If you’ve reached a stage where your knee is severely worn, injured or damaged by arthritis, then you may be considering total knee replacement surgery. Whilst this procedure represents one of the most impressive orthopaedic surgical advances of the twentieth century, the essential role rehabilitation plays in both pre and post-operative stages cannot be underestimated. AposTherapy helps ensure an optimal surgery outcome by preparing the patient’s muscles for maximum rehabilitation and the highest possible quality of life post knee replacement.
Currently 70,000 patients in Britain, mainly women and mostly over 65, undergo knee replacement surgery each year. Despite the fact that this number is growing, it remains a treatment decision that is never taken lightly by medical practitioners, or patients themselves. Having opted for surgery, it’s critical to understand how important preparation in the build-up to the operation, as well as post-operative rehabilitation is for a positive long-term outcome. AposTherapy prepares the muscles around the joint for effective rehabilitation and following surgery, trains the patient to walk evenly using both the operated and non-operated limbs equally.
The majority of total knee replacement surgeries result from symptomatic degenerative arthritis, however many other conditions can lead to joint replacement, including trauma and rheumatoid arthritis. In the UK, the National Institute of Health and Clinical Excellence, advices that a total knee replacement should only be considered when at least two or more conservative treatments have proved unsuccessful and daily functioning is limited.
As with any surgery the outcome is not guaranteed and many risks are involved. Research indicates an orthopaedic success rate of 90-95%, lasting for about 10 years. Nevertheless, many patients say they still feel pain and limited function following surgery. Even after a successful total knee replacement surgery, the patient’s muscle function remains impaired, in both the operated and non-operated knee, significantly compromising the rehabilitation process. AposTherapy offers an effective rehabilitation approach in these cases by re-educating the body to incorporate the operated limb in renewed and optimal patterns of motion.
The aim of surgery is to resurface the damaged area of the knee. To achieve this, the upper surface of the tibia (lower leg bone) and the lower surface of the femur (thigh bone) are removed with artificial joint surfaces then implanted. The prosthesis varies to suit the patient and the operating surgeon’s preference and can be implanted with or without the use of cement, depending on the patient’s age and bone quality. The procedure takes about one to one and a half hours in the operating room, and the patient can expect to be out of bed the next day.
It is very important to realise the significant impact that pre-operative conditions have on post-operative outcomes. For this reason, it is essential that the patient maintain normal levels of activity and complete therapeutic exercise to effectively prepare the muscles and joint for the operation. The surgical procedure does not involve replacement or repair to any soft-tissue. Therefore any limitations to the range of motion, due to muscle, or tendon shortening or the presence of impaired neuromuscular control and weakness will still be present after the surgery. In order to achieve the best operative outcome, following total knee replacement, it is essential to focus on rehabilitation through appropriate therapeutic exercise.
Post operative expectations include correct prosthetic alignment, together, with reduced pain and increased function - a perception shared by AposTherapy. It is quite common that the area around the joint may continue to be painful immediately after the joint replacement surgery, even up to months, or years later. As a reaction to pain and arthritis, pathological muscular movement patterns develop prior to and post surgery. A valuable rehabilitation process will address and, where possible, reverse these soft-tissue pathologies, ensuring an extended life-span for the new knee and protecting the non-operative knee from damage.
Ideally, the role of AposTherapy with a total knee replacement begins in the run up to surgery. The aim being to best prepare the patient’s muscles to achieve maximum rehabilitation and the highest possible quality of life post-knee replacement. AposTherapy addresses the distribution of loads across all the joints in the lower limb, pelvis and back, reducing the chances of joint problems in the future.
AposTherapy can then be re-introduced as early as 3 weeks following surgery with the intention of training the patient to walk evenly using both the operated and non-operated limbs equally. By introducing micro-instability, AposTherapy re-designs the way the patient walks, aligns the body and re-educates the muscles around the joint. By carrying out treatment in the patient’s own environment, as part of their ordinary daily life, AposTherapy can overcome the challenge of matching suitable therapeutic exercise with the functional use of the affected muscles, during ordinary routine.
As a long-term treatment, AposTherapy can also be used in conjunction with other treatments to maintain the health of the replaced joint, provide pain relief and ensure the highest level of functional ability.