Knee Replacement Surgery, Massage & PT, What to Expect, Scar Massage

I’m scheduled for a right knee replacement in November ’23 because of my athletic sports lifestyle so I wanted to do some research and this is what I found.

My surgeon explained to me that I’m a candidate for either a partial knee replacement or a complete knee replacement.   After talking to my doctor and doing the research I decided on the partial knee replacement. 

What to Expect after a Knee Replacement Surgery – my personal experience

  1. Make sure all your insurance paperwork is in order! Double check!
  2. Make sure all your hospital paperwork is in order! Double check!
  3. Understand that most insurance coverage covers a 1-night stay in the hospital or as they call it “outpatient or 23 hours in the hospital”.
  4. No one tells you about the pain you are going to experience- it’s going to be substantial. After the nerve block wears off that your anesthesiologist gave you, that’s when you will really know where your real pain level is going to be. The first 2 weeks will be the toughest.
  5. Your insurance will more than likely cover 2 weeks of in-home PT and then you’ll be going to do outpatient PT somewhere.
  6. I experienced bruising in my toes, calf muscles, quads, and hamstrings. Your knee, calf, and foot will be swollen. Elevate your leg and use ice often.
  7. My doctor prescribed Percocet for pain. After 4 days of taking 8 ea a day, I was done with that. I was nauseous all day so I called my doctor and he prescribed oxytocin which worked better for me.; I was always thirsty because of the drugs so I had to drink a lot of water and had to get up often to use the restroom a lot.
  8. One of my big issues was getting sleep. The first few days I did not sleep at all. Still having issues sleeping and this is day 15. So you’re going to be tired and not going to feel like not doing much. I ended up binge-watching Bosch on Amason and Yellowstone.
  9. Do as much PT at home as possible and get off your ass and walk around the block a few times a day.
  10. more coming

Rehabilitation after knee surgery typically lasts about 12 weeks. However many people can walk without an assistive device after 3 weeks and drive after 4–6 weeks.

After total knee replacement (TKR) surgery, recovery and rehabilitation can help you get back on your feet and return to an active lifestyle. Each surgeon may have different protocols, and each person’s recovery is unique. This article outlines a general recovery timeline.

 

The 12 weeks following surgery are important for recovery and rehab. Committing to a plan and encouraging yourself to do as much as possible daily will help you heal faster from surgery and improve your chances of long-term success.

Read on to learn what to expect during the 12 weeks after TKR surgery and how to set goals for your healing.

Day 1

Rehabilitation begins right after you wake up from surgery.

Some people have a total knee replacement as an outpatient procedure. This means they leave the hospital soon after the surgery, on the same day.

Some people may have this procedure as an inpatient procedure and stay in the hospital for a portion of their recovery.

After either inpatient or outpatient surgery, a physical therapist (PT) typically helps you stand and walk using an assistive device. Assistive devices include:

  • walkers
  • crutches
  • canes

The PT can show you how to get in and out of bed and move around using an assistive device. They may ask you to sit at the side of the bed, walk a few steps, and transfer yourself to a bedside commode.

If needed, a nurse or occupational therapist will help you with tasks such as dressing and using the toilet.

Before leaving the hospital, the PT will likely instruct you on exercises you’ll do at home.

Most people should start physical therapy within the first 24 hoursTrusted Source after surgery. Following your exercise plan helps you get back to your regular activities faster.

What can you do at this stage?

You’ll need to meet specific criteria before being discharged from the hospital. Your healthcare team will check that:

  • your blood pressure and other vital signs are within an acceptable range
  • your pain is manageable
  • you do not feel nauseous
  • you can get out of bed and stand up from a chair without assistance
  • you can walk a short distance with an assistive device
  • you can safely navigate a short flight of stairs

When you can leave the hospital depends on factors such as your health before surgery and your age.

As you recover from surgery, your activity level will increase gradually.

Some pain, swelling, and bruising are expected after TKR surgery. Try to use your knee as soon as possible, but follow your surgeon and PT’s instructions to avoid pushing yourself too far too soon. Your healthcare team can help you set realistic goals.

During the first 48 hours after surgery, focus on achieving full knee extension (straightening the knee). Increase knee flexion (bending) by following your surgeon’s recommendations.

The first week

Your daily routine will include the exercises your PT has provided to improve your mobility and range of motion.

Your exercise plan at this stage may focus on:

You can start higher-intensity strength training during the first weekTrusted Source after surgery if your physical therapist and surgeon give you the go-ahead.

It’s important not to push yourself too hard before your body is ready. Signs of overly aggressive training include:

  • severe pain during exercises
  • excessive swelling
  • prolonged soreness after exercising

If you notice these signs, you may need to stop what you’re doing and talk with your healthcare team.

Follow a doctor’s instructions to help manage pain after surgery. This can include:

How to shower after knee surgery

Your healthcare team will let you know how long you must wait before showering.

If the surgeon used waterproof dressings, you may be able to shower the day after surgery or after several days. If they use dressings that are not waterproof, you will usually have to wait longer before showering.

Avoid soaking your knee for 3–4 weeks to let the incision heal fully, according to the American Association of Hip and Knee Surgeons (AAHKS).

What can you do at this stage?

Starting the day of surgery, you should be able to fully extend the knee.

Your knee may be strong enough that you’re no longer carrying weight on your walker or mobility aid.

By week 3

Keep doing exercises to improve your mobility and range of motion.

Most people progress to using a cane or nothing at all by 2–3 weeks.

If you’re using a cane, hold it in the hand opposite to your new knee and avoid leaning away from your new knee. This can help offset your weight and improve the mechanics of walking.

Throughout your recovery, alternate between sitting and walking throughout the day. Long periods of sitting can cause your knee to feel stiff.

What can you do at this stage?

You can probably walk and stand for more than 10 minutes, and showering and dressing should be easier.

Many people have moved on from using a walker and can get around with a cane or without assistance.

By week 3, most people no longer require prescription medication to manage postsurgical pain.

Frequently asked questions

The following includes common questions about the total knee replacement surgery rehabilitation timeline.

How long is bed rest after knee replacement?

While you may experience pain and swelling following surgery, there is no bed rest period. Instead, you may begin moving around with an assistive device, such as a walker, and performing physical therapy exercises to improve your mobility and range of motion.

What activities should you avoid after a knee replacement?

After total knee replacement surgery, you may need to avoid getting your bandages wet or submerging the healing area in water.

Later in your recovery, doctors typically recommend avoiding activities with twisting motions and those where you can risk knee injuries, such as football, skiing, and snowboarding.

How painful is rehab after knee replacement?

Rehabilitation after a knee replacement helps to restore mobility, range of motion, and strength as you recover, though you may experience some pain and discomfort from swelling. You typically receive prescription medication to help manage your pain.

If your exercises cause you severe pain at any point, stop doing them and talk with a doctor or physical therapist.

What is the fastest way to recover from a knee replacement?

