Occupational Therapy and Total Knee Replacements

Introduction to Occupational Therapy

Occupational therapy is a crucial part of the recovery journey for patients undergoing knee replacement surgery. This specialized form of therapy is designed to help individuals overcome physical, emotional, or cognitive limitations so they can participate fully in everyday activities. Occupational therapists work closely with patients to assess their unique strengths and challenges, set meaningful goals, and create personalized plans that support their ability to perform daily tasks. After knee replacement, occupational therapy focuses on managing pain, restoring function, and empowering patients to regain independence in their daily lives. By addressing the specific limitations caused by surgery and knee pain, occupational therapists make a significant difference in helping patients return to the activities that matter most to them.

Understanding Knee Replacement Surgery

Knee replacement surgery, also known as total knee arthroplasty, is a procedure in which a damaged or diseased knee joint is replaced with an artificial implant. The primary goal of knee replacement is to relieve pain, restore mobility, and improve the patient’s overall quality of life. There are several types of knee replacement surgeries, including total knee replacement, partial knee replacement, and kneecap replacement, each tailored to the patient’s specific needs and the extent of joint damage. By replacing the affected knee with a new joint, patients can look forward to reduced pain and a greater ability to participate in daily activities, making a positive impact on their life after surgery.

Pre-Operative Assessment and Planning

Before knee replacement surgery, patients undergo a thorough pre-operative assessment and planning process to ensure the best possible outcome. Occupational therapists play a vital role during this stage by evaluating the patient’s current abilities, identifying potential challenges, and setting realistic goals for recovery. This process includes discussing the use of adaptive equipment such as walkers, canes, and leg lifters, and educating patients about the recovery process and the importance of protecting their new knee. By preparing patients for what to expect after surgery and helping them plan for any necessary modifications at home, occupational therapists help set the stage for a smoother recovery and a successful return to daily life.

Evaluation

In some facilities, the occupational therapy evaluation may be performed by the therapist on the day of surgery, known as post-op day zero, or the day after surgery.

Since the patient still may be groggy from anesthesia or medication, especially if general anesthesia was used, it’s important to review the patient’s chart and communicate with nursing before starting the evaluation. Be sure to monitor vitals during this session and take extra time before position changes to avoid orthostatic hypotension (the client’s safety is always the first priority; if vitals are unstable, the evaluation can be delayed!).

After a knee replacement, patients will likely be able to bear full weight or as much weight as they can tolerate on their new knee, and there are typically not any formal precautions (although this may depend on facility-specific protocols and physician recommendations). A patient may have a knee brace or bulky dressing - ensure you are having the patient apply the brace per the physician’s order.

The amount of activity that the patient completes during an evaluation depends on their pain levels and activity tolerance at this time. They may get as far as the side of the bed, or they may be able to walk to the bathroom.

At the end of the evaluation, check vitals again and discuss the plan of care with the patient for the rest of their stay. The evaluation should be completed by the therapist, and all necessary documentation must be completed before proceeding. During an evaluation, try to obtain the patient’s home set-up by assessing the home environment for safety and equipment needs. This way, you will be able to determine if any adaptive equipment/durable medical equipment will be needed before the patient is discharged home.

During the first week after surgery, the therapist will monitor the patient's progress and coping skills.

Pain

All patients experience pain differently. While some patients may experience no pain, others may experience extensive pain on the day of surgery, depending on medications. Be sure to educate patients to stay on top of their pain medication schedules, and modify their therapy schedule if needed. Occupational therapy can also help patients manage pain by teaching coping strategies and activity modification, which can lead to greater independence and reduced discomfort. Always remind your patient to keep ice on their knee between therapy sessions to help reduce the overall pain and swelling, reducing pain to improve participation in therapy and daily activities.

Activities of Daily Living

The important thing to address when treating a client after any joint replacement surgery is their ability to safely and effectively perform ADL/IADL tasks, with a focus on performing daily self-care activities upon discharge. While this section focuses on knees, similar principles apply to other joints. The road to recovery is different for everyone, and clients may need to use compensatory strategies during ADLs depending on the range of motion of their knee.

Is the client able to bend at their waist to don and doff pants, socks, and shoes, or will they need to use a compensatory strategy such as resting their thigh on the bed during lower body dressing? Being able to get dressed independently after surgery is a key goal, and occupational therapy addresses this by teaching safe techniques and recommending assistive devices.

