Rehabilitation after a knee prosthesis
Introduction - Why do you need rehab after a knee prosthesis?
After installing a knee prosthesis, the knee cannot immediately be fully resilient. And in the further weeks, professional support is required to slowly build up the muscles and increase the load on the joint and the prosthesis. In rehab, there are people from the nursing, physiotherapeutic, occupational therapy and medical side who are specialized or trained in the phase after the operation and who know exactly which activities and exercises are allowed and what should be avoided. If you do not go to rehab, there is a risk that the knee prosthesis will become unstable due to excessive and incorrect loading and that another operation will be required.
What forms are there?
Rehabilitation after a knee prosthesis can take place in different scenarios. It can take place in fully inpatient, partially inpatient and also outpatient form. The patient has a limited say in the location of the rehab. Usually, the rehab is applied for in the clinic and the social service discusses with the medical team and the patient, as well as their relatives, if necessary, which type of rehab is desired or recommended. In the course of applying to the pension or health insurance scheme, these provide suggestions for facilities from which the patient can usually choose. Many clinics also have a rehab department attached to which the patient is referred after the operation. Other clinics, for example, also cooperate with rehabilitation clinics.
If the rehab is fully inpatient, then the patient is usually in a rehab clinic for 3-4 weeks in which he also lives in a room for the time.
In a semi-inpatient variant, the patients live at home, but come to the clinic every morning and go home in the evening. During the day, they take part in the clinic's normal rehab routine.
With an outpatient form of rehab, it works in the same way as with a semi-inpatient rehab. The difference lies in the different wording in the statutory text of the health insurance companies.
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The knee joint is one of the joints with the greatest stress.
Therefore, the treatment of the knee joint (e.g. meniscus tear, cartilage damage, cruciate ligament damage, runner's knee, etc.) requires a lot of experience.
I treat a wide variety of knee diseases in a conservative way.
The aim of any treatment is treatment without surgery.
Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.
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Advantages of the outpatient variant
The advantage of outpatient rehab is that patients are not completely torn from life. You are usually back home in the late afternoon and can take part in everyday family life. For example, if the spouse works long hours or in shifts, it is ensured that someone is still there to look after the children, relatives, pets or general household chores. Another advantage is that the lack of a stay in a clinic results in lower costs for the cash register, and therefore additional payments are lower or even eliminated. There is a further advantage for younger patients, who can get adequate rehab, but are still not separated from their parents.
Disadvantages of the outpatient variant
Disadvantages of outpatient rehab are that, depending on the situation, the patients sometimes have to travel long distances. One outward journey and one return journey must be made every day. That is not an option for everyone. Another disadvantage is that the person undergoing rehabilitation does not come to rest. While it is positive for the family that the father or mother will be back in the afternoon and be able to organize everyday life, there is a risk for those affected that the knee will be strained and not as it would actually be necessary after a long rehab Day is high.
Advantages of inpatient admission
The advantage of inpatient rehab is that the patient is tied to a fixed schedule throughout the rehabilitation measure and is in a secure environment at all times, where he can be referred to a clinic at any time in the event of problems. Above all, patients who are not cared for at home but are left to their own devices are so well cared for until the knee is sufficiently resilient again. Another advantage is that the inpatient stay means that the stress that arises from daily travel to and from the home does not exist, and the person in rehab is also relieved of the everyday stress in everyday life at home.
Disadvantages of inpatient admission
The disadvantage of inpatient rehab is that you are in a clinic-like facility for a long time and you are limited in the daily organization of the day apart from the rehab measures. In addition, depending on the location and duration of the rehab, there is often an additional payment, as the health insurance company does not cover the full costs. It could also be seen as problematic that parents in inpatient rehab are separated from their children for longer periods of time, even if special languages can be agreed with the health insurers depending on the age of the children and the family situation.
What can I expect in an outpatient rehab after knee prosthesis?
After the operation, the patient will stay in the clinic for about 8-10 days until he is released into outpatient rehab. While the patient is in rehab, mobilization and exercise of the knee begins. Every day that the knee is not moved is a lost day. Therefore, the stay in the clinic can also be extended if it is not possible to regulate a seamless transition to rehab. If there is also the problem that the patient is not yet able to care for himself, then follow-up treatment (AHB), which runs until the patient can be discharged into rehab.
During the outpatient rehab, the patient lives and sleeps at home. In the morning he is picked up by a driver or taxi and transported to the rehabilitation facility. Depending on the rehabilitation center, the patients may have a room for the day in which they can rest. Otherwise, the same treatments take place in outpatient rehab as in inpatient rehab. In the afternoon or as agreed, the patient will be transported back home in the afternoon.
In general, the focus of rehab is mobilizing and strengthening the knee. At the beginning, the patient is usually only allowed to use full weight bearing adapted to the pain and only bend to a maximum of 110 °. Adapted to this, physiotherapy does strength, mobilization, movement and coordination exercises with the patient. Other components are lymph drainage, massages and occupational therapy (coping with everyday life). Depending on the therapy center, aqua aerobics are also offered. The further the rehab progresses, the more strength training is added. At the beginning there are only exercises in the closed chain, such as squats.
Sports that involve physical contact, rapid changes of direction, the risk of falling and great stress on the knee are not only advised against during rehab, but generally also for the time afterwards. Otherwise, after 3 to 6 months, you can fully exercise and do sports again without pain.
What can I expect in inpatient rehab after knee prosthesis?
The patients remain in the clinic for about 8-10 days after the operation until they are released for rehab. Mobilization of the knee begins at this time as well.
Physiotherapy moves the knee. At the beginning only passively, which means that you don't work with your own muscle power, but that the knee is moved by the physiotherapist. The wound drainage is removed within 3 to 5 days. In the first 10 days, the first short distances should be covered with forearm crutches, such as the way to the toilet.
A specially developed program awaits the patient in the rehabilitation facility. Physiotherapy treatments usually take place throughout the day. In addition, there are sports activities adapted to the course. At the beginning it is important that the mobility of the joint is maintained or restored. This takes place through initially passive movements of the knee through physiotherapy. In addition, applications such as lymphatic drainage, massages, kneecap mobilization, climbing stairs, strength training in the closed chain, as well as occupational therapy methods such as ADL training (tasks of everyday life) are offered.
In the 2nd - 3rd week after the operation, full weight-bearing can usually be used in a pain-adapted manner. Be careful here with the diffraction (Flexion) allow the knee to flex - a maximum of 110 ° may be bent and not crouched. Only with a stable and trained muscle system on the knee can it be fully used again later. At the beginning, aqua aerobics can be helpful, as less forces act on the knee. The rule here is that the wound has to be well closed.
The knee can also be practiced well on the bicycle ergometer.
From the 4th week onwards, full load is usually allowed. Sports that involve rapid changes of direction or exert stress on the knee will not be found in rehab after knee prosthesis - as a general rule, most sports can only be resumed after 3 to 6 months at the earliest. It is important to know that after rehab there is usually not complete freedom from pain and training for the knee and the entire body must not be stopped. Treatment is usually continued with the outpatient physiotherapist.
