8 Must-Do Knee Replacement Exercises To Do Before Surgery

When to Consider a Total Knee Replacement Surgery?

Coming to the conclusion that it’s time to finally have knee replacement surgery can be a difficult decision to make. I usually recommend that you start by asking yourself, “Is my knee limiting my daily function? Is it stopping me from performing the activities that I love to do?” Think about activities like playing with your grandchildren or going for daily walks outside. If your knee arthritis pain is preventing you from doing these activities, then it’s likely a good time for you to schedule that surgery.

“Is my knee limiting my daily function? Is it stopping me from performing the activities that I love to do?”

If your knee pain is not quite hindering you yet from doing your daily activities, then you may want to speak with your doctor and discuss the possibility of getting a corticosteroid injection into the knee joint. The corticosteroids act as anti-inflammatories as they can reduce inflammation and pain within the knee joint. Depending on the severity of osteoarthritis (a.k.a. arthritis) in the joint, these injections can be very successful for a certain amount of time. They can significantly reduce your knee pain for several months, but they should only be thought of as “band-aids.” They will temporary knee pain relief only.

Most orthopedic surgeons are okay with providing these injections every 3-months. However, it is typical that the pain relief timeframe after each successive injection usually decreases as the effects from the repetitive injections gradually decrease over time. Eventually, you will get to the point where the pain relief only lasts a couple of weeks, which is then time to schedule yourself for the total knee replacement surgery.

Preferably during this time period, while you are still debating on whether to have the knee replacement surgery or not, you would start performing these knee replacement exercises and stretches daily. It is imperative to use this time wisely to improve the supporting muscles of the knee joint to ease the difficulty of your post-operative physical therapy rehab.

Important Functional Goals to Achieve Prior to Surgery

Current evidence suggests that patients who participate in a “knee replacement rehabilitation” program, a pre-surgical physical therapy program that typically begins about 6-8 weeks prior to the procedure, experience a faster recovery post-operatively. By performing the proper knee replacement exercises and stretches before surgery, you would strive to achieve the following goals:

1. Increase Knee Joint Range of Motion

   • Loss of knee range of motion (the ability to bend your knee) is typically seen in patients who have had moderate to severe knee arthritis for several years. A gradual loss of motion happens over time as the knee joint surfaces deteriorate and pain increases.
   • Goal #1: Improve the knee joint range of motion as much as possible (without causing significant increases in joint pain).

     

2. Increased Leg Strength

   • Disuse atrophy (muscle weakness) occurs gradually as it becomes increasingly painful to use the leg with walking, stair ambulation, squatting, etc. Over time, disuse of the leg muscles will lead to increasing weakness of these muscle groups, most notably in the quadriceps and glutes.
   • Goal #2: Increase muscle strength in all muscle groups that support the knee joint including the quadriceps, glutes, hamstrings, and calf muscles.

3. Improve Flexibility

   • As joint arthritic pain increases over time and knee range of motion decreases, the flexibility of the muscles that cross the knee joint also decreases further restricting knee range of motion after the joint replacement surgery.
   • Goal #3: Improve the muscle flexibility in the quadriceps and hip flexors, hamstrings, and calf muscles.

How to Prepare for a Total Knee Replacement Surgery

Several other considerations should be taken into account before having knee joint replacement surgery. These include:

1. Declutter your home (remove tripping hazards)

   • Many of us have rugs, dog or children’s toys, clothing, etc. lying about in our homes. These objects become tripping and slipping hazards after joint replacement surgery when you’re medicated, weak, and not feeling well.

2. Make plans for assistance in the home for the first 1-2 weeks post-operatively

   • For the first couple of weeks after surgery, you WILL NEED help around the home. This includes help with bathing (using a shower chair), cooking, dressing, and other basics around the home. If you live alone, you can speak with your surgeon about going to an inpatient rehab facility during this period where you will receive daily physical therapy and nursing support.

3. Plan for alternative transportation for 4-6 weeks post-operatively

   • You will not be permitted to drive while actively taking opioid medications. Also, if you have surgery on your right knee (the side used to press on the brake and gas pedal), plan for 4-6 weeks until the surgeon clears you to drive independently.

4. Purchase a walker and a single-point cane

   • Most surgical centers require that you bring your own walker with you to surgery as they will not provide you with one. Most patients usually purchase a rolling walker (a walker with wheels on the front legs), however, if you are a fall risk and have difficulty with balance, I recommend that you purchase a regular non-wheeled walker as this type is more stable. Go ahead and get an adjustable single-point cane as you will transition from the walker to the cane within 2 or 3 weeks.
   

   9.6

   Rolling Walker (Wheeled)

   • ROLLING WITH WHEELS
   • FOLDING WALKER
   • QUALITY CONSTRUCTION
   • 5″ WHEELS, VINYL CONTOURED HAND GRIP
   • SAFE AND EASY OPERATION

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   9.5

   Non-Wheeled Walker

   • NON-WHEELED
   • FOLDING WALKER
   • QUALITY CONSTRUCTION, YET LIGHTWEIGHT
   • PREMIUM FEATURES
   • SAFE & EASY TO USE

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   4.9

   Walking Cane

   • ERGONOMIC AND SMOOTH OFFSET HANDLE
   • ANTI-CORROSION ALUMINUM CANE
   • ADJUSTABLE HEIGHTS AND WEIGHT CAPACITY
   • ANTI-SLIP RUBBER CANE BASE

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5. Arrange sleeping and waking hours to be on the same floor of the home

   • If possible, arrange so that you can sleep, eat, bathe, etc. all on the same floor as it will be very difficult for you to maneuver up and down the stairs for the first few weeks after surgery.