Performing your physical therapy exercises and following your doctor’s instructions may help speed your recovery from a total knee replacement.

Takeaway

You will likely be well on your way to recovery 12 weeks after total knee replacement surgery. However, you may be able to start returning to typical household tasks after about 4–6 weeks.

Committing to your rehabilitation exercises and performing the activities assigned by a PT can help your knee become stronger and regain full motion.

 

The knee joint is one of the largest and most complex joints in the body. It is constructed of 4 bones and an extensive network of ligaments and muscles. It is a bi-condylar type of synovial joint, which mainly allows for flexion and extension (and a small degree of medial and lateral rotation). 

https://www.physio-pedia.com/Knee

What is a knee replacement?

One of the most widely performed surgeries nowadays is knee replacement surgery. Knee replacement surgeries are done for more than 700,000 people in the United States every year, and most of them experience a noticeable improvement in the durability of the joint and its capability of flexing and extending. Knee replacement, which is also called arthroplasty, is a well-known surgical procedure and is done all over the world nowadays. Knee replacement results in pain relief and retaining the joint’s ability to smooth movement by replacing the most affected and weight-bearing part of the joint with an inert and safe material.

The first knee endoscopy was done by a physician from Denmark called Dr. Severin Nordentof in 1912, while the first recorded knee arthroscopy was done forty-three years later by a Japanese surgeon called Masaki Watanabe He removed a solitary giant cell tumor from a knee joint during the procedure. Two years later, Dr. Watanabe shared his knowledge and experience and published The Atlas of Arthroscopy which is still considered the basis of modern minimally invasive knee arthroscopy.

Many studies were published to sum up the causes that may lead to knee replacement. However, we are going to cover the most frequent roots. Osteoarthritis is the most common cause of knee replacement. It is a chronic condition in which bones or cartilage of the joint are inflamed for some reason.  Many studies say that symptomatic knee osteoarthritis (confirmed by a radiologist) especially in its late stage affects nearly 3.8% of the population all over the world. This inflammation may potentially cause serious impairments. Pain and stiffness generally progress and get worse, so in the early stages, alternative non-invasive methods of treatment are available in most cases and can resolve osteoarthritis in most cases.

Symptoms of osteoarthritis include limited motion, joint pain with activity, redness, and swelling of the knee. Making efforts such as carrying heavy weights, climbing stairs, bending, or squatting becomes much harder and exacerbates the pain. The damaged tissues in tendons, ligaments, and bone mostly give the patient no choice except a total knee replacement. Severe deformity from trauma or late-stage arthritis may lead to knee replacement surgery. Autoimmune diseases such as rheumatoid arthritis may damage the articular parts of the knee joint which will eventually lead to a knee replacement surgery to restore the joint smoothness. Osteoporosis isn’t considered by many orthopedics as a potential cause so it does not typically cause deformity or inflammation and is not a reason to perform knee replacement. Other minor causes are cartilage defect and ligamental tear which are less frequently reported than the previously mentioned causes.

What is the fastest way to relieve knee pain?
 
 
Rest, ice, compression, and elevation (RICE) are good for knee pain caused by a minor injury or an arthritis flare. Give your knee some rest, apply ice to reduce swelling, wear a compressive bandage, and keep your knee elevated. Don’t overlook your weight,
 
What is the best painkiller for knee pain?
 
 
Over-the-counter medications — such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) — may help ease knee pain. Some people find relief by rubbing the affected knee with creams containing a numbing agent, such as lidocaine, or capsaicin, the substance that makes chili peppers hot.

 

What is the best sleeping position for knee pain?
 
 
 

Sleeping with knee pain may require you to elevate the knee and leg. If so, sleeping on your back is the best option. Place pillow under both legs to elevate the knee above the level of the heart. If there is swelling in the knee, the elevation can help to reduce it.
 
What is better for knee pain heat or cold?
 
Knee pain is one of the most common issues that doctors attend to. It can be caused by a sprain, cartilage tears, tendonitis, runner’s knee, or many other issues. If there is swelling in your knee, you should ice for at least 72 hours until the swelling goes down. After that, heat can be used to help regain mobility.
 
Understanding knee replacements – a good info link – a must-see!
 
 
 

 

Knee replacement surgery is a very well-established surgery that has been performed regularly since the 1970s, though technology has obviously evolved.  The number of knee replacements done on an annual basis continues to increase each year.  However, it is not without risk and can be an uncomfortable experience in the immediate post-operative time.

When quantifying how much pain there is after surgery, it is relative to the patient. The pain after a knee replacement is typically no worse than one of your worst days before you had surgery. However, you can feel this way for the first two to three weeks after the day of surgery.  The amount of pain after surgery is usually manageable by the pain control plan you develop with your surgeon, but to think that surgery will be pain-free is unrealistic.

One of the biggest improvements with joint replacements over the years has been pain management before you go into the operating room, during surgery, and post-operative care.

The day of surgery you may be started on an anti-inflammatory to help with pain.  Sometimes you are given a narcotic before the start of the case as a preemptive strike on the pain.  The anesthesia department will typically talk to you about an adductor canal block.  This is an injection of some long-acting numbing medication that is placed above the femoral nerve, and which can decrease the body’s pain perception after your surgery.

During your surgery, there are several things that your surgeon will do to help decrease the amount of pain. Using smaller incisions and careful handling of the soft tissues around your knee can help decrease the amount of pain. Decreasing the amount of time that a thigh tourniquet is inflated can also help with pain after surgery. Your surgeon may also opt for an injection of narcotic and numbing medication in and around your knee joint once the knee replacement is done.

After surgery, the nursing staff will start putting ice on your knee. It will take four to five days before your knee will start to swell. Putting ice on the joint right away will help with the swelling that will occur later.  Icing your knee four to five times a day is recommended during the first three weeks. Icing and elevating your knee regularly can help keep the swelling down, which in turn helps with reducing your pain and improving your range of motion.

The nursing staff will also use a combination of Tylenol and narcotics to help control your pain. Over-the-counter Tylenol taken at the correct dosage and used on a regular schedule can help with pain.  Narcotics can help with breakthrough pain that the ice and Tylenol do not control.  Research has shown that managing your pain with several different options is better than just using one technique.

The first two to three weeks post-op is generally the time patients feel most discouraged due to the pain. It’s hard to get up from a chair, it’s difficult going up and down stairs, you’re moving slowly and you have to use a walker because you have no strength or balance.  It does get better, but most people during this time are not thinking that the surgery was a great idea.

At four to six weeks, you should be doing much better. You are taking little or hopefully no narcotics by this point.  You are starting to sleep better at night. The simple activities of walking and getting up from the toilet are much easier. Your knee is starting to look more like a knee and your range of motion is improving. People are starting to think about going back to work if they do desk work. The biggest issue at six weeks is that your strength and endurance have not yet fully returned and that can be frustrating.

