Congratulations on successfully completing your knee surgery! We are excited for you to learn how to live to your fullest again with your new breakthrough.

The goal is for you to return to your normal lifestyle as safely and independently as possible.

The following information will complement the discussion, demonstration and practice in each of these areas you will work on during your occupational therapy sessions.

As ordered by your doctor, you will participate in physical and occupational therapy while in the hospital.

Bed Transfers


Please be sure that your bed is firm and not too low. Waterbeds are not recommended.

  1. Back up to the bed until you feel it with the back of your legs.
  2. Slide your affected leg forward as you reach back for the bed with both hands and slowly lower yourself to sit on the edge of the bed.
  3. Turn diagonally so you are facing the end of the bed. Lift your legs on to the bed one at a time while pivoting on your bottom.
  4. Use your arms to scoot back and up onto the bed.
  5. Do not lie down in the bed until you are positioned correctly. You should be in the middle of the bed with both legs on the bed.
  6. It is recommended that you lie on your back or on your affected side. In either case, be sure to keep a pillow between your legs to avoid crossing your legs during the night.
  7. To get out of bed, reverse the above technique.

Sitting

  1. Back up to the chair until you feel it behind your knees.
  2. Slide the foot of your affected leg forward as you reach back for the armrests and lower yourself slowly, keeping your affected leg forward.
  3. To stand, scoot forward in the chair. Do not lean forward in the chair.
  4. Slide the foot of your affected leg forward and push yourself up using the armrests. When you have your balance, reach for your walking aid (walker/crutches).

Toilet Transfers


You may need a raised toilet seat or a handicapped-height toilet if you have difficulty getting on or off of a standard-height toilet. A specific commode chair and/or other equipment may be recommended by your occupational therapist.

  1. Back up to the toilet until you feel it with the back of your legs.
  2. Step your affected leg forward. Reach back for the edge of the toilet seat or safety rails and slowly lower yourself, keeping your affected leg forward.
  3. To stand up, slide your affected leg forward and push up from the seat or safety rails using your arms.
  4. Be sure you have your balance before reaching for your walking aid.

Tub Transfers


Use a tub seat and grab bar for safety and/or or any other equipment recommended by your occupational therapist. You cannot soak in the tub until your incision is healed and you obtain approval from your surgeon. If your tub has sliding doors, it is recommended to remove them and replace with a shower curtain.

  1. Back up to the tub with your walking aid and make sure you are even with the tub seat. Reach back with one hand for the grab bar and with the other hand for the tub seat. Keep your leg forward as you slowly lower yourself to the seat.
  2. Swing your legs into the tub one at a time.
  3. To transfer out of the tub, swing your legs out one at a time. Slide your affected leg forward and use your arms to push up from the tub seat and/or grab bar.
  4. Get your balance before reaching for your walking aid.

Shower Transfers


Use a shower seat and/or any other adaptive equipment recommended by your occupational therapist.

  1. Using your walking aid, back up to the shower until you feel the shower ledge with your heels.
  2. Step over shower ledge with your unaffected leg first, then bring your affected leg in.
  3. Reach back for the shower chair with both hands and slowly lower yourself to the chair.
  4. Pivot on the shower seat towards the faucet. If your shower is too small for this technique, problem-solve alternative techniques/positions with your occupational therapist (e.g., stepping forward into shower with affected leg and crutches).
  5. Use a long-handled sponge and/or a hand-held shower to wash your legs/feet.
  6. Reverse the above process to get out of the shower. Step out of the shower with your affected leg first.

Dressing

While you are not required to use adaptive equipment to get dressed, you and your occupational therapist will determine if such equipment would make getting dressed easier following surgery. Always dress the affected leg first and undress it last. Sit on the edge of the bed or in a firm armchair for dressing.

