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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:
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