Further follow-up treatment - exercises

After you come home, you will need assistance with the housework and, in particular, with shopping. In general you will not be able to participate actively in normal life until 6-8 weeks after the operation, when you can walk without crutches. You are not allowed to drive a car again until three months after the operation; by this time you will have regained strength in your legs, a normal sense of movement and normal reactions.

During the first year after the operation, you will experience continuous progress and improvements.

Take advantage of the regular follow-up examinations. It is important to check the seating of your new knee joint. In this way, any problems which occur can be identified promptly and treated properly.

If you notice anything unusual about your knee joint, e.g. persistent swelling, unusual pain, elevated temperature or changes such as reddening or secretion from the wound, consult your physician immediately.

An artificial knee joint will never attain the mobility of a natural joint. To regain your ability to walk normally, it is important that the knee can be extended completely; for this reason, do not place any cushions or rolled blankets under the knee joint. Moreover, you should be able to bend your knee through 100 degrees so that you can sit down comfortably and get up from your chair without any assistance. Normal stair climbing is possible only after you have achieved this degree of bending.

During the first period after the operation, it will undoubtedly be helpful to use a cane - held in the opposite hand - when you go for long walks to take weight off the knee joint and to increase your safety.

At home, as in the hospital, you can cool the knee joint before and after exercise with an ice bag. This cold treatment alleviates pain, prevents swelling, relaxes the muscles and thus promotes better mobility of the knee joint.

It is extremely important that you do your exercises regularly without overexerting your knee. Your knee needs relaxation and rest. By doing exercises while sitting down, with your lower legs dangling, you can improve the bending capability of the knee joint. To strengthen all the muscles, you will also have to carry out some exercises while lying on your stoma

A few more tips:

• Avoid carrying heavy items. Do not carry your shopping bags on your crutches. Use a pack instead.
• Take your weight off your knee by using a cane on the contralateral side (i.e. the side opposite the new knee joint).
• Frequent stair-climbing or mountain-climbing puts a severe strain on the knee joint - so does standing for long periods of time.
• Watch your weight.
• Make sure that you are wearing the right shoes. The shoes must give you good support and have soft soles that cushion your steps.
• Beware: if you are free of pain, it is easy to forget that you have an artificial knee joint and to overload it. Overloading is just as unfavorable as exaggerated attempts to «protect» the knee.
• When doing housework, avoid kneeling and climbing on ladders. Light garden work is o.k. but not strenuous chores such as digging up the yard.
• Any general infection poses a risk for the knee joint. If you develop an infection following major dental treatments - or if you have infected toenails - talk to your doctor about antibiotic treatment.

Which sports are possible and suitable?

Sport can basically be recommended for many different reasons. Sport keeps you fit, strengthens the muscles and has a positive effect on the cardiovascular system. It's also a lot of fun and a good way to socialize.

If you use your muscles in a selective manner and don't overdo it, it you will achieve maximal mobility and strengthen your muscles. Start your sport program carefully and in measured doses. Take breaks and increase the pace slowly. If you experience pain at any point, interrupt your training. You can achieve good results by exercising regularly. It is better to participate in a sport you engaged in before the operation that to learn a new sport. The general objective of participating in sports after implantation of an artificial knee joint is to build up the muscles around the joint; this serves to stabilize the joint and increase the resistance of the bony bed underneath the impla

Alpine skiing

The danger of failing cannot be ruled out even in trained athletes skiing on carefully selected slopes. Knee implant patients should adjust their speed accordingly (i.e. slow down).

Ball sports

Here there is a danger of injury as a result of external force or excess enthusiasm (i.e. overcompetitiveness). Abrupt movements and changes of direction are additional risk factors.

Team sports

These sports can be made suitable for knee implant patients by changing the rules (e.g. smaller playing field, softer balls, slowing down the game, etc.).

Weight-lifting

Movements and weights must be precisely coordinated. The training should be planned to ensure slow forward and backward movements.

Golf

The torsional forces generated when you hit the golf ball and follow through may be transferred to the knee joint. This can be prevented, however, by controlling your movements and slowing down your swing. Walking on the golf course is a sport comparable to hiking.

Normal walking / power walking

Walking is good exercise if performed on soft level ground and terrain which does not contain any hidden risks. Important: walking shoes that provide good support and cushion your step.
Walking is not a suitable sport, however, when it requires sustained exertion (e.g. jogging), running through woods or over uneven ground, or interval training. The walker should try to develop an ergonomic walking style.

Bowling

Bowling is risky because of the combination of large striding steps and braking movements and the pronounced hip and knee bending when the ball is let go. This sport can be considered safe only if the players limit or eliminate the running steps leading up to the release of the bowling ball.

Cycling

Your can also exercise your muscles rhythmically and uniformly on the exercise bike at home. When cycling outdoors, avoid steep uphill or downhill slopes. A gear system is required to reduce the amount of force required.

Riding

Enormous danger of falling. Only patients who have ridden for many years are capable of modifying their riding style to avoid excess strain on the implant.

Swimming

This is a good sport which exercises many groups of muscles at the same time. The buoyant force exerted by the water makes it easier to carry out the movement sequences. Knee implant wearers should favor the kicking movement used during the crawl.

Sailing

Sailing in small boats is too dangerous because of the danger of extreme movements. However, sailing in large boats is an option if the implant patients wear non-skid shoes.

Cross-country skiing

Cross-country skiing can improve your stability when standing. Select the loipes or ski trails carefully, avoiding extreme slopes.

Dancing

When dancing it is important to avoid twisting the upper body with the leg that has been operated on fixed in place.

Tennis

Tennis can be recommended only for implant wearers who have already engaged in this sport for years before the operation. Pay attention to the court surface. Implant wearers should play only on courts where larger forces of friction do not occur; they should consider sticking to doubles and modifying the rules a bit (e.g. allowing the ball to bounce twic

Does sport cause premature loosening of the implant?

During clinical studies, implant loosening did not occur more frequently in patients who had taken part in endurance sports with at least partial loading of the joints. This points to a biopositive effect of these sports. In contrast, sports involving non-physiological load peaks (e.g. jumping, ball sports) result in premature implant failure. However, lack of exercise leads to a sustained higher risk of osteoporosis and apparently also a distinctly higher risk of loosening. Merely classifying sports as «suitable», «suitable with reservations» and «not suitable» is too simple since sports which are generally considered unsuitable for implant patients may be beneficial if the techniques involved are adapted to the individual case. Likewise, even «safe sports» can be dangerous if implant wearers fail to recognize their limitations. In general, patients with knee joint implants should avoid sports with large abrupt loading, with extreme movements and abrupt changes of direction. In contrast, sports characterized by uniform flowing rhythmic movements, with minimum force applied to the joint, have a positive effect.

Relative contraindications to athletic activities:

• A joint infection
• A feeling of instability
• An implant which has been replaced repeatedly
• Insufficient muscle development
• More than 10% overweight as measured by the Broca Method