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I have developed a new rehab approach for total knee replacements that allows patients to avoid the traditional, aggressive therapy regimen that has been in place for decades. I call this approach the Therapy-Free Total Knee Replacement. Since implementing the therapy-free recovery plan for total knee replacements, I have seen great improvements in the recovery process.
I have over 17 years of experience in total knee replacements and I’m currently the top joint replacement specialist in New York State. Over the course of my career, I have performed over 10,000 joint replacements. I constantly seek to improve outcomes for patients, both in the immediate recovery period and long-term. My experience in total knee replacement, combined with my drive to improve surgical outcomes, lead to the development of the Therapy-Free Total Knee Replacement.
What Is a “Therapy-Free” Total Knee Replacement?
I developed the Therapy-Free Total Knee Replacement technique in 2015. This technique specifically addresses the traditional, aggressive postoperative therapy that most patients have to participate in following total knee replacement. The procedure itself is the same as a typical total knee replacement, but the rehabilitation process is much less aggressive.
I practice in Utica, a city in New York. In discussing postoperative therapy with patients, I found that some patients lived far away from formal physical therapy services, which placed a significant burden on them to progress in their recovery. These patients asked me for a simple exercise program that they could do at home, rather than having to travel long distances to physical therapy facilities. I created an at-home exercise program for these patients and continued to monitor their results in follow-up appointments over the years.
After working with several patients with this “therapy-free” method, I found that these patients consistently had better range of motion, less pain, and a quicker recovery than patients who participated in intensive therapy programs at formal rehab centers. The therapy-free patients were much happier with their recovery process, and they saved an average of $720 in copays to physical therapy facilities as an added benefit.
I now use this method for all total knee replacements because the outcomes have been so positive. I have also presented his data on the Therapy-Free method at the World Arthroplasty Conference in Rome, Italy, Orthopedics Today in Hawaii, and the first annual Arthroplasty Conference in Hyderabad, India.
What Are the Benefits of a Therapy-Free Total Knee Replacement?
Therapy-Free total knee replacements offer many benefits to patients, including the following:
- Easier recovery – Many patients report that the total knee replacement procedure is not bad, but the rehab process is awfully difficult and painful. The Therapy-Free method improves this process.
- Cost savings – Patients using the Therapy-Free method save an average of $720 in copayments to physical therapy facilities.
- Time savings – Formal physical therapy typically takes about 90 minutes per session. With the Therapy-Free method, patients do 4 simple exercises once an hour. The exercises take less than 8 minutes to complete, and they can be done at home or wherever the patient happens to be during the day.
- Less pain and reduced narcotic use – 35% of patients use no narcotics after surgery, and 75% use less than 5 narcotic pain pills after surgery.
- Quicker improvement in range of motion – As of 2018 the American Academy of Orthopedic Surgeons suggests that it takes the average patient 10-12 weeks in rehab to achieve a range of motion of 0-110 degrees. Patients following the Therapy-Free protocol can achieve this milestone WITHOUT therapy by the 3-week mark. That is 7 to 9 weeks sooner than the traditional method.
On average, 85% of patients need no home health aide, no post-op physical therapy, and no skilled nurses when using the Therapy-Free method. Even if a patient does need professional assistance, the Therapy-Free protocol can still be used. For example, if a patient is very anxious, is in the early stages of dementia, is mentally challenged, or has poor coping skills, I may recommend working with a physical therapist to reinforce Therapy-Free protocols.
Post-Op Recovery Timeline with Therapy-Free Protocols
- Day 1 is usually not very painful. BE CAREFUL! This is where many patients often try to do too much and this results in terrible pain and swelling.
- Patients often say the leg feels like a “telephone pole”–heavy, stiff, and swollen.
- It is critical to ice and elevate the leg (toes above the nose for total knee replacements) for 40 minutes to an hour while awake.
- Begin the simple exercises protocol on Day 1, starting with 8 minutes of your 4 exercises hourly while awake.
- The leg still feels very heavy and stiff, and has significant bruising that drifts down toward the toes.
- These are typically the toughest days in the post-op period. Some patients may need a few narcotic pain pills during this period.
- It is normal to have a good day or a good morning, followed by a more difficult day or evening.
- Continue with ice and elevation and simple exercises hourly while awake.
- Pain is typically 20-30% better at this point—an improvement but still fairly difficult.
- It is normal for the knee to be stiff in the morning, and achy at night. It can take up to 12 weeks for sleeping patterns to normalize.
- Patients often report that it feels like there is a tight rubber band around the knee. This is normal, and non-narcotic medications may help.
- Many patients also have significant sensitivity around the incision. This should get better with time.
- Continue with ice, elevation, non-narcotic pain medications, and your hourly 4 exercises.
- Avoid strenuous activities like aggressive strengthening, lunges, etc.
- By this point, you should be able to straighten the leg fully and bend your knee about 100 degrees—a little more than a right angle.
- Swelling may still be present, but should be going down.
- Many patients are able to start leaving the house for short trips, but should return home or rest if the knee starts to swell. Upon returning home, ice and elevate the knee.
- Patients should still continue with hourly exercises.
- Some patients are able to return to light-duty work during this time frame
3 Weeks After Surgery
- By this point, most patients who follow Therapy-Free protocols have achieved a range or motion from 0-120 degrees.
- Though you have achieved a great improvement in range of motion, keep up with your simple exercises at least 3-4 times per day for another 6 weeks. You will continue to see improvement over time.
6 Weeks After Surgery
- By this point, most patients are able to resume normal activities. However, don’t push yourself too hard. If an activity is painful, stop! It will all come back in time–you just have to be patient.
- Your knee strength will improve over time, so don’t jump into heavy strength training all at once. If you want to work on strengthening, start with an exercise bike with light resistance 3 times a week.
Most importantly, remember that every patient is different! Stick to the plan, be patient, and you will achieve great results.
Therapy-Free Total Knee Replacement in Upstate New York
With over 17 years of experience in total joint replacement, Dr. Wickline is always seeking to improve outcomes for his patients. His Therapy-Free Total Knee Replacement protocols have yielded excellent results for patients, including easier recovery, cost savings, and reduced narcotic use. If you would like to learn more about Therapy-Free Total Knee Replacement, or would like to schedule a consultation with Dr. Wickline, please call our office at (315) 738-5069. You can also request an appointment via our convenient online form.
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