Activity progression for TKRs

[Josephine]

Activities of Daily Living are assessed in hospital as a means of assessing your fitness to be discharged home. Your domestic circumstances will be taken into account as in if you are living alone, etc.

ADLs include:
~ Personal hygiene and grooming
~ Dressing and undressing
~ Functional transfers, e.g. Getting out of bed
~ Voluntarily controlling bladder and bowel elimination
~ Ambulation (Walking or using a wheelchair)
~ Housework
~ Meal Preparation
~ Care of pets
~ Meal preparation and cleanup

Walking and other activity
Walking is about the best exercise you can do but again, you need to moderate your time and distance.
Always use your walker, crutches or canes as appropriate, only moving from one to the other as you gain confidence.
Don't be despondent if you have to go back once in a while in the early days.

Week 1
Just walking around the house - trips to the bathroom and kitchen are included!
Be up on your feet several times a day as you need to but don't get obsessive about it
A 5-6 minute walk every 3-4 hours is plenty
Spend most of your time resting and elevating

Week 2 - add this to previous instructions in Week 1
Start on a plan of walks around the house 3-4 times a day for about 5 minutes but don't

​

a) get obsessive about it​

b) get into too much pain and​

c) get too tired. Stop before you get to that point.​

Week 3 - add to all the previous
Lengthen the walks to about 5-10 minutes as before
Activity: prepare yourself a small meal or a snack


Weeks 4 and 5 - add to all the previous
Increase walks to out in the garden or street; to 20mins or longer if you feel up to it bt don't forget that means 10mins there and 10mins back!

Additionally activity:
Gather a little bit of laundry OR put it in the machine OR take it out but not all of it
Now you can do a little dusting and tidying;
Do a little meal prep (for yourself not the entire family!)

Weeks 6 and onward - add to all the previous
Start taking car trips to the shops but keep them short and sweet at the start, no longer than 15-20 minutes
Take at least one 5 minute rest while you are out

Activity: a very little ironing, washing, meal prep but get someone else to clear up after. Wash up but someone else clears the table, brings you the dirty dishes, dries and puts them away after, NOT you!!

Week 10 add to all the previous
Bed making and changing sheets, cleaning bedrooms etc., can wait now by which time, all things being well, you should pretty much start getting back to normal but don't rush it. If you start getting pain and stiffness in your knee, that's a sign your knee doesn't like what you're doing, that you're rushing ahead too fast. Slow down, right down, and start again. This stage might last until week 14 or even 16 but if it takes a even longer, don''t worry about it.

Returning to work
It's becoming the norm for knee patients to be pressured back to work after 6 weeks or so. This can be done but it is even more important one needs to try and negotiate a "Phased return to work" because going straight back to full time work can be very hard on the new knee and cause tendinitis in various places. But in essence, I would advise that 6 weeks is far too early and 10-12 weeks would be a more sensible target!

 

[Josephine]

exercise bikes

TKR: Using an exercise bike requires restraint at the start and - as ever - patience! Start with very short sessions, about 3mins. And only rock back and forth. Do that for many days until you feel brave enough and free enough to try a full rotation - but at first do it backwards!

When you've done a number of those, try one or two forward rotations. Do not, under any circumstances, let it be painful! If you find it is painful going 'over the top' stop at once and try again the next day. Although to be absolutely truthful, the first time is always somewhat painful but it shouldn't be excruciating! Take it slowly, v-e-r-y s-l-o-w-l-y!

It's a frequently asked question on this forum: which is best, upright or recumbent?

Simple answer is that it's a matter of choice. Hip patients feel more comfortable in a recumbent while knee patients might feel an upright has more ability to adjust and test the joint. Whatever suits you is the right one to use.

This is a recumbent bike

Make sure you don't slouch, that your posture is upright and your rear pushed well into the back of the seat. Have the seat setting as far back to begin with so your joint (hip ior knee) isn't stressed too much, moving it forward a bit as you feel able. Also have the resistance on zero to begin and slowly increase as you recover. Under no circumstances rush this. Spend at least one, probably two weeks on the lowest settings.

This is an upright bike

You may find it helpful to have a step stool to assist mounting the bike.
To start with, have the seat as high as you can get it and still reach the pedals and set the resistance set at zero.

For TKRs, do not attempt to do full rotations, just rock the pedals back and forth. It may take you two weeks to manage a full rotation but don't worry if it takes you longer.

Once you have managed that, you can begin to lower the seat a notch at a time. When you feel up to it, also begin increasing the resistance.

Under no circumstances rush this.
If you are a hip patient, spend at least 1, probably 2 weeks on the lowest settings.
If you are a knee, double that time - as a minimum! So 2-4 weeks on lowest setting.

However, once the first early weeks of recovery are over, a stationary bike is one of the very best modes of exercise you can undertake!

On the other hand - if you can't run to or don't have the space for either of those, consider a peddler instead.
Some even have tensioners and on-board computers! Such a device would really be worth its weight in gold so far as your recovery is concerned. And when you're done you can always sell it on in Ebay!
(Prices added 16th January 2012)

UK version
Pedex Deluxe Fitness Pedal Cycle Exerciser
Amazon.co.uk £44.95

US version
Sunny Health & Fitness Mini Cycle
Amazon.com $58.

 

[Jamie]

If you can't get your exercise bike seat low enough to get a good testing for your knee, then a crank shortener might be the answer.

Here is one I found at tandemseast.com :

$118 per pair

Here is another at adaptivemall.com that is quite inexpensive compared to the first one:

Regular price: $44.00
(Sale price today: $39.60)

 

[Roy Gardiner]

Ankle Pumps and foot rotations (Both Legs)



These are simple exercises and can be done any time you are resting with your leg elevated or not, doesn't matter. It's something you should be doing from the moment you get back to the ward after your surgery.

It generally doesn't cause any pain in your knee and it will be very good for keeping your circulation going and preventing things like DVT or blood clots which is their primary function. Do them as often as you feel able for the first couple of weeks but once you are ambulant, they are no longer necessary.