Complete Knee Replacement

After any major surgery such as complete knee replacement (total knee arthroplasty), one of the patient’s prime concerns is regaining function and mobility. Exercise has been found to be beneficial for wound healing and also for more complete and quicker recovery of mobility and function. Exercise achieves these outcomes through several different methods. Some recent studies, written up in medical journals, provide pointers for anyone wishing to have a positive effect on their own rehabilitation after surgery.

One of the immediate results of almost all major surgery is reduced function and mobility. Reduced function and mobility immediately raises the stress level of the patient who is now confined an unable to provide complete care for themselves. This has the direct effect of increasing stress.

It has been demonstrated in numerous studies that stress slows the healing process. In Neuroimmunomodulation, Vol 13, 2006, Glaser and Christian write that “…stress can significantly slow wound healing: stressors … impair healing in humans and animals. For example, in humans…the relatively brief stress of academic examinations impedes healing.” They go on further to state “Recent evidence suggests that interventions designed to reduce stress and its concomitants (e.g., exercise, social support) can prevent stress-induced impairments in healing.”

A 2005 report in the Journals of Gerontology describe a study on exercise and healing among older adults that was completed with some surprising findings. The study followed the results of 28 adults, with an average age of 61, who had not exercised in the previous 6 months. Half the group was started on a program of 75 minutes of exercise activity for three times a week. The other half did nothing other than their normal routine. After four weeks of exercise, all the adults received small puncture wounds on their upper arms and were then monitored for rate of healing. They also performed stress tests twice, at the beginning and at the end of the study. Their cortisol levels were measured before and after each stress test.

When they did the stress test before the study, the researchers found that neither group showed any increase in cortisol levels after the stress test. Exercise normally increases cortisol levels. The ability to produce cortisol diminishes with age. This is significant because cortisol increases the efficiency of immune system function. This is a factor in the commonly observed increased time for wounds to heal in older adults.

The results of the study were that the exercisers healed faster, typically within 29 days instead of 39 days for the non-exercisers. The researchers expected this. They reasoned that exercise increases circulation, and that fact alone would improve the flow of nutrients to the wound site and the flow of wastes away from it. What surprised the researchers was that when they administered stress tests at the end of the study, the exercisers showed increased cortisol levels typical of younger adults. This increase in cortisol levels was a second mechanism that promoted improved healing.

Exercise also plays a role beyond improvement in healing rates. Patients that undergo total knee arthroplasty or hip replacements will be dependent on walkers and canes for mobility during the early stages of their recovery. It is not uncommon for the increased exercise load on the upper body to lead to soreness, pain, and decreased energy levels in those unaccustomed to doing this type of activity.

In the 2007, May issue of Journal of Strength and Conditioning Research an article reported on the results of a case study involving two TKA patients. One underwent 4 weeks of pre-habilitation exercises. (Pre-habilitation is physical therapy delivered before any surgical intervention). There were significant differences in both function and self-reported pain perception in the exercising case than in the non-exercising case.

This supports the findings of a study reported in the February 2002 issue of Applied Nursing Research that compared preoperative exercise, anesthesia, or analgesia on the ability to walk after surgery. It was found that anesthesia, or analgesia had no effect. Subjects who exercised before surgery were able to walk significantly greater distances afterwards.

What does all this mean for people looking forward to surgery, whether total knee replacement or some other major intervention? It’s simple. Exercise can help you in four ways.

1. It will actually help speed healing of the wound site through improved circulation and the attendant improved flow of nutrients to your wound.

2. It will help stimulate the proper regulation of cortisol levels in your body, which will improve your immune system function.

3. It will help strengthen your body, leading to improved mobility, especially if you must use an assistive device such as a walker or can after your operation.

4. And finally improved mobility will mean less stress on the recovering patient. In addition, exercise is a proven stress reducer in its own right. By reducing stress, you remove the ability of stress to slow healing.

The studies seem to be quite clear. If you know you are going to go for surgery, start exercising, even if it is a limited program. Any exercise, done regularly, is better than no exercise. And remember, discuss your exercise program with your doctor.


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