Maybe they will need equipment such as a reacher or a sock-aid to complete the task independently. In the rare event that the client is discharged home with a catheter, you will need to provide education on threading the catheter through the pant leg first.

Also, if the patient is discharged with a knee immobilizer and ROM restrictions, dressing using adaptive equipment while long sitting in bed may be the safest option.

Compression stockings are another challenge. If a client is having difficulty donning regular socks, having a family member assist with compression stockings is best (if possible). If a family member is not available, the client can use a rigid sock-aid to start the stockings over their toes. Another method is turning the stocking halfway inside out, stretching it as much as possible, then starting it over the toes.

Functional Transfers

Another key piece of occupational therapy treatment is the performance of safe functional transfers. Is the client able to sit down and stand up from the commode without assistance? A toilet riser may be needed upon discharge for the patient’s commode at home. Will the client be able to raise their leg to step into the bathtub or over the threshold of the shower?

Be sure to check with the doctor about advising patients when to shower, as this process can change depending on the type of wound dressing they have. For safety, a shower seat, transfer tub/bench, and/or grab bar may be recommended.

Transfer tub benches are helpful if the patient has a tub shower (as long as there is enough space in the client’s bathroom and the shower has curtains, not doors). With a tub bench, the client can easily back up to the seat, then lift their legs into the tub while seated, rather than standing. If your patient is interested in this option, be sure to know where to recommend locations where this equipment can be obtained/purchased. To prepare for this home set-up, have the client practice getting in and out of bed on the side they normally would at home, with the head of the bed flat and bedrails down.

If a client is having difficulty with bed mobility, a leg lifter or bed cane may be recommended. Be sure to teach the client the correct use of the leg lifter and emphasize maintaining proper alignment of the leg.

Car transfers can be simulated by using a transfer tub bench if one is available in your facility. Trash can be turned on its side is one idea that can be used to simulate the car door threshold.

Improving Mobility and Strength

Regaining mobility and building strength are essential steps in the recovery process following knee replacement surgery. Occupational therapists design individualized exercise programs that target range of motion, flexibility, and muscle strength, all tailored to each patient’s needs and goals. These programs often include mobility training, such as walking, navigating stairs, and practicing safe bed mobility, as well as strengthening exercises for the operated leg and surrounding muscles. Occupational therapists also teach patients how to use assistive devices like walkers and canes to support safe movement and reduce the risk of falls. By focusing on these areas, occupational therapy helps patients regain independence, improve their quality of life, and confidently return to their everyday routines.

Discharge Planning

Luckily, acute care stays following knee replacements typically only last 1-2 days, so discharge planning can start during the initial evaluation. If possible, have the client’s family or caregiver present during therapy sessions, so they are aware of how much assistance the patient will need upon discharge, and be able to assess and adapt the home environment for safety and independence, making the necessary home modifications for a seamless transition.

If a client is having difficulty using the stairs in physical therapy, discussing a temporary first-floor set-up with the client and family may be necessary. In this case, you may need to recommend a bedside commode, and the patient’s willingness to sponge-bathe if a bathtub is not available on the first floor. You will also have to discuss walker safety with the client (e.g. not carrying items while pushing a walker). Walker bags or trays can help with this.

There are cases where clients will be returning home alone and will have little to no assistance available. Occasionally, these clients may opt to go to a skilled nursing facility for a few days to receive additional therapy before returning home. If they are returning home alone, you may need to address light meal prep and housekeeping strategies. These are all things to be discussed throughout the client’s stay.

Many patients achieve significant progress within the first two weeks after surgery, making this an important milestone for recovery and planning further care.

“Interdisciplinary communication is key; social workers and case managers are very good about managing the client’s insurance information and communicating the discharge plans with the client’s family.”

Outpatient Therapy and Rehabilitation

After the initial hospital stay, outpatient therapy and rehabilitation become key components of the recovery process for knee replacement patients. Occupational therapists continue to work with patients in outpatient settings to further enhance mobility, strength, and functional abilities. Outpatient therapy may involve ongoing mobility training, strength-building exercises, and instruction in the use of adaptive equipment to support daily living. Occupational therapists also provide education on managing pain, preventing complications such as blood clots, and adapting daily activities to promote safety and independence. By addressing ongoing challenges and supporting patients through each stage of rehabilitation, occupational therapy plays a vital role in helping individuals achieve lasting recovery and a higher quality of life after knee replacement surgery.