Underwear & Pants

  1. Using a reacher, hold underwear at the waistband and bring it toward your affected leg. Slide the leg hole over your foot and pull it up to your knee. You can also gather the leg of the underwear up and into the clamp of the reacher in order to better see the opening at the bottom of the underwear. While sitting, pull your underwear up above your knees as far as you can until you are ready to stand.
  2. Repeat the same process with your pants by bringing them to the same height as your underwear. (This way you only have to stand up once to complete the task.) You can also gather the entire pant leg in the reacher clamp in order to better see the opening at the bottom of the pant leg
  3. For safety, have your walking aid in front of you and stand up by pushing from the bed/armchair until you are balanced. Pull up your underwear and pants over your hips.
  4. To undress, reverse the process, remembering to remove your clothing from the unaffected leg first.

Socks & Stockings

  1. Slide the sock/stocking onto a sock aid until the toe is flush to the bottom of the sock aid. Be sure the top of the sock is not over the top of the sock aid.
  2. Holding onto the straps of the sock aid, lower the sock aid to the floor in front of your affected foot. Slide your foot into the sock aid and pull on both straps until the sock comes up your leg. Continue to pull on the straps of the sock aid until the sock aid comes completely out of the sock. Unhook the sock aid from your leg.
  3. Put on your other sock onto the unaffected leg by either bringing your foot up to you or using the sock aid.
  4. To take off your sock/stockings, hook the end of the dressing stick, reacher, or long-handled shoehorn at the top of your sock and slide it down your leg, over the back of your heel and off your foot.
  5. If your sock falls on the floor, you may pick it up with your reacher or dressing stick.

Shoes

Slip-on shoes are generally recommended. If you prefer shoes that lace up, your occupational therapist can show you how to use elastic shoelaces.

  1. Slide the toes of the affected leg into your shoe. Position a long-handled shoehorn in the back of your shoe and slide your heel down the shoehorn into the shoe. This may be easier to complete when standing as opposed to sitting.
  2. Be sure not to turn your leg inward as you do this.

Home Making


  1. Use a walker apron or plastic bag attached to your walker to transport items within your home. You can also spread a folded towel over the top of the walker to carry light objects.
  2. Carry liquids in containers with lids or covers (e.g., thermos, unopened cans of soda, water bottles).
  3. Slide items along counter tops whenever possible rather than trying to carry them.
  4. Use a reacher to pick up items dropped on the floor or to retrieve items from low areas (e.g., the crisper in the refrigerator, low dresser drawers).
  5. Sit on a high stool whenever possible (e.g., at a kitchen counter for meal preparation, a work table).
  6. Remove all throw rugs in your home to avoid catching your walking aid or foot and possibly tripping or falling.
  7. Use a long-handled brush to clean the toilet and tub.
  8. Use long-handled tools (specifically, mops, brooms, dust pans and feather dusters) for cleaning.
  9. For laundry, use a pushcart or shoulder bag to transport clothing to/from your washer and dryer. You can also have friends or family assist.

Vehicle Transfers


  1. You will need to get into the front passenger seat of the vehicle.
  2. Before getting in, have the seat positioned as far back as possible from the dashboard and in a semi-reclining position if possible.
  3. Back up to the vehicle as you would a chair until you feel the seat behind your legs.
  4. Lower yourself to the seat, holding onto a stable surface (e.g., the back of the seat, dashboard or, if possible, lower the front and back windows and hold onto the frame between the windows).
  5. Slide your bottom back on the seat as far as you can.
  6. Swing your legs into the vehicle one at a time. Remember when going toward your affected side, use a leg lifter or have assistance to get your leg into/out of the car.
  7. You can move the seat up from the reclined position as you ride.
  8. To get out of the vehicle reverse the above process.

Adaptive Bending Techniques


When reaching for low or dropped items, hold onto something that is secure.

  1. With one hand, hold onto a counter or table.
  2. Kick back your affected leg as you bend forward and reach down with your free hand. Keep the toe of your affected leg on the ground for balance and your knee straight.
  3. Once you have picked up the item, stand back up and regain your balance.

Use of An Assistive Device for Walking


Your physical therapist will prescribe an assistive device for you while you are in the hospital and at home. Walkers and crutches are the most common equipment used. On rare occasions patients are able to walk with only the assistance of a cane.

