Management of Knee Osteoarthritis should follow the 2017 released guidelines from the Australian Commission on Safety and Quality in Health Care. It involves a multidisciplinary approach, whereby conservative management should be first choice. This consists of;
- Comprehensive assessment
- Diagnosis
- Education & self management
- Weight loss and exercise
- Medicines
- Patient Review
Physiotherapists role is to assist with knee range of motion, strengthening of lower limb muscles to support the knee, improving balance and assisting to maximise performance of every day activities. They can also help in exercise prescription in weight loss.
When conservative management is no longer working to manage symptoms, surgery is often considered in the form of a Total Knee Replacement (TKR). So lets put things in perspective with recovery afterwards!
Firstly, most who have a TKR have had a period prior to surgery of pain, swelling, reduced knee range of motion, and with this comes weakness of the surrounding muscles. If you have pain and your muscles are weak before surgery, then there is going to be a fair bit of work to do afterwards! Some surgeons recommend some pre-operative strengthening to get your knee in the best condition possible before surgery.
Secondly, a TKR is a big surgery! Bones and soft tissue are cut, and there is a lot of handiwork to be done! So its no surprise that people are quite sore post surgery, and there is a fair bit of swelling. Managing this is very important and can be done by:
- Icing the joint
- Taking your pain and anti-inflammatory medications as prescribed by your surgeon
- Resting the joint – elevate the leg for periods throughout the day, use of crutches
- Completing your exercises given by the physiotherapist in hospital.
Managing pain and swelling and doing your exercises will help regain your knee range of motion. Functional knee range is 90o of bend (it’s the amount of bend you need to sit), so its essential you get this range as a minimum, but more is better!
Then there is the strengthening side of things, and this takes the most time. Changes in muscles strength take 6-12 weeks, but functional strength takes longer. Then think about how long the muscles were weak for prior to surgery, and it gives you a good idea why they say it takes a good year to get the knee working really well again. Persistence is the key, and a well-trained physiotherapist will be able to set you a program for strengthening, and progress this to increased difficulty and load over some months. The end goal is to have you walking, moving from sit to stand easily and get you back to the things you enjoy, whether it be walking the foreshore, playing bowls or getting back into the garden!
The Management of Knee Osteoarthritis Guidelines can be found here.
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