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{"id":253,"date":"2018-06-29T06:10:56","date_gmt":"2018-06-29T06:10:56","guid":{"rendered":"https:\/\/www.dr-antoinecombes.com\/?page_id=253"},"modified":"2018-07-02T21:18:31","modified_gmt":"2018-07-02T21:18:31","slug":"reeducation-apres-une-prothese-totale-de-genou","status":"publish","type":"page","link":"https:\/\/www.dr-antoinecombes.com\/reeducation\/reeducation-apres-une-prothese-totale-de-genou\/","title":{"rendered":"R\u00e9\u00e9ducation apr\u00e8s une Proth\u00e8se Totale de Genou"},"content":{"rendered":"
\n\t<\/h1>\n
\t\t\t\t<\/p>\n
Voici les recommandations habituelles pour votre r\u00e9\u00e9ducation.<\/p>\n
Elles peuvent changer en fonction de la chirurgie r\u00e9alis\u00e9e, et doivent \u00eatre confirm\u00e9es par le chirurgien. <\/p>\n
Votre kin\u00e9sith\u00e9rapeute saura vous guider, mais il est important que vous consacriez du temps \u00e0 votre r\u00e9\u00e9ducation entre vos s\u00e9ances avec lui, afin d\u2019optimiser le r\u00e9sultat de la chirurgie.<\/p>\n
\t\t\t\t<\/p>\n
\n\t\tPrincipe g\u00e9n\u00e9ral \n\t<\/h2>\n
L\u2019objectif imm\u00e9diat est le m\u00eame que l\u2019objectif final\u00a0: souplesse et mobilisation douce du genou, puis r\u00e9-autonomisation \u00e0 la marche.<\/p>\n
Le facteur limitant initial est la douleur qui est souvent importante au 2\u00e8me jour post-op\u00e9ratoire, ainsi que le gonflement de votre genou, qui peut persister plusieurs semaines.<\/p>\n
Habituellement, Il n\u2019y a pas de contre-indication particuli\u00e8re, Il convient simplement de ne pas faire d\u2019effort trop important qui risquerait d\u2019augmenter votre douleur. Il est cependant important de r\u00e9cup\u00e9rer le plus rapidement possible les mobilit\u00e9s du genou.<\/p>\n
\n\t\tMOBILISATION DU GENOU ET AMPLITUDE ARTICULAIRE \n\t<\/h2>\n
C\u2019est l\u2019\u00e9l\u00e9ment cl\u00e9 de la r\u00e9\u00e9ducation. <\/p>\n
Souvent un peu douloureux, ce n\u2019est pas\u00a0 le signe d\u2019une complication mais d\u2019un bon travail r\u00e9ductionnel. Elle se fait en passif (pas de contraction musculaire autour du genou) ou en actif (contraction volontaire). Le travail passif n\u00e9cessite un rel\u00e2chement musculaire complet.<\/p>\n
\n\t\tL\u2019EXTENSION \n\t<\/h2>\n
Au lit<\/strong><\/p>\n
Passif\u00a0: laissez l\u2019arri\u00e8re du genou toucher le plan du lit. Le gros orteil regarde vers le ciel. Attention \u00e0 la position genou fl\u00e9chi sur le cot\u00e9 qui permet au genou de toucher le plan du lit sans travailler l\u2019extension. <\/p>\n
Actif\u00a0: contraction flash pour \u00e9craser votre main sous votre genou.<\/p>\n
Sur une chaise\u00a0: <\/strong><\/p>\n
Posez votre pied sur un tabouret ou une autre chaise.<\/p>\n
Debout :<\/strong><\/p>\n
Attention ! Mettre un coussin sous votre genou permet souvent de soulager, mais cela a tendance \u00e0 nuire \u00e0 la r\u00e9cup\u00e9ration des amplitudes articulaires. Mettez-le plut\u00f4t pour vous soulager apr\u00e8s une s\u00e9ance soutenue.<\/p>\n
\n\t\tLA FLEXION \n\t<\/h2>\n
Au bord du lit,<\/strong> assis de mani\u00e8re sym\u00e9trique, laissez tomber votre jambe \u00e0 la verticale, le pied restant libre.<\/p>\n