If you already own a walker, crutches or cane, you may bring it to the hospital for the therapist to adjust for you. It is best to have your family bring it in the day after your surgery. If you would rather leave your equipment at home, you may borrow our equipment while in the hospital.

If you DO NOT already own a walker, crutches or cane, they can be purchased or rented. Your physical therapist can provide information for you to obtain the equipment or the therapist can order the equipment for you. Equipment ordered by your physical therapist will be delivered to your hospital room at no additional charge. Walkers and crutches can be billed to your insurance and may be paid for depending on your policy.

Your physical therapist will train you on how to use your assistive device for walking and for going up and down stairs.

Stair Climbing

Going Up One Step with a Walker

  1. Approach the step with your walker or crutches.
  2. Step into your walker close to the step.
  3. Move your walker up onto the step.
  4. Step up onto the step with your unaffected leg.
  5. Step up onto the step with your affected leg.

Hip-Stair-Climbing


Going Down One Step with a Walker

  1. Walk to the edge of the step with your walker.
  2. Step into your walker.
  3. Move your walker off the step and onto the ground.
  4. Step down onto the ground with your affected leg.
  5. Step down with your unaffected leg.

Going Up One Step with Crutches

  1. Approach the step with one crutch under each arm.
  2. Step up onto the first step with your unaffected leg.
  3. Bring your affected leg onto the step.
  4. Bring your crutches onto the step.

Going Down One Step with Crutches

  1. Approach the top of the step with one crutch under each arm.
  2. Lower the crutches down.
  3. Step down with your affected leg.
  4. Step down with your unaffected leg.

Going Up a Flight of Stairs with Crutches and a Railing

  1. Approach the stairs with your crutches.
  2. Hold onto the rail with your closest hand and place the crutches under the opposite arm.
  3. You can either place both crutches under one arm or place one upright and the other perpendicular to it (as shown in photos). Your physical therapist will help you determine which method is easiest for you.
  4. Step up onto the first step with your unaffected leg.
  5. Step up onto the step with your affected leg.
  6. Bring your crutches up onto the step.
  7. Continue this sequence until you reach the top of the stairs.

Going Down a Flight of Stairs with Crutches and a Railing

  1. Hold onto the rail with your closest hand and place the crutches on the other side.
  2. Lower the crutches onto the first step.
  3. Step down with your affected leg.
  4. Step down with your unaffected leg.
  5. Continue this sequence until you reach the bottom of the stairs.

Going Up a Flight of Stairs with Crutches without a Railing

  1. Approach the stairs with one crutch under each arm.
  2. Step up onto the first step with your unaffected leg.
  3. Bring your affected leg onto the step.
  4. Bring your crutches onto the step.
  5. Continue this sequence until you reach the top of the stairs.

Going Down a Flight of Stairs with Crutches without a Railing

  1. Approach the top of the stairs with one crutch under each arm.
  2. Lower the crutches down onto the first step.
  3. Step down onto the step with your affected leg.
  4. Step down onto the step with your unaffected leg.
  5. Continue this sequence until you reach the bottom of the stairs.

Home Exercise Program

You have invested much time and energy into your rehabilitation and now need to continue your efforts to further improve the strength in your new knee.

The following section includes additional exercises to increase your strength and flexibility. Your physical therapist will provide instructions for these exercises while you are in the hospital. Upon discharge from the hospital, you should perform these exercises three times a day, starting with 10 repetitions and working up to 20 repetitions each. It is important to remember to breathe steadily throughout all your exercises. You will continue to be guided in your rehabilitation by your outpatient or home physical therapist.

Occasionally patients ask for a therapist to come to their home. There are extenuating circumstances that may cause your surgeon to order this for you but it is generally preferred for you to go to an outpatient clinic for your therapy. Outpatient therapy tends to be more aggressive, which will help you return to your prior level of function more quickly.