At three months, life is typically much better. Your knee has not functioned this well in a long time.  Most patients are no longer seeing their surgeon anymore. You have returned to work by now. Patients are doing the extra things of life: going for walks, going to the gym, and getting out of the house regularly again. Your knee will still have some soreness, but it is very tolerable. You may get tired if you are on your feet for long periods of time, but strength can continue to improve with time.  This is still some swelling in the knee, but it is usually better than before surgery.

At between six months to one year after surgery, you are fully recovered. Whatever swelling or pain or motion you have will likely be it. A knee replacement is not a perfect surgery. Your new knee will not feel like the knee you had when you were twenty, but it is better than before you started this journey. The goal of the surgery is to take away eighty to ninety percent of the pains, aches and stiffness that you had before you started.  Knee replacements allow you to walk two miles for exercise, run errands around town, and go to sporting events. When fully recovered, most patients will say that it was the best thing they ever did and would do it again if need be.

If you decide to undergo a knee replacement, there is going to be pain after surgery.  However, your surgeon is going to use several different medications to try and keep that pain tolerable so that you are able to complete your rehab and function in the way you need to get through the tough days right after surgery, which means you can enjoy life again further along in recovery.

Here are some common causes of knee pain:

MEDICAL CONDITIONS

  • Arthritis — Including rheumatoid arthritis, osteoarthritis, lupus, and gout
  • Baker cyst — A fluid-filled swelling behind the knee that may occur with swelling (inflammation) from other causes, such as arthritis
  • Cancers that either spread to your bones or begin in the bones
  • Osgood-Schlatter disease
  • Infection in the bones around the knee
  • Infection in the knee joint

INJURIES AND OVERUSE

  • Bursitis — Inflammation from repeated pressure on the knee, such as kneeling for a long time, overuse, or injury
  • Tendinitis — Inflammation of the tendon with change in activities, can be related to overuse or deconditioned tissue
  • Dislocation of the kneecap
  • Fracture of the kneecap or other bones
  • Iliotibial band syndrome — Injury to the thick band that runs from your hip to the outside of your knee
  • Patellofemoral syndrome — Pain in the front of your knee around the kneecap
  • Torn ligament. — An anterior cruciate ligament (ACL) injury, or medial collateral ligament (MCL) injury may cause bleeding into your knee, swelling, or an unstable knee
  • Torn cartilage (a meniscus tear) — Pain felt on the inside or outside of the knee joint
  • Strain or sprain — Minor injuries to the ligaments caused by sudden or unnatural twisting

 

Discuss in-depth right knee replacements & all the muscles, ligaments and bones involved
 
ChatGPT

A right knee replacement, also known as a total knee arthroplasty (TKA), is a surgical procedure performed to replace a damaged or deteriorated knee joint with an artificial prosthesis. This procedure is typically done to alleviate pain, improve function, and enhance the quality of life for individuals suffering from conditions such as osteoarthritis, rheumatoid arthritis, post-traumatic arthritis, or other severe knee joint problems. To understand the anatomy and the structures involved in a right knee replacement, let’s delve into the relevant bones, ligaments, and muscles.

1. Bones of the Knee Joint:

  • Femur (Thigh Bone): The upper bone of the knee joint. During a knee replacement, the end of the femur is reshaped to accommodate the femoral component of the prosthesis.
  • Tibia (Shin Bone): The lower bone of the knee joint. The tibial component of the prosthesis replaces the top surface of the tibia.
  • Patella (Kneecap): The patella articulates with the femur and is also involved in knee movement. In some cases, the patellar component of the prosthesis may be used to resurface the back of the patella.

2. Ligaments of the Knee:

  • Anterior Cruciate Ligament (ACL): A ligament that prevents the femur from sliding backward on the tibia. During knee replacement, the ACL is typically removed as it’s not replaced.
  • Posterior Cruciate Ligament (PCL): A ligament that prevents the femur from sliding forward on the tibia. Like the ACL, it is usually removed during the procedure.
  • Medial Collateral Ligament (MCL): A ligament that provides stability to the inner side of the knee.
  • Lateral Collateral Ligament (LCL): A ligament that provides stability to the outer side of the knee.

3. Muscles Around the Knee:

  • Quadriceps: This group of four muscles on the front of the thigh includes the vastus lateralis, vastus medialis, vastus intermedius, and rectus femoris. The quadriceps muscles are essential for extending the knee joint and play a crucial role in knee stability and function.
  • Hamstrings: These muscles, including the biceps femoris, semitendinosus, and semimembranosus, are located on the back of the thigh and are responsible for flexing the knee joint.
  • Gastrocnemius: This is the calf muscle, which crosses the knee joint and is involved in flexing the knee when the foot is pointed downward (plantar flexion).
  • Popliteus: A small muscle located behind the knee joint, it helps unlock the knee by rotating the tibia internally during the initial stages of knee flexion.
  • Iliotibial (IT) Band: A thick band of connective tissue that runs along the outer side of the thigh and helps stabilize the knee joint.

During a right knee replacement surgery, the surgeon will typically make an incision, remove damaged cartilage and bone from the femur and tibia, shape these bones to fit the prosthetic components, and then secure the prosthesis in place. The patella may also be resurfaced if needed. The goal is to restore proper alignment, stability, and function of the knee joint while reducing pain.

Physical therapy and rehabilitation are essential components of the recovery process to help patients regain strength, range of motion, and function in their new knee joint. Overall, a right knee replacement involves careful consideration of the complex anatomy and function of the knee to ensure a successful outcome for the patient.

Discuss the artificial prosthesis of the right knee and the success rate
 
ChatGPT

The artificial prosthesis used in a right knee replacement is designed to replicate the functions of the natural knee joint as closely as possible. These prosthetic components typically consist of three main parts: the femoral component, the tibial component, and in some cases, the patellar component.

1. Femoral Component: This component replaces the end of the femur (thigh bone). It typically consists of a metal alloy (e.g., cobalt-chromium) and is shaped to fit the restructured end of the femur. The femoral component has a groove or groove-like structure that articulates with the tibial component, allowing for smooth flexion and extension of the knee.

2. Tibial Component: The tibial component replaces the top surface of the tibia (shin bone). It is usually made from a combination of metal and plastic (polyethylene) and is designed to sit on the prepared tibial surface. It often includes a metal tray with a plastic insert that acts as a cushion to facilitate smooth movement.

3. Patellar Component: In some cases, the back of the patella (kneecap) may also be resurfaced with a patellar component made of plastic. This is done to reduce friction and improve the functioning of the patellofemoral joint.

The success rate of a right knee replacement surgery can vary depending on several factors:

1. Surgical Technique: The skill and experience of the surgeon play a crucial role in the success of the procedure. Surgeons who specialize in joint replacement surgery tend to achieve better outcomes.

2. Patient Selection: The success of the procedure can also depend on the selection of appropriate candidates. Patients who are in good overall health and have realistic expectations tend to have better outcomes.

