Turbo Knees

By David Boyce PT, EdD, OCS, ECS

Recent advances in total knee replacement surgery and rehabilitation are getting people out of the hospital at warp speeds.
With the recent advent of Minimally Invasive Total Knee Replacement (MIT-Knee) and computer aided surgery, patients have less pain after surgery, walk sooner, limp less and return to functional activities in record time. I call these patients TURBO KNEES! In todays world of high tech orthopedic surgery, rehabilitation principles need to keep pace with surgical advances. The changes in total knee replacement rehabilitation remind me of the rehabilitation advances that were introduced in the 1990s for Anterior Cruciate Ligament (ACL) surgery.

It used to take 9 to 12 months to fully recover and return to sport following ACL surgery, today athletes return in 3 to 4 months. Because of the advances in surgical technique and rehabilitation principles people can rehab at an accelerated pace with minimal risk.

Who Can Get a Minimally Invasive Total Knee Replacement?

MIT-Knee surgery is not for everyone. Important factors that come into play regarding your candidacy relate to, body mass index (BMI), your general health, and age. There is not much you can do about your age, but there is a lot you can do about your general health and BMI. To receive a MIT-Knee, it is suggested that your BMI be under 30. BMI is an index that takes your body weight and compares it to your height. If you are over a BMI of 30 you might weigh too much given your height (e.g. if you are 5 and 6 feet and weigh 200 pounds your BMI would be 33). In most cases body mass and general health go hand in hand. Obesity is defined as a BMI over 30.

What is PRE- HAB?

To improve your chances of becoming a candidate for a MIT-Knee replacement, or if you decide traditional total knee replacement is for you, pre-rehabilitation (PRE-HAB) can improve your odds of having a good outcome.

The best outcomes occur in patients that are educated about the surgical and rehabilitative process and that have the greatest strength, range of motion, and cardiovascular endurance going into the surgery. I recommend that all patients undergo physical therapy (if possible) prior to total knee and hip replacement.

A good PRE-HAB program consists of the following 10 steps:

1. Cardiovascular training and weight reduction
2. Stretching and mobilization of the hip, knee, and ankle to maximize range of motion.
3. Strengthening of all of the lower limb musculature to maximize strength.
4. Balance Training.
5. Education about the surgery and the rehabilitation process that follows.
6. Instruction on how to properly use assistive devices.
7. Instruction on safe transfer and bed mobility principles.
8. Review of total knee replacement precautions.
9. Review of all basic exercises that you will be taught in the hospital immediately after your surgery.
10. How to prepare your home for your return from the hospital.

What Happens After Surgery?

Once your surgery is complete your doctor will order physical therapy, in most cases, the same day as surgery. Most patients receiving MIT-Knee replacements have less pain and they can perform functional tasks more quickly. Treatment initially focuses around standing, transfers from bed to chair, ambulation training, stairs training, knee range of motion, and exercises focusing on hip and lower leg strength. Patients are usually discharged from the hospital 2 to 3 days after they can independently transfer from bed to chair, rise from a chair, ambulate 100 feet with a walker or crutches, ascend and descend 2 to 4 steps, perform an independent straight leg raise, and flex the knee to 90 degrees.

Once discharged from the hospital, home health care is ordered for about 1 week and then outpatient physical therapy is started 2 weeks after surgery. Outpatient physical therapy is where the patient really starts to show significant advances in their function. The outpatient rehab program focuses on a SAID principle (Specific Activities for Imposed Demands). Emphasis is placed on regaining normal strength, range of motion, endurance, and return recreational activities.

The Bottom Line

Correct patient selection, advances in surgical technique, and a rapid rehabilitation program are the keys to a successful outcome after knee replacement surgery. Minimally Invasive Total Knee Replacement in combination with an accelerated rehabilitation program is safe, less painful, results in more rapid functional recovery, and does not result in increased complications rates. If you are interested in learning more about this surgery and the rehabilitation associated with it please visit www.ptpluslouisville.com.

David Boyce PT, EdD, OCS, ECS is an Assistant Professor of Physical Therapy at Bellarmine University and the co-owner of Physical Therapy Plus, an outpatient physical therapy clinic in Louisville, KY. David has advanced training in Orthopedic Manipulative Therapy and is co-author of the book Orthopedic Physical Therapy Secrets. David can be contacted at:
ptpcorporate@earthlink.net or dboyce@bellarmine.edu.