General guidelines and advice to follow immediately postoperatively and during the first weeks.
- During the first weeks: take your time and do not force!
- During the first weeks: it is important that you regularly increase the height of the operated leg to reduce the swelling. You can do this by, for example, putting a towel under the heel (certainly not in the knee fold!) so that the foot is higher than the knee.
- As long as the knee feels warm, it is best to regularly apply ice to the knee.
Which positions and movements must be avoided ?
Avoid forced folds of the knee such as the squatting position when cleaning at home. Avoid kneeling for a long time as you do when cleaning or working in the garden. Avoid rotational movements on the operated leg.
Walking is a very good exercise. Important here is that you avoid an irregular surface and certainly do not make too long distances in the beginning.
Below are a number of specific exercises described for people who are operated from a total knee prosthesis. We advise you to do these exercises daily. The aim of the exercises is to strengthen the muscles that stabilize the joint and maintain the flexibility of the knee that is important for daily activities. These exercises should not be painful at any time. If you still experience pain during or after performing the exercises, ask your physiotherapist or surgeon immediately.
Most important exercise:
Sit on the edge of a solid table (for example, the kitchen table) and swing with both legs back and forth. This promotes folding without any strain on the operated knee.
Exercises that promote knee stretching:
Starting position: Sit on the back with a rolled up towel below the knee.
Exercise: Then stretch the muscles so that you push the towel flat with the knee and push the heel towards the bed end by pulling the toes towards you (this to stretch the muscles in the leg to the maximum). Hold this posture for about 10 seconds and then release. Repeat this ten times for both legs.
Stretch exercises of the rear thigh muscles to promote knee stretching:
Starting position: Sit upright on a chair with the heel on another chair or stool so that the knee is stretched.
Exercise: Keep this position as often and for as long as possible (at least ten minutes at a time). This is a good exercise when you feel resistance when fully extending the knee.
Stretch exercises of the front thigh muscles to promote knee folding:
Starting position: Lie down on your belly and cross the lower legs.
Exercise: Fold the knees further, bringing the heels to the seat without tilting the pelvis. In doing so, one foot pushes the other foot as close as possible to the seat. Hold this posture for about 10 seconds and then release. Repeat this ten times for both legs.
Strengthening the front thigh muscles:
Starting position: Sit upright on a chair and let the heel rest on, for example, a telephone book.
Exercise: Stretch the leg (without the thigh coming off the chair) by pulling the foot towards itself. Hold this posture for about 10 seconds and then release. Repeat this a ten times for both legs.
Strengthening the back thigh muscles:
Starting position: Sit upright on a chair and put a telephone book under the heels.
Exercise: Try pressing the telephone book with the heel. Hold this posture for about 10 seconds and then release. Repeat this ten times for both legs.
Getting out of bed:
Come out of bed via the non-operated side (i.e. you have been operated on the left leg then you come out of the bed via your right side). Lie as close as possible to the edge of the bed. Slide the non-operated leg under the operated leg and lift it gently. Turn the body in block so that you are sitting with the legs hanging on the edge of the bed. Then take support on the non-operated leg (with or without crutches) and try to keep the operated leg slightly stretched while standing up.
To lay down in bed:
Sit down on the edge of the bed where you take support on both hands. Hook the operated leg with the non-operated leg and then move both legs in a block.
If you have a low bed at home, you can easily increase it by placing phone books under the legs of the bed or putting a second mattress on the bed.
Choose a good seat or seat. Make sure that it is steady with a relatively high seat with straight backrest and armrests. So no deep low seat.
To sit down:
Stand up with your legs against the chair or seat. Sit down and take support on the arms to slow down the sagging of the seat. Keep the operated leg almost stretched.
To stand up:
Take support with the arms on the armrest and use the non-operated leg to straighten while keeping the operated leg stretched.
When you change direction or you turn around, do not turn on the operated leg: when you have operated on the right leg, turn left to change direction.
Avoid standing still for a long time and divide the body weight over both legs when you are supported by 2 stools.
Gait with 1 or 2 crutches
Depending on the type of prosthesis, the age, the condition before the operation, the general fitness, you will have to go through 1 or 2 crutches for a very short to a slightly longer period.
How do I adjust my crutches well?
Adjust the crutches at the correct height. The elbow is best folded 30 degrees so that the arm muscles can work so more powerful. The handle should be aware of the hip (this is about the height of the bony protrusion that you can feel on the side of the thigh called trochanter).
How do I use my crutches while walking?
When standing with the 2 crutches you take support on the non-operated leg. Place both handles at the same time about half a meter in front of you. Support on both crutches and bring the operated leg forward and place the foot on the floor without fully supporting it. Then apply the non-operated leg. Then divide your weight over both crutches and the non-operated leg. Then repeat the cycle.
When using 1 crutch:
Hold the crutch on the unoperated side and move the crutch together with the operated leg.
How do I go up and down stairs with crutches?
Take step by step in three times
Phase 1: Bring the non-operated leg to the top step by taking support on the crutches. Tool for this: 'you are ascending to heaven' (you start with the healthy leg, the good leg).
Phase 2: Take support on the non-operated leg and bring the operated leg at the same time as the crutches.
Phase 3: Both feet and the two crutches are now on the same step. Now repeat the movements until you are above.
Take step by step also in three times
Phase 1: Place both crutches on the lower step where you take support on the non-operated leg.
Phase 2: Lower the operated leg with the crutches. Tool for this: 'you descend to hell' (you start with the operated leg, the so-called bad leg)
Phase 3: You add the non-operated leg. Both feet and the two crutches are now on the same step. Now repeat the movements until you are down.
Choose a shower over a bathtub. In the shower you can use a simple plastic chair. It can be useful here to lay an anti-slip mat in the shower or bath. In any case, it is safer to wash yourself while sitting. In the beginning, a hairdryer can be easy to dry or a large towel.
Putting on socks and shoes
Closed shoes that fit well, are sturdy and are provided with an anti-slip sole are recommended. Very easy during the first weeks are sport shoes with velcro's. Avoid excessive heels. Heels of 3-4 cm high and wide are better.
Putting on shoes
Avoid a standing posture where you stand on one leg and pull on the shoe. Instead, take a long shoe puller, sit down and put on the shoes for. There is also a kind of stocking puller for putting on stockings.
To put on a pair of pants, suspenders can be useful (not to hold up the pants but to attract the pants more easily). Always first insert the operated leg through the leg. Shorts are also easy during the first weeks.