3. Rehabilitation and Post-Operative Care: Following surgery, a comprehensive rehabilitation program is essential for a successful recovery. Patients who diligently follow their rehabilitation plan and commit to strengthening exercises tend to achieve better results.

4. Implant Quality: The quality and design of the prosthetic components used can impact the success of the surgery. Advances in implant technology have led to more durable and long-lasting prostheses.

5. Complications: Complications such as infection, implant loosening, or instability can affect the success rate. While these complications are relatively rare, they can occur.

Overall, the success rate of knee replacement surgery is generally high. Many patients experience significant pain relief, improved mobility, and an enhanced quality of life after the procedure. However, it’s important to note that knee replacement is a major surgery, and there are risks associated with it. Complications can occur, and the lifespan of the prosthetic components is not indefinite. Prosthesis longevity can vary, but modern knee replacements are designed to last for 15-20 years or more in many cases.

It’s important for individuals considering knee replacement surgery to have a thorough discussion with their healthcare provider, including an orthopedic surgeon, to understand the potential risks and benefits specific to their situation. The success of the surgery also depends on the patient’s commitment to post-operative care, including physical therapy and lifestyle modifications to maintain joint health.

 

What should someone expect for recovery time after right knee replacement surgery? How long will the pain last? How long should you do PT?
 
ChatGPT

The recovery time after a right knee replacement surgery can vary from person to person, but here are some general expectations:

1. Hospital Stay: Most patients spend 1 to 3 days in the hospital after knee replacement surgery. During this time, you will receive pain management, begin physical therapy, and learn how to navigate daily activities with your new knee.

2. Immediate Post-Operative Period (Days 1-2):

  • Pain: You will likely experience significant pain and discomfort during the initial days after surgery. Pain management is a priority during this time, and medications will be administered to keep you as comfortable as possible.
  • Mobility: You will begin to work with a physical therapist to start moving and walking with the help of a walker or crutches.

3. First 6 Weeks:

  • Pain: Pain is most intense during the first few weeks but gradually decreases as you heal. Pain medications will be adjusted accordingly.
  • Mobility: You will gradually regain mobility and independence. Physical therapy is crucial during this period to improve your strength, flexibility, and range of motion.
  • Weight-Bearing: You’ll gradually transition from using crutches or a walker to walking with a cane or unaided, depending on your progress.

4. 6 Weeks to 3 Months:

  • Pain: Pain continues to diminish, and you may rely less on pain medication. However, some discomfort during activities is normal.
  • Mobility: Your strength and mobility should continue to improve. You may begin to engage in low-impact activities like stationary biking.
  • Physical Therapy: Physical therapy usually continues during this period, with a focus on building strength and function.

5. 3 to 6 Months:

  • Pain: Pain should become minimal and occur mainly with strenuous activities.
  • Mobility: You should be able to resume most daily activities and may begin to incorporate more strenuous exercises into your routine.
  • Physical Therapy: Your physical therapy sessions may continue, but they may become less frequent as you progress.

6. Beyond 6 Months:

  • Pain: Many patients experience minimal to no pain beyond the 6-month mark.
  • Mobility: You should have regained most of your mobility and be able to perform a wide range of activities.
  • Physical Therapy: By this point, you may have completed formal physical therapy sessions, but you should continue exercises and stretches independently to maintain your knee’s strength and function.

It’s important to note that recovery is an individual process, and your progress may vary. Factors such as your overall health, commitment to rehabilitation, and adherence to your surgeon’s recommendations will influence the speed and success of your recovery.

Regarding pain, while significant pain should improve over time, it’s not uncommon to experience occasional discomfort or stiffness, especially during weather changes or with increased activity. However, severe or persistent pain should be discussed with your healthcare provider.

The duration of physical therapy (PT) can vary but is typically recommended for several weeks to several months after surgery. The goal of PT is to help you regain strength, flexibility, and function in your knee. Your PT plan will be tailored to your specific needs and progress. It’s essential to follow your PT plan diligently to achieve the best possible outcome from your knee replacement surgery. Your healthcare team will provide guidance on when it’s appropriate to transition from formal PT to independent exercises.

 

The How and What: Causes and Some Common Types of Scars

Scars develop for a variety of reasons, but some of the most common include burns, surgeries, or injuries. According to Johns Hopkins Medicine, there are many different types of scars, but some of the most common include keloid scars, hypertrophic scars, and contractures.

Keloid scars are thick, rounded, irregular clusters of scar tissue that typically grow much larger than the original injury that caused the scar. They usually appear red or darker in color compared to the uninjured surrounding skin, can appear anywhere on the body, and are most common on the chest, back, shoulders, and earlobes.

According to the American Academy of Dermatology Association, keloid scars can take months to appear after the original injury and can continue to grow for years. With these scars, collagen fiber arrangement is random and disorganized, and more blood vessels are present than with hypertrophic scars.

Keloid scars do not go away without treatment.

Some Risk Factors for Developing Keloid Scars

According to The Mayo Clinic, keloid scars are most common in people with Black or brown skin, though the reasons for this predisposition are not known.

  • A personal or family history of keloids.
  • Age—you’re more likely to develop keloid scars if you’re between the ages of 20 and 30.

Hypertrophic scars are similar to keloid scars, but their growth is confined within the boundaries of the original injury. Hypertrophic scars may also appear red, but they are usually thick and raised. These scars may improve on their own over time.

The Cleveland Clinic describes hypertrophic scars as being an abnormal response to wound healing, wherein extra connective tissue forms within the original wound. In contrast to keloid scars, collagen fibers are arranged parallel to the upper skin layer.

Hypertrophic scars may fade and become less noticeable with time.

Some Risk Factors for Developing Hypertrophic Scars

  • Burn wounds, especially second and third-degree burns.
  • Systemic inflammation.
  • Infection that inhibits proper wound healing.
  • Genetics.

Contractures differ from keloid and hypertrophic scars in that they occur when a large area of skin is damaged or lost. This scar formation pulls the edges of the skin together, causing a tight area of skin.

This decrease in the size of the skin can affect muscles, joints, and tendons, and decrease the range of motion, especially when the scar occurs over a joint. According to the American Academy of Dermatology Association, any scar that limits movement is called a contracture scar.

Some Risk Factors for Developing Contracture Scars

  • Severe burns and flame burns.
  • Traumatic injury.

Massage Therapy’s Effects on Scars

For scars that may be causing pain or discomfort after healing, massage therapy is showing real benefits in terms of providing relief. “Clients with scarring tend to favor function over appearance when we work together addressing their scarred tissues,” says Pete Whitridge, BA, LMT, BCTMB. “Surgical scars are common, and we can quickly improve the texture, feel, and pliability of the scar. More dramatic scars may never attain a ‘normal’ skin appearance, but the underlying tissues may become more pliable and allow for more glide and function as we consistently work on them.”