The four most important things you can do for the rehabilitation of your knee are as follows:

  1. Bend: Bend your knee as far as possible several times per day. You cannot hurt your new knee by bend¬ing it too much although you may feel pain by doing so. A good goal to achieve is a 90-degree bend before you leave the hospital (a square angle).
  2. Straighten: Sit in a chair with your affected leg up on another chair directly in front of you. Maintain this position (as pictured) for 20-30 minutes up to several times per day. It is very important for your new knee to get as straight as possible.
  3. Lift: The most important strength¬ening exercise you can do is the straight-leg raise. This exercise will help you regain the strength in your quad¬riceps muscle, the large muscle group located on the front of your thigh.
  4. Walk: Walking will help strengthen your knee and leg

Isometric Exercises


Quad Sets:

  1. While lying on your back, straighten your affected leg as much as possible, tightening the muscles on the top of your thigh.
  2. Hold for 5 seconds and relax.
  3. Repeat

Hamstring Sets:

  1. While lying on your back, keep one leg straight and bend the other to a height of approximately 6 inches.
  2. Tighten the bent leg by digging down and back with the heel.
  3. Hold for 5 seconds and relax.
  4. Repeat

Glute Sets:

  1. Lie on your back and keep both legs straight.
  2. Squeeze your buttocks together as tightly as possible.
  3. Hold for 5 seconds and relax.
  4. Repeat

Range of Motion Exercises

Gravity-Assisted Flexion (Bending Your Knee)

  1. Sit on a sturdy chair that allows free movement of your foot backward. Keep your thigh well supported on the seat.
  2. Bend your knee as far as possible. You can help pull your knee back by using your other leg or a long sheet placed under your foot.
  3. Repeat

Strengthening Exercises

Seated Knee Extension (Straightening Your Knee)

  1. Sit in a chair with another chair facing you.
  2. Place your operative leg up on the chair in front of you. Make sure there is a gap between the two chairs.
  3. Allow your knee to straighten as much as possible.
  4. Maintain this position
  5. Repeat

Calf Stretch

  1. Sit with your knee straight and a towel looped around your foot. Gently pull on the towel until a comfortable stretch is felt in the calf.
  2. Hold for 15 seconds.
  3. Repeat

Heel Slides

  1. Bend your knee, sliding your heel toward your buttocks.
  2. Slowly lower your leg.
  3. Repeat

Short Arc Knee Extension

  1. Lie on your back.
  2. On your affected side, place a large coffee can or rolled up blanket under your knee.
  3. With your thigh resting on the can, lift your heel off the bed and straighten your knee as much as possible.
  4. Pause and then lower your heel.
  5. Repeat

Bridging

  1. Bend both knees up and put your feet flat on the bed.
  2. Squeeze and lift your buttocks off the bed.
  3. Lower your buttocks back down to the bed.
  4. Repeat

Straight Leg Raise

  1. Bend your unaffected leg and put your foot flat on the bed.
  2. Lift your affected leg 8 inches off the bed, holding the knee straight.
  3. Lower slowly.
  4. Repeat

Hip Abduction Slide

  1. Lie on your back with your legs straight.
  2. Keep a pillow between your knees during this exercise to avoid breaking your hip precautions.
  3. Keep your toes pointed toward the ceiling and slide your operative leg out to the side (like opening a pair of scissors).
  4. Slowly return your leg to the original position.
  5. Repeat

Seated Knee Extension

  1. Sit in a chair with your feet on the floor.
  2. Slowly kick the affected leg out front and try to straighten the knee as much as possible.
  3. Repeat

Standing Exercises

These exercises should be done near a kitchen counter or other high sturdy surface.

Standing Hip Abduction (Kicking Your Leg Out to the Side):

  1. Move your leg straight out to the side with the knee and foot pointing straight ahead.
  2. Do not hike your hip or lean to either side.
  3. Slowly lower the leg.
  4. Repeat

Standing Hip Flexion (Marching)

  1. Holding onto a stable surface such as a railing or back of a chair, bend your knee up toward your chest while keeping your trunk straight.
  2. Lower the leg slowly.
  3. Repeat

Standing Hip Extension (Kicking Your Leg Backwards)

  1. Keep your body straight and upright throughout this exercise.
  2. Move your operative leg back as far as possible, keeping the knee straight.
  3. Slowly return to the starting position.
  4. Repeat