6. Install grab bar handles near the shower and toilet

   • Installing grab bar handles in the bathroom will significantly help with getting into/out of the shower or up and down from the toilet, which can be very difficult after a knee joint replacement.
   

   9.6

   Shower Grab Bars

   • 2 PACK
   • 16″ LONG EACH
   • ANTI-RUST STAINLESS STEAL WITH CHROME FINISH
   • NON-SLIP KNURLED SURFACE
   • STYLISH END COVERS CONCEAL MOUNTING HARDWARE

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7. Use a raised toilet seat

   • A raised toilet seat can also help by temporarily elevating the height of the toilet seat making it much easier to both sit down and stand back up.
   

   9

   Raised Toilet Seat

   • ADDITIONAL 5″ IN TOILET SEAT HEIGHT
   • ADJUSTABLE WIDTH ARMS
   • FOAM PADDED ARM RESTS
   • UNIVERSAL FIT
   • LIGHTWEIGHT & DURABLE

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8. Use a shower chair in the tub/stand-up shower

   • After surgery, you will not be able to stand independently while bathing due to knee pain and swelling. Use a shower chair to allow yourself to sit reducing the risk of falling.
   

   9.3

   Shower Chair

   • SIT, SHOWER & RELAX
   • DURABLE & SECURE – WEIGHT CAPACITY 350 LBS
   • COMFORTABLE
   • VERSATILE & EASY TO USE
   • LIGHTWEIGHT & PORTABLE

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9. Obtain a cryotherapy machine to control post-op swelling

   • Most insurances will cover the purchase of a cryotherapy machine that circulates ice-cold water through a special sleeve that fits around the knee. This is perfect to combine with elevation on a wedge bolster pillow to reduce swelling post-operatively.
   

   9

   Cold Therapy System

   • EFFECTIVE, SOOTHING AND LOCALIZED TREATMENT
   • OFFERS POST-OPERATIVE PAIN AND SWELLING RELIEF
   • STAY COOLER, LONGER!
   • STRONG, SILENT AND LIGHTWEIGHT
   • INCLUDES A KNEE PAD
   • 6-MONTH MANUFACTURER WARRANTY

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10. Schedule your first physical therapy appointment for after the surgery

    • Now is the time to go ahead and schedule your first post-operative physical therapy appointment. You can ask your surgeon, but traditionally your first appointment should be scheduled for when you are 1 week post-op.

11. Do not watch any total knee replacement videos prior to the surgery!

    • Trust me as I’ve watched several total knee replacement surgeries in person, most people should wait until after the surgery is performed to then watch the video of the surgery for those who are curious.

What to Expect After Knee Replacement Surgery?

After the surgery, most people will be discharged from the surgical center later on the same day. Total knee replacements are considered outpatient procedures, or “same-day” surgeries. You will need to be picked up from the surgical center by someone willing to care for you for the first couple of weeks while you are recovering.

1. Pain medications

   • Initially, you won’t be able to feel much in the entire surgical leg. This is because the medical team gives you what is called a Femoral Nerve Block. This blocks the pain nerves from communicating with your brain, so you have no perception of the pain. However, the nerve block will wear off after 24-48 hours, and you will need to make sure that you are already taking your prescribed opioid pain medications (i.e. Oxycodone) before the nerve block wears off. If you delay your oral pain meds, you risk “falling behind” on your pain and you do not want that to occur! As always, be sure to follow the recommendations of your doctor or pharmacist regarding the pain medication schedule.

2. Ankle pumps, ankle pumps, and more ankle pumps!

   • Risk of Deep Vein Thrombosis (DVT), which is essentially a blood clot, is heightened significantly after surgery. These most commonly occur in your lower legs because of stagnant blood pooling in the legs. To prevent DVTs, it is imperative that you stand and move around at least once per hour and perform ankle pumps several times throughout the day.
   • Ankle Pumps Exercise: Perform 30 repetitions (several times per day)
     

3. Wear graduated compression stockings to control leg swelling

   • Compression stockings should be considered if you are suffering from significant swelling in the lower legs (below the knee to the foot). To get the proper size for the stockings, you’ll need to closely measure the calf circumference with a tape measure per the directions specific to each brand of stocking. Most doctors recommend stockings with graduated compression of 15-20 mmHg, though some prefer 20-30 mmHg (moderate compression), so you should ask your surgeon for his/her preference before you buy them.
   

   9.3

   Compression Stockings

   • MULTIPLE COLORS AVAILABLE
   • STRENGTH GRADUATED COMPRESSION
   • IMPROVES CIRCULATION FOR EXTENDED SITTING, STANDING, OR TRAVEL
   • HELPS REDUCE SWELLING, VARICOSE VEINS, SPIDER VEINS, DVT BLOOD CLOTS

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4. Sleep with your knee straight

   • Try your best to sleep with your knee straight. During the first week or two after surgery, it would feel much more comfortable to sleep with a pillow under your knee and have your knee bent, but this will only prolong the time it will take for you to gain full knee extension (straightening). If you find that you need to have pillows under your leg when sleeping, try to build a ramp with pillows or purchase a bolster pillow, so that your knee will be elevated and supported by the pillows, yet the knee will be straight at the same time.
   

   8.8

   Leg Wedge Pillow

   • MEASUREMENTS: 18″ Width, 11 3/4″ Height, 23″ Length
   • PERFECT FOR REDUCING VENOUS ISSUES, LEG DISCOMFORT, LEG SWELLING AND BACK PAIN
   • PROPER ELEVATION ANGLE
   • DURABLE FABRIC PERFORMANCE COVER TO REPEL STAINS AND MOISTURE

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