A 2023 study explored the physical and psychological effects of scar massage for burn patients. This systematic review and meta-analysis of randomized-controlled trials and quasi-experimental trials ultimately reviewed seven studies investigating scar massage for burn patients, comprising a total of 420 patients.

In all of the studies, massage sessions lasted between five and 30 minutes and were delivered by massage therapists between one and three times per week for 12 weeks. Overall, researchers noted that scar massage decreased pain levels, improved scar thickness, reduced pruritus, and reduced anxiety (although no significant effect on depression was found). The study concluded scar massage was a feasible and effective intervention for burn patients.

“As a massage therapist, I feel a difference in a client’s scar tissue after two sessions,” says Kate Peck, LMT, owner of Journey to Health, founder of the Massage Burn Scar Therapy Foundation. “It can feel thinner, more pliable, and more responsive to the scar work.”

Peck has found myofascial scar release, manual lymphatic drainage, therapeutic massage, and craniosacral therapy to be the most effective.

Another study explored the effectiveness of various methods of manual scar therapy on postoperative scars (more specifically cesarean section scars). The study included manual scar manipulation, massage, cupping, dry needling, and taping, and results showed a significant positive effect on pain, pigmentation, pliability, pruritus, surface area, and scar stiffness. Improvement of skin parameters—such as scar elasticity, thickness, regularity, and color—were also noted.

 

One vital caveat for massage therapists working with clients who have scars: Scars may be painful or tender, but scar massage should not cause pain. “I explain to my clients that the work should not be painful and that they should tell me if they feel any pain or discomfort, or if they just don’t like what I am doing,” Peck says.

Similarly, Whitridge notes, “Massage in general should never be painful. This is especially important for people who have experienced any type of scarring.”

Hands-On: What May a Typical Scar Massage Session Entail?

There is no one-size-fits-all approach to scar massage because no two scars or clients are the same. As such, a thorough intake is especially important when working with clients who have scars.

“I have a specific intake form for my burn survivor clients,” Peck says. “I want to know where they’ve been burned, how long ago their burn injury was, details of their last surgeries if they have any prostheses, where I can touch them, where they do not want to be touched, what areas they are most concerned with, and if I can work gently with those areas.”

Whitridge also notes the importance of communication. “There is a need for a lot of communication with clients about what scar massage should feel like, how long you’ll be working on the area, and how the scar might feel after the massage session,” he notes.

For Peck, the massage process usually begins with putting her hands gently on the client’s body to feel how they respond to touch. She looks for things such as flinching and guarding. From there, Peck will usually do some manual lymphatic drainage to check their lymphatic system, as the superficial lymphatic system is often damaged with a burn injury.

Myofascial scar release, mobilizing and restoring slide and glide, and getting the scar tissue “unstuck” from the underlying tissue come next. “The last step is to massage with a moisturizing cream or oil,” says Peck. “The intent is to hydrate and soothe the skin and increase blood flow to the area.”

 

Whitridge emphasizes the importance of starting slowly with any scar massage client. “People with scars are generally skeptical about receiving scar work because they are afraid that the area around the scar will rupture,” he says. “This population needs to be introduced to scar work in small doses (two to five minutes) to build confidence that the area can take touch, movement, and manipulation.”

So the client isn’t receiving touch on just one region of the body, Whitridge usually includes scar work as part of a longer massage session. In subsequent sessions, Whitridge performs a general assessment of the tissues (pliability, color, texture, and mobility) before pushing and pulling the area in the cardinal directions of the body to assess restrictions and ease of movement.

“Then I pull or push the area into the direction of restriction and hold the area steady for 30 to 90 seconds, and sometimes up to two minutes,” he says. “Then, I will return the tissue to its natural state and reassess the area.” He ends the session with some light lymphatic strokes toward the heart.

Peck has seen firsthand the benefits massage has on burn scars. These success stories include a client who could finally smile and feel comfortable eating in public after not being able to open her mouth wide enough for seven years. Additionally, clients with foot and ankle burns experienced an increased range of motion for better walking, as well as boosts in mood and quality of life.

Whitridge also has clients who have experienced drastic changes in their scars through massage therapy. The most profound success story he has witnessed involved a client who burned over 80 percent of his body in a fuel tanker fire. After receiving regular massage and attention to his scars for years, his scars dramatically improved. “In some areas, you could not tell the burned skin from the unburned skin,” says Whitridge.

Self-Massage for Scars: Client Self-Care

One thing that can help clients see even more improvement in their scars is learning some self-massage techniques they can use between regular massage sessions. Peck teaches clients how to do self-lymphatic drainage, self-myofascial scar release, and stretching to improve their range of motion without causing pain.

“Clients who understand the wound healing process and apply the idea of working slowly and gently with their own tissues can have excellent success when working on their own scars,” Whitridge says. “This empowers them to become more whole, embodied, and confident that the area can fully heal and that they can live full, productive lives without pain and with complete range of motion.”

Effects of Scar Massage on Burn Scars

The Study. A 2023 systematic review and meta-analysis of randomized controlled trials and quasi-experimental trials exploring the physical and psychological effects of scar massage on burn patients was conducted. The study followed the Centre of Reviews and Dissemination guidelines, as well as the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

Databases were searched for studies published between January 1990 and February 2022, and quality was assessed using the Joanna Briggs Institute (JBI) Appraisal Checklist. The final recommendation strength was assessed according to the JBI recommendations rating. A meta-analysis was performed using software with a random-effect model.

The Results. Seven studies investigating scar massage for burn patients were included, with a total of 420 participants. Scar massage sessions ranged from five to 30 minutes, one to three times per week for 12 weeks. Overall, scar massage decreased pain levels, improved scar thickness, and reduced anxiety. No significant effect on depression was noted.

“The meta-effects of scar massage among burn patients are significantly improved scar formation, and reduced pruritus and anxiety,” researchers noted. “Providing scar massage is feasible and effective for burn patients.”

Effectiveness of Manual Scar Therapy

Researchers asked: How effective is manual scar therapy on postoperative scars?

The Study. Researchers evaluated the effectiveness of manual scar therapy combined with complementary methods on postoperative scars. Treatment protocols included two of any of the following therapies—manual scar therapy, massage, cupping, dry needling, and taping—for 30 minutes per week for eight weeks.

The Results. “Treatment had a significant positive effect to influence pain, pigmentation, pliability, pruritus, surface area, and scar stiffness,” researchers concluded. “Improvement of skin parameters like scar elasticity, thickness, regularity, and color were also noticed.”

Discuss the science, research, benefits, and procedures for a complete knee replacement
 
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A complete knee replacement, also known as total knee arthroplasty (TKA), is a surgical procedure performed to address severe knee joint problems caused by conditions like osteoarthritis, rheumatoid arthritis, or traumatic injuries. This procedure involves the removal of damaged knee joint components and their replacement with artificial implants. Let’s delve into the science, research, benefits, and procedures associated with complete knee replacements:

Science and Research:

  1. Knee Joint Anatomy and Biomechanics: A thorough understanding of the knee’s anatomy and biomechanics is crucial for successful TKA. Researchers continually study knee joint function to improve implant design and surgical techniques.