Au d\u00e9but, aidez-vous de la jambe non op\u00e9r\u00e9e, qui vient se glisser sous la jambe op\u00e9r\u00e9e afin de contr\u00f4ler la vitesse de flexion et ainsi diminuer la douleur.<\/p>\n
Sur une chaise<\/strong>, les fesses bien pos\u00e9es, la jambe non op\u00e9r\u00e9e poussera sur la jambe op\u00e9r\u00e9e afin d\u2019augmenter la flexion.<\/p>\n
Sur un lit <\/strong>, une tierce personne pourra mobiliser doucement votre genou en flexion.<\/p>\n
\n\t\tLE RODAGE ARTICULAIRE \n\t<\/h2>\n
Sur une chaise,<\/strong> \u00e0\u00a0l\u2019aide d\u2019une planche \u00e0 roulette, faites des mouvements de va et vient.<\/p>\n
Sur un v\u00e9lo d\u2019appartement,<\/strong>\u00a0les premiers jours avec une selle haute, moulinez sans r\u00e9sistance. Puis abaissez progressivement la selle , la r\u00e9sistance peut \u00eatre augment\u00e9e apr\u00e8s 6 semaines.<\/p>\n
A la marche,<\/strong> levez les genoux vers le haut.<\/p>\n
\n\t\tLA MARCHE \n\t<\/h2>\n
La marche est autoris\u00e9e imm\u00e9diatement, le jour de l\u2019intervention, sauf avis contraire du chirurgien, avec un appui complet et \u00e0 l\u2019aide de cannes.<\/p>\n
Il faut se lever progressivement, d\u2019abord en vous asseyant au bord du lit pendant quelques minutes, surtout le premier jour (vous \u00eates rest\u00e9 allong\u00e9 parfois 12 heures de suite, la t\u00eate peut tourner).<\/p>\n
Commencez par avancer vos b\u00e9quilles vers l\u2019avant, en appui principal sur la jambe non op\u00e9r\u00e9e, puis contractez, verrouillez vos avant bras et appuyez doucement sur la jambe op\u00e9r\u00e9e et avancez celle non-op\u00e9r\u00e9e.<\/p>\n
La marche se fait progressivement selon votre ressenti.<\/p>\n
Les 15 premiers jours il s\u2019agit de marcher dans sa maison, prendre les escaliers marche apr\u00e8s marche, avec les cannes.<\/p>\n
Les cannes sont retir\u00e9es entre 4 et 6 semaines, en fonction de votre ressenti.<\/p>\n
\n\t\tLES ESCALIERS \n\t<\/h2>\n
Retrouver une marche fluide dans les escaliers est souvent long, les douleurs ant\u00e9rieures li\u00e9s \u00e0 l\u2019espace entre la rotule et le f\u00e9mur, sont souvent exacerb\u00e9es notamment \u00e0 la descente. <\/p>\n
Le travail des mobilit\u00e9s et le renforcement musculaire permettront d\u2019am\u00e9liorer progressivement cette difficult\u00e9 particuli\u00e8re.<\/p>\n
\n\t\tLE RENFORCEMENT MUSCULAIRE \n\t<\/h2>\n
Il n\u2019est pas essentiel, surtout en d\u00e9but de r\u00e9\u00e9ducation, o\u00f9 la r\u00e9cup\u00e9ration des mobilit\u00e9s est prioritaire.<\/p>\n
Les exercices de renforcement doivent \u00eatre peu douloureux\u00a0 (il n\u2019est pas n\u00e9cessaire de se faire mal, contrairement \u00e0 la mobilisation du genou).<\/p>\n
Voici quelques exercices<\/h3>\n
Contraction flash\u00a0:<\/strong> \u00e9crase boudin en extension.<\/p>\n
Verrouillage\u00a0 de la cuisse\u00a0:<\/strong> lever de la jambe sur le lit.<\/p>\n
Rodage articulaire sur un v\u00e9lo<\/strong> en augmentant la puissance.<\/p>\n
R\u00e9\u00e9ducation \u00e0 l\u2019effort\u00a0:<\/strong> promenade progressivement plus longue \u00e0 partir de la 3\u00e8me semaine.<\/p>\n