help avoid back problems that may arise from the initial uneven weight bearing. Your therapist will instruct you in the type and number of exercises, the amount each exercise is to be done, and how often they should be done.
You will be given instructions and assistance on how to move and change positions in bed as well as getting yourself to the seated position. Your physical therapist will also assist you to the standing position and will teach you how to transfer safely from the bed to a chair and toilet. Proper body mechanics will be stressed during all activities.
Walking and Stairs
Your surgeon will determine the amount of weight you can bear on the operated knee while walking, and your physical therapist will provide you detailed instructions as to how to achieve that amount of weight bearing. Weight bearing on the operated side may range from as much weight bearing as tolerated by you, to partial weight bearing with a specified percentage, to toe touching only. You may use a walker, a cane, or other assistive devices.
Instructions will be given to you in the hospital for stair climbing. The general rule is you go up the stairs holding onto the handrail with one hand and with your walking aid in the other hand. The non-operative leg goes up first and then the operative leg and walking aid are brought up together to that same step. Going down the stairs is the opposite; the operative leg and walking aid go down the step first, followed by the non-operative leg to the same step.
Your physiotherapist will indicate which activities you should avoid, which put a strain on the surgical area. You do not want to twist your knee, and you will be instructed in turning your entire body to avoid stress on the knee. In addition, you should not impose any jarring forces on your knee. During your activities, pain acts as your guide. If you feel pain with any activity, stop and consult with your physical therapist to determine if what you are doing is straining or irritating the knee.
While you are in the hospital, your physiotherapist may see you for therapy up to two times each day, and you will progress from doing activities bedside to doing them in the therapy department. You may expect to stay in the hospital several days after your knee replacement surgery depending on which surgical technique was used.
For more detailed information, check out MyJointReplacement.ca.
ACL Surgery (Anterior Cruciate Ligament in the Knee)
Surgery for anterior cruciate ligament (ACL) injuries involves the reconstruction or repairing of the ACL. A graft is used to replace the ligament, the most common type being an autograft, using part of your own body, such as the tendon of the kneecap (patellar tendon) or one of the hamstring tendons. Other good choices include allograft tissue, which is donor material. In repair surgery, the ends of the torn ligament are sewn back together.
Reconstruction gives better results than repair surgery, which is fairly uncommon. Repair surgery generally is only used when the ACL has been torn from the upper or lower leg bone. In the case of an avulsion fracture, the bone fragment connected to the ACL is reattached to the bone. ACL surgery is done by making small incisions in the knee and inserting instruments for surgery through these incisions (arthroscopic surgery) or by cutting a large incision in the knee (open surgery).
ACL Surgery is done to restore normal knee stability and function. It is especially important for people who are very active in sports or who depend on their knee strength for their work. When there is only a minor ACL tear and the person does not use their knee aggressively, then they often won’t require surgery.
Arthroscopic surgery is often used instead of open surgery for ACL injuries because:
- It is easy to see and work on the knee structures.
- It uses smaller incisions than open surgery.
- It can be done at the same time as diagnostic arthroscopy (using arthroscopy to determine the injury or damage to the knee).
- It may have fewer risks than open surgery.
- Rehabilitation is often faster after arthroscopy than after open surgery.
In ACL surgery, usually two to three small insicions are made around the knee. Sterile saline (salt) solution is pumped into the knee through one incision to expand it and to wash blood from the area. This allows the health professional to see the knee structures more clearly.
An arthroscope is put into one of the other incisions. A camera at the end of the arthroscope transmits pictures from inside the knee to a TV monitor in the operating room. The surgeon then drills small holes into the upper and lower leg bones where these bones come close together at the knee joint. The holes form tunnels through which the graft will be anchored.
The surgeon pulls the graph through the two tunnels that were drilled in the upper and lower leg bones, and secures the graft with screws or staples, closing the incisions with stitches or tape. A temporary surgical drain may be put in place. The knee is bandaged, and you are taken to the recovery room for 2 to 3 hours.
Physiotherapy after ACL surgery may take a couple of months to a year. You can usually return to your previous activities between 6 and 12 weeks. There is about an 85% success rate and minimal risk involved. You should talk to your surgeon about this.
Surgeons in the Peel Region
The following is a list of Surgeons who have worked on many patients who have come to us for rehabilitation after surgery. To get a consult with a surgeon, a referral from a family doctor is generally required.
Dr. F Tavazzani
164 Queen Street East
Brampton, ON L6V 1B4
Harrington J P Dr
40 Finchgate Boulevard,
Brampton, ON L6T 3J1
Sekyi-Otu A Dr
201 County Court Boulevard,
Brampton, ON L6W 4L2
Karabatsos B Dr
164 Queen Street East
Paitich C B Dr
201 County Court Boulevard,
Brampton,ON L6W 4L2