  2. Implant Materials: Advances in materials science have led to the development of artificial knee components made from materials like metals (e.g., titanium, cobalt-chromium), ceramics, and polyethylene. Research focuses on enhancing the durability and longevity of these materials.

  3. Surgical Techniques: Ongoing research in surgical techniques for TKA aims to optimize the procedure’s safety, accuracy, and outcomes. Minimally invasive approaches and computer-assisted navigation are areas of interest.

Benefits of Complete Knee Replacement:

  1. Pain Relief: The primary benefit of TKA is the alleviation of chronic knee pain, enabling patients to resume activities with significantly reduced discomfort.

  2. Improved Mobility: TKA can restore joint function and mobility, allowing patients to walk, climb stairs, and perform daily activities more comfortably.

  3. Enhanced Quality of Life: Patients often report an improved quality of life after TKA, as they regain independence and experience less pain and disability.

  4. Long-Term Durability: Modern knee prostheses are designed for durability, with many patients experiencing relief from pain and improved mobility for several decades.

Procedures for Complete Knee Replacement:

  1. Preparation: Before surgery, the patient undergoes a comprehensive evaluation, including physical exams, imaging (X-rays, MRI), and blood tests. The surgeon discusses the procedure, potential risks, and benefits with the patient.

  2. Anesthesia: During the surgery, the patient is placed under either general anesthesia (unconscious) or regional anesthesia (epidural or spinal anesthesia) to numb the lower body while keeping the patient awake.

  3. Incision: The surgeon makes an incision over the knee, exposing the damaged joint.

  4. Joint Resurfacing: The damaged cartilage and bone surfaces of the knee joint are removed, preserving as much healthy bone as possible.

  5. Implant Placement: The artificial knee components, which include the femoral, tibial, and patellar components, are securely implanted into the prepared bone surfaces. These components may be fixed with or without cement, depending on the patient’s condition and the surgeon’s preference.

  6. Closure: The incision is closed with sutures or staples, and a sterile dressing is applied.

  7. Recovery and Rehabilitation: After surgery, patients typically stay in the hospital for a few days and then transition to physical therapy and rehabilitation to regain strength and mobility. Recovery times vary but may take several weeks to months.

  8. Follow-Up: Regular follow-up appointments with the surgeon are essential to monitor the healing process and ensure that the artificial knee joint is functioning correctly.

In conclusion, complete knee replacement is a well-established surgical procedure with a substantial body of scientific research backing its safety and efficacy. It provides significant benefits in terms of pain relief, improved mobility, and enhanced quality of life for individuals suffering from severe knee joint problems. Advances in materials, surgical techniques, and prosthesis design continue to improve outcomes, making knee replacement a viable option for many patients with knee-related conditions.

 
Discuss the science, research, benefits, and procedures for a partial Knee replacement
 
 
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Partial knee replacement, also known as unicompartmental knee arthroplasty (UKA), is a surgical procedure designed to address limited joint damage in a specific compartment of the knee, typically involving just one of the three knee compartments: the medial (inner), lateral (outer), or patellofemoral (between the kneecap and thigh bone) compartments. Here, we’ll explore the science, research, benefits, and procedures associated with partial knee replacement:

Science and Research:

  1. Knee Joint Anatomy: A thorough understanding of the knee’s anatomy and biomechanics is essential for successful partial knee replacement. Researchers continually study knee joint function to improve implant design and surgical techniques.

  2. Implant Materials: Advances in materials science have led to the development of artificial knee components made from materials like metals (e.g., titanium, cobalt-chromium), ceramics, and polyethylene. Research focuses on enhancing the durability and longevity of these materials.

  3. Patient Selection: Research helps identify the most suitable candidates for partial knee replacement. Patient selection is based on factors such as the extent of joint damage, the location of the damage, and the patient’s overall health.

Benefits of Partial Knee Replacement:

  1. Preservation of Healthy Tissue: The primary advantage of partial knee replacement is the preservation of healthy knee joint tissue. Only the damaged compartment is replaced, leaving the rest of the knee intact.

  2. Reduced Pain: Partial knee replacement provides pain relief in the affected compartment, allowing patients to regain mobility with less discomfort.

  3. Faster Recovery: Because it is a less extensive procedure than total knee replacement, partial knee replacement often results in a quicker recovery time.

  4. Enhanced Functionality: Patients who undergo a successful partial knee replacement typically experience improved joint function and range of motion.

Procedures for Partial Knee Replacement:

  1. Preparation: Before surgery, the patient undergoes a comprehensive evaluation, including physical exams, imaging (X-rays, MRI), and blood tests. The surgeon discusses the procedure, potential risks, and benefits with the patient.

  2. Anesthesia: During the surgery, the patient is placed under either general anesthesia (unconscious) or regional anesthesia (epidural or spinal anesthesia) to numb the lower body while keeping the patient awake.

  3. Incision: The surgeon makes a smaller incision than in total knee replacement, exposing the damaged compartment.

  4. Resurfacing and Implant Placement: The damaged cartilage and bone surfaces in the affected compartment are carefully removed, preserving healthy tissue. The artificial knee components, including the tibial and femoral components, are securely implanted into the prepared bone surfaces. These components may be fixed with or without cement, depending on the patient’s condition and the surgeon’s preference.

  5. Closure: The incision is closed with sutures or staples, and a sterile dressing is applied.

  6. Recovery and Rehabilitation: After surgery, patients typically stay in the hospital for a shorter duration compared to total knee replacement patients. They then transition to physical therapy and rehabilitation to regain strength and mobility. Recovery times vary but may be shorter than total knee replacement, often measured in weeks.

  7. Follow-Up: Regular follow-up appointments with the surgeon are essential to monitor the healing process and ensure that the artificial knee joint is functioning correctly.

In conclusion, partial knee replacement is a valuable option for individuals with limited knee joint damage. It offers benefits such as reduced pain, preservation of healthy tissue, and a potentially quicker recovery compared to total knee replacement. Advances in implant materials, surgical techniques, and patient selection have contributed to improved outcomes for patients undergoing partial knee replacement. However, patient selection and the decision to opt for partial or total knee replacement should be made in consultation with a healthcare provider, considering the specific condition and needs of the patient.

Discuss the science, research, benefits, and procedures, and compare total knee replacements and partial knee replacements, the recovery time for both, and the success rates of both
 
 
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Total knee replacement (TKR) and partial knee replacement (PKR) are surgical procedures used to address knee joint problems caused by conditions like osteoarthritis or traumatic injuries. While both procedures involve replacing damaged knee joint components with artificial implants, they are distinct in their approach. Here, we will discuss the science, research, benefits, procedures, recovery times, and success rates for both total and partial knee replacements, and provide a comparison of the two:

Science and Research:

  1. Knee Joint Anatomy and Biomechanics: Understanding the complex anatomy and biomechanics of the knee joint is fundamental for both TKR and PKR procedures. Scientific research continually informs improvements in implant design and surgical techniques.

