Total Knee Replacements in Mumbai – Rehabilitation after Knee Surgery
Thank you for opting to have your surgery done with us.
I hope that you are cognizant of the other methods of treatment of your problem which has been discussed with you by me, my staff and assistants in my clinic, in advance, at the time of your consultation, and I trust if you have had any queries, they have been answered.
Based on our discussions, we have determined the suggested plan of action as the best option under the circumstances, keeping in mind your requirements and our current expertise.
To help you understand the process, I am comparing it to taking a flight from Mumbai to a foreign destination.
Just like before a flight, you need passports, visa, ticket bookings, like-wise for the operation, you need to book a date for admission and a date and time for surgery.
Just like the visa process, we need to know that you are fit for surgery and therefore, you need to share your medical history with us, alongwith ALL the medication that you normally take including tablets such as Aspirin and Clopilet which are blood thinners and can cause bleeding at the time of surgery, and medication for Asthma (you may need more oxygen during the surgery) and Diabetes (if your blood sugars are high, then wound healing is very poor). All inputs by you help make us more prepared to help you.
Specific medication & conditions of the heart (ECG, 2D Echo), lungs (PFT/X-rays), liver and kidney etc., need to be known as various drugs can interact with these functions. The physical act of giving you anesthesia may require extra tests like specialized x-rays of your spine, CT or MRI screening of parts of your body, so that we are better prepared to tackle your spinal position during the process of the surgery.
Just like you have a security check before taking a flight, we need the Physician and the Anesthetist to look through these pre-operative medical reports and to examine you so that we may reduce the risks still further.
Just like in an aircraft before take-off, there is a safety drill in case of any risks, likewise, in any surgery we are taking RISKS but minimizing it by trying to cover as many events as we can.
Just as every landing at an airport, the pilot has to contend with cross-winds, haze, other flights, weather changes, quality of communication etc., similarly every surgical procedure is individualized, some are longer, some are shorter and there are multiple variables.
The OTC is like a ticket. Just like you pay for a ticket before your travel. The Hospital expects you to do an OTC (Operation Theatre Clearance) so that the hospital and you are both aware of the expected expenses. Against your paid ticket you get a boarding pass, likewise against an OTC, the institution permits you to be taken to the theatre for surgery. This is based on averages, but in your individual case the total expenses may be more if there are complications or emergency requirements which may or may not be related to the actual surgical procedure.
You need to be aware therefore that this is an estimate only based on an AVERAGE and is NOT a PACKAGE.
Recovery thereafter is a natural process, and we as doctors help nature help you, with medication, nursing, physiotherapy and other techniques required for your recovery. I reiterate that healing is a process dictated by nature, we only help in this. Just as nature has storms, weather changes, etc, recovery can sometimes in your individual cases be slower and therefore worrisome to you.
Such delays are also worrisome to us as individuals and as a team. The nurses, other staff and my team help the recovery process. Your concerns will be addressed.
Just like in the airline industry the cost of the ticket for travel supports the airline staff, the salaries, the fuel for the aircraft etc., for our team to successfully execute the whole process, there is staff in the hospital which is supported by the expenses incurred for your case, for administration, security, laundry, dining, meals, air-conditioning, water, catering etc.,
Like certain budget airlines offer cheaper fares and skeleton services many doctors and medical facilities will be able to offer you these at lesser rates. In our institutions we have overheads to ensure that checks and measures are carried out for your safety and these necessitate the charges quoted by us.
Just like in any travel there is an Economy class or Business Class or First class at different charges, helping you reach the same destination, similarly in the hospital there are various classes of admission with different levels of comfort, helping you attain the best results. My team’s training, experience, etc., should make this a smooth landing.
I hope this helps you understand the process and I really look forward to greeting you on the other side with every success in your case.
– DR. SANJAY AGARWALA
SA:bf:10th July 2018
Rehabilitation after Knee Surgery
Knee replacement surgery is a complex procedure, and physical knee rehabilitation is crucial to a full recovery. In order for you to meet the goals of total knee surgery, you must take ownership of the rehabilitation process and work diligently on your own, as well as with your physical therapist, to achieve optimal clinical and functional results. The knee rehabilitation process following total knee replacement surgery can be quite painful at times.
Your Orthopedic Surgeon and/or Physical Therapist will most likely assign a specific protocol to you, based on your rehabilitation needs. The following protocol is meant only to give you an idea of the kind of exercises you might do during rehabilitation. When in doubt about an exercise, follow the protocol outlined by your Surgeon and/or Physical Therapist.
Your knee rehabilitation program begins in the hospital after surgery. Early goals of knee rehabilitation in the hospital are to reduce knee stiffness and maximize post-operative range of motion as well as to help you get ready for discharge. The following steps may be taken to help maximize your range of motion following surgery.
- Strict adherence to the CPM protocol as prescribed by your surgeon
- Early physical therapy (day 1 or 2) to begin range of motion exercises and walking program
- Edema control to reduce swelling (ice, compression stocking, and elevation)
- Adequate pain control so you can tolerate the rehabilitation regimen
Outpatient Physical Therapy
Your outpatient knee rehabilitation program will consist of a variety of exercises designed to help you regain range of motion in the knee and build strength in the muscles which support the knee. You will follow an advanced strengthening program, adding weights as tolerated. A stationery cycle and walking program will be used to help increase range of motion and stamina, and an aquatic therapy program may be added as well.
Typical Home Exercises
Instructions in your home exercise program may include the exercises shown below.
Consult your therapist regarding the appropriateness of the exercises and the number of reps.
Ankle Pumps: Flex ankle up and down.
Quadriceps sets: Tighten thigh muscles and Hold for five seconds.
Heel slides: Flex your hip and knee. Return knee to the straight position.
Leg lifts: Raise leg six inches above the floor, keeping knee straight.
Knee extension: Place a pillow under your knee. Lift your foot off the mat.
Knee flexion stretch: Place a towel under your heel. Pull your knee towards your chest. Hold your knee in this flexed position for 15-20 seconds. Return knee to the straight position.
There are several things you can do at home to make your knee rehabilitation more successful. First of all, do the home exercise program as prescribed by your physical therapist. Next, follow these suggestions for daily activities:
- Sitting: Use a chair with arms to help you rise to a standing position. Avoid sitting for longer than an hour if possible. If you must sit for a longer time, elevate the foot to avoid swelling.
- Walking: Do not put weight through the joint until you’ve been cleared to do so by your surgeon.
- Lifting: Do not lift more than ten pounds.
- Showering: Showering is preferable to bathing because of difficulties getting in and out of the tub.
- Exercising: Do the exercises that were recommended by your doctor and physical therapist. Go to physical therapy as prescribed and get advice from your therapist as to whether you’re doing the exercises correctly.
- Getting into a car and driving: Get into a car by sitting on the edge of the seat, then pulling in the legs and turning to face forward. Driving is usually not recommended for the first six weeks post-op. Talk with your surgeon about driving sooner.
Long-Term Knee Rehabilitation Goals
Once you’ve completed your knee rehabilitation therapy, you can expect a range of motion from 100-120 degrees of knee flexion, mild or no pain with walking or other functional activities, and independence with all activities of daily living.