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Total Knee Arthroplasty Rehab Protocol

Total Knee Arthroplasty Rehab Protocol

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The intent of this protocol is to provide the clinician with a guideline for the post-operative rehabilitation course of a patient that has undergone a total knee arthroplasty. It is by no means a substitute for one’s clinical decision making regarding the progression of a patient’s post-operative course based on their physical exam/findings, individual progress, and/or the presence of post-operative complications. If a clinician requires assistance in the progression of a post-operative patient they should consult with the referring surgeon.

GENERAL GUIDELINES:

  • Focus on protection of surgical site.
  • Individualized gradual progression of therapy to promote optimal level of functional independence
  • Supervised physical therapy takes place for 3-6 months.

GENERAL PROGRESSION OF ACTIVITIES OF DAILY LIVING (ADLs)

  • No bathing/showering of surgical site until after suture removal (about 2 weeks)
  • Driving: Return within 12 weeks of surgery, average around 4 weeks
  • Weight-bearing as tolerated immediately post-op if no complications
  • Wean from walker/rollator/cane or return to prior level of function for ambulation as treatment progresses 
  • Return to normal daily activities/work as directed by PT/MD based on demands and goals.

Rehabilitation Progression

PHASE I: Week 0 – 6:

Goals:

  • Protection of surgical site
  • Improving safety with mobilization and transfers
  • Decrease pain and inflammation
  • Restore knee range of motion
  • Promote optimal quadriceps contraction
  • Prevent muscle atrophy
  • Muscle re-education and motor control of post-op leg
  • Educate patient on weight bearing status
  • Normalize gait, gradual ween off of assistive device 
  • Gradual progression of exercises to improve strength
  • Initiate home exercise program of aerobic and light resistance training

Precautions:

  • Avoid prolonged sitting
  • Monitor wound healing for signs and symptoms of infection
  • Monitor for increased edema

Weight Bearing Status:

  • Weight bearing as tolerated (WBAT) with walker or cane

Exercises:

  • Gait training
  • Ankle pumps
  • Heel slides
  • Straight leg raise
  • Short arc quads
  • Long arc quads
  • Glute sets
  • Weight shifts
  • Mini-squats
  • Forward, retro and lateral step downs
  • Heel and toe raises
  • Progressive hip abduction strength
  • Core stabilization progression

Criteria to advance:

  • No signs of infection
  • Demonstrate adequate quad set and straight leg raise with no knee lag
  • Tolerable pain if any with exercises

PHASE II: Weeks 6-9:

Goals:

  • Protect surgical site
  • Normal gait with no assistive device or prior assistive device
  • Stair navigation with reciprocal gait with or without railing
  • Improve dynamic and static balance 
  • Continue progressive home exercise program
  • Restore functional knee strength
  • Promote optimal knee range of motion

Precautions:

  • Avoid prolonged sitting

Weight Bearing Status:

  • Weight bearing as tolerated (WBAT)

Exercises:

  • Continue prior exercises as needed with increased range of motion and intensity
  • Dynamic balance activities
  • Advanced open and closed knee strengthening

Phase III:  Week 9 to 12):

Goals:

  • Symmetrical knee ROM
  • Able to tolerate 20 minute walk
  • Up/down stairs without railing
  • Knee strength at functional level
  • Adequate range of motion for ADL’s, gait and recreational activities
  • Able to resume normal lifestyle without limitations in pain or weakness
  • Progress home exercise program

Exercises:

  • Progression of prior phase
  • Advanced static and dynamic balance activities
  • Include individualized recreational/ADL/work specific exercises

Phase IV:  3 to 6 Months:

Goals:

  • Resume normal lifestyle of work, ADL’s and recreation
  • Individualized progression of exercises based on patient’s goals
  • Patient independent with home exercise program for continued improvements of strength, balance and cardiovascular exercise
  • Maintain cardiovascular stamina and knee strength
  • Maintain balance to prevent falls

Exercises:

  • Progression of previous phase
  • Higher level recreation/ADL/work specific exercises