  2. Implant Materials: Advances in materials science have led to the development of artificial knee components made from materials like metals (e.g., titanium, cobalt-chromium), ceramics, and polyethylene. The research aims to enhance implant durability and longevity.

  3. Patient Selection: Research helps identify appropriate candidates for TKR and PKR based on factors such as the extent and location of joint damage, the patient’s overall health, and joint stability.

Benefits:

Total Knee Replacement (TKR):

  1. Comprehensive Pain Relief: TKR provides extensive pain relief as it replaces all three compartments of the knee joint.
  2. Improved Functionality: TKR restores full joint function and mobility.
  3. Long-Term Durability: Modern TKR prostheses are designed for long-term durability, with many lasting for decades.

Partial Knee Replacement (PKR):

  1. Preservation of Healthy Tissue: PKR preserves healthy tissue in the unaffected compartments of the knee joint.
  2. Reduced Pain: PKR provides pain relief in the affected compartment, allowing patients to regain mobility with less discomfort.
  3. Quicker Recovery: Due to its less extensive nature, PKR often results in a faster recovery time.

Procedures:

Total Knee Replacement (TKR):

  • TKR involves removing all damaged knee joint components (femoral, tibial, and patellar) and replacing them with artificial prostheses. This typically requires a longer incision and a more extensive surgical approach.

Partial Knee Replacement (PKR):

  • PKR involves replacing only the damaged compartment of the knee joint while preserving healthy tissue in the unaffected compartments. This procedure requires a smaller incision.

Recovery Times:

Total Knee Replacement (TKR):

  • Recovery time for TKR varies, but patients may need several weeks to months of rehabilitation to regain full mobility.
  • Full recovery may take around 3-6 months, depending on individual factors and the extent of rehabilitation.

Partial Knee Replacement (PKR):

  • PKR generally involves a shorter recovery period compared to TKR.
  • Patients may regain mobility more quickly, often within a few weeks.

Success Rates:

  • The success rates of both TKR and PKR are generally high, with the majority of patients experiencing significant pain relief and improved function.

Total Knee Replacement (TKR):

  • TKR is often considered an advanced knee joint disease involving multiple compartments. Success rates are typically excellent, and many patients experience long-term relief.

Partial Knee Replacement (PKR):

  • The success rates of PKR are generally good, especially for individuals with isolated compartmental knee damage.
  • However, the outcomes may vary depending on the patient’s condition and the specific reason for the procedure.

Comparison:

  • TKR provides comprehensive pain relief and improved functionality for individuals with widespread knee joint disease.
  • PKR preserves healthy tissue, offers pain relief in the affected compartment, and generally has a quicker recovery time, making it suitable for select patients with isolated knee damage.

In conclusion, the choice between TKR and PKR depends on the extent and location of knee joint damage, among other factors. Both procedures have high success rates and provide substantial benefits for patients. Advances in implant materials, surgical techniques, and patient selection have contributed to improved outcomes. Patients should consult with their healthcare provider to determine the most appropriate treatment option for their specific knee condition and needs. Success rates are generally good for both TKR and PKR, and patients often experience significant improvements in pain relief and joint function.

Discuss Physical Therapy for knee replacements and the exercises, length of time, and recovery
 
 
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Physical therapy plays a crucial role in the rehabilitation and recovery process after knee replacement surgery, whether it’s a total knee replacement (TKR) or a partial knee replacement (PKR). Physical therapy helps improve strength, flexibility, and mobility of the knee joint, reduces pain and swelling, and enhances overall function. Here, we’ll discuss physical therapy for knee replacements, including the exercises, duration, and recovery timeline:

Physical Therapy Exercises for Knee Replacements:

  1. Range of Motion (ROM) Exercises: These exercises aim to restore the normal range of motion of the knee joint. They include ankle pumps, heel slides, and passive and active knee flexion and extension exercises.

  2. Strengthening Exercises: Strengthening exercises target the muscles around the knee joint, including the quadriceps, hamstrings, calf muscles, and hip muscles. Examples include leg lifts, heel raises, wall squats, and leg presses.

  3. Balance and Proprioception Training: Balance exercises help improve stability and coordination. These exercises can include standing on one leg, balance board exercises, and heel-to-toe walking.

  4. Gait Training: Learning to walk properly and regain a natural gait pattern is a crucial part of recovery. Your physical therapist will work with you to ensure you are walking safely with your new knee joint.

  5. Functional Activities: As you progress, your therapist will incorporate functional activities like stair climbing, sitting down standing up from a chair, and getting in and out of a car.

  6. Pain and Swelling Management: Techniques such as ice application and soft tissue mobilization may be used to manage pain and reduce swelling.

Duration of Physical Therapy:

The duration of physical therapy after knee replacement surgery can vary depending on several factors, including the type of surgery (TKR or PKR), the patient’s overall health, the extent of joint damage, and individual progress. Generally, here is what you can expect:

  1. Inpatient Rehabilitation: Many patients start physical therapy while still in the hospital immediately after surgery. This initial phase often focuses on pain management, gentle range of motion exercises, and standing or taking a few steps with assistance.

  2. Outpatient Rehabilitation: Most patients continue physical therapy as an outpatient, attending sessions several times a week for a few weeks to a few months. The duration depends on individual progress.

  3. Home Exercises: Your physical therapist will also prescribe exercises for you to do at home. Consistency with home exercises is essential for a successful recovery.

  4. Long-Term Maintenance: Even after formal physical therapy ends, some patients may benefit from ongoing exercises and maintenance to ensure the knee remains strong and functional.

Recovery Timeline:

Recovery after knee replacement surgery is gradual and varies from person to person. However, here is a general timeline:

  • 0-2 Weeks: Focus on pain management, gentle range of motion exercises, and starting to walk with assistance. Swelling and bruising are common during this period.

  • 2-6 Weeks: Continue to improve knee range of motion and strength. Begin to walk without assistance or with minimal aids like a cane. Pain and swelling usually decrease.

  • 6-12 Weeks: Work on further improving strength, balance, and endurance. Continue to practice functional activities and work toward normal walking and stair climbing. Most patients return to driving around this time.

  • 3-6 Months: By this point, many patients experience significant improvement in function and mobility. Activities like cycling and swimming may be added to the exercise routine.

  • 6 Months and Beyond Continue with exercises and activities to maintain knee function. Many patients experience continued improvement in the first year, and the knee continues to adapt.

It’s essential to follow your physical therapist’s recommendations and maintain a consistent exercise routine both during and after formal physical therapy to achieve the best outcomes. Patience and dedication to the rehabilitation process are key to a successful recovery after knee replacement surgery. Always consult with your healthcare provider and physical therapist for guidance tailored to your specific condition and progress.

Six Exercises to Keep Knee Pain in Check

An NBA strength coach advises players to manage aching knees and avoid tendinitis with this workout

 

Knee pain is a fact of life. It affects about 25% of adults, according to the American Academy of Family Physicians. It can deter us from participating in activities like skiing, tennis and basketball, and affect basic tasks like walking up and down steps.

As strength and conditioning coach for the National Basketball Association’s Washington Wizards, Kyle Moschkin constantly helps players manage knee pain.

Basketball players’ knees take a beating from the sport’s fast, multidirectional movements and the impact of landing jumps, Mr. Moschkin says. The repetitive nature of the sport leads many players to develop patellar tendinitis. Also known as jumper’s knee, this overuse injury is characterized by an inflammation of the patellar tendon, which connects your kneecap to your shin bone. 

To help treat and prevent tendinitis, Mr. Moschkin has athletes perform exercises that build resilience in the tendons and muscles around the knee joints. When the muscles around the knees are strong, they can alleviate stress on the joint. With players who have tight ankles and hips, like Wizards forward Anthony Gill, he also prescribes drills that work on mobility.

Here are six exercises for healthier knees:

Banded Ankle Dorsiflexion Pulses

Why: If you have stiff ankles, absorbing a landing can be jarring on the knee. When you have good ankle mobility, you can more efficiently absorb the impact of landing and thus alleviate the stress on the knee, Mr. Moschkin says. He suggests using this drill as part of a warm-up.
How: Loop one end of a resistance band around the right foot just below the ankle joint. Place the front foot on a slightly elevated surface like a pad. Drop into a low lunge, with the other end of the band anchored beneath your left foot. Keep the right heel planted as the knee pushes over the toes on each pulse. Perform two sets of 15 to 20 pulses. 

 

Kyle Moschkin holds a resistance band as Anthony Gill performs banded ankle dorsiflexion pulses.

Soleus Heel Raises

Why: The soleus is the deeper of the two calf muscles and is primarily activated when the knee is bent. It plays an important role in plantar flexion, the movement that occurs at the ankle when we point the foot downward. It also helps stabilize the knee.
How: 
Sit on a chair’s edge so the knees are bent at 90 degrees and feet are flat on the ground. Use a dumbbell or your hands to put pressure just above the right knee and slowly raise the heel against the resistance, then lower back down. Perform two to three sets of 10 to 15 reps per leg.
Options: If you work out at a gym, Mr. Moschkin suggests performing this on a seated heel-raise machine. It can also be done with your heels hanging off a raised surface, like a pad, in front of a Smith machine—a rack with a barbell attached to a sliding track. Hold the rack, sit your hips back and perform heel raises. 

Mr. Moschkin performs a variation of soleus heel raises.

90/90 Hip CARs (Controlled Articular Rotations)

Why: Hip mobility allows the athlete to access the muscles on the back side of the body for explosive actions, reducing the jarring load on the knees, Mr. Moschkin says. This drill, sometimes called shin box rotations, takes the hip through the full range of external to internal rotation.
How: Start seated in a 90/90 position: Your right leg will be in front of you, creating a 90-degree angle at your knee and hip joints so that your shin is perpendicular to your body, or as close to your thigh as is comfortable. Now, bend your left leg behind you, making 90-degree angles at the knee and hip joints, and keeping your leg as flat on the ground as possible. To transition to this position, keep feet planted and torso tall while the knees come off the ground and hips rotate the other way. Take a deep inhale and exhale before switching directions. You can extend your arms in front of you to help with balance. Perform five to eight reps per side.

Mr. Gill demonstrates the 90/90 Hip CARS drill.

Staggered-Stance Romanian Dead Lift

Why: This exercise for the glutes and hamstrings allows for minimal knee flexion, so you can increase load without irritating the knee. Focusing on one leg minimizes the chance of compensating with the stronger leg when you are recovering from an injury.
How: Start in a staggered stance, feet hip-width apart, with the front foot flat and trail leg slightly back, planted on the ball of that foot. You can hold weights in both hands or the hand of the front foot. Bend at the hips as you lower the weight or weights with straight arms until your torso is almost parallel to the floor. Maintain a flat back throughout the movement to engage the glutes and hamstrings, keeping the feet stationary, with minimal knee flexion. Return to standing. Perform six to 12 reps.

Mr. Moschkin performs staggered stance Romanian dead lifts.

Spanish Squat Iso

Why: Going right into a dynamic exercise that involves movement, like a squat, may irritate injuries, Mr. Moschkin says. Isometric exercises, where you hold a position rather than moving through a range of motion, will set the stage for pain-free movement later in the workout, he says. This exercise works the quads.
How: Anchor a resistance band (or bed sheet or bathrobe belt) to a sturdy post at about knee height. Face the anchor, step inside the band and place it just below the back of the knees. Take a step back until you feel tension on the band. Sink your hips back into a squat. Lean into the band and hold the bottom position. The knees should be at about 90 degrees and torso as vertical as possible. Hold for 45 seconds. Return to standing. Repeat four to five times. 
Option: When body weight feels easy, hold dumbbells or a kettlebell. 

Mr. Moschkin, performing a Spanish squat iso, suggests holding for 45 seconds at the bottom.

Reverse Sled Drag

Why: After performing the Spanish squat iso, the body is prepped to perform this isotonic exercise, which requires the muscles to resist weight throughout a range of motion. This is a great quad-development exercise in general, but can be particularly helpful for working through physical therapy, since you can do it at high volume without creating the same muscle soreness that a weighted lower-body lift might.
How: Attach a harness or belt around the waist, with the other end anchored to a sled about 3 to 5 feet away weighted to about 25% of your body weight. Lean back against the harness and walk backward with the weight, concentrating on smooth toe-to-heel transitions and full knee extension on each push-off. The torso should stay vertical. Progress to two times your body weight as strength increases. Perform five to 10 sets of reps ranging from 50 to 300 feet, or 30 seconds to two minutes.
Option: If you don’t have a sled, you can use resistance bands anchored to a weight or walk backward on a treadmill at a low incline and low speed, holding the rails for balance, if needed.

Mr. Gill pulls a weighted sled in reverse.

 

more info at:

https://en.wikipedia.org/wiki/Knee_replacement

 


 

*Disclaimer: This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. The information provided is for educational purposes only and is not intended as a diagnosis, treatment, or prescription of any kind. The decision to use, or not to use, any information is the sole responsibility of the reader. These statements are not expressions of legal opinion relative to the scope of practice, medical diagnosis, or medical advice, nor do they represent an endorsement of any product, company, or specific massage therapy technique, modality, or approach. All trademarks, registered trademarks, brand names, registered brand names, logos, and company logos referenced in this post are the property of their owners.