PT Resources

Total Knee Replacement (Arthroplasty

Total Knee Arthroplasty Protocol

 


Developed with Michael Becker MD

 

General Information:

  • Walker or crutches should be used until discontinued by Doctor or Physical therapist
  • Ice knee frequently with cryocuff, up to 30 minutes out of every 2 hours
  • Change knee position at least once an hour, while awake, to avoid stiffness
  • Home exercises should be performed 3x/day

General Information:

  • Upstairs – the nonoperative leg goes first, then the operative leg, lastly the crutches or cane
  • Downstairs – the crutches or cane go first, then the operative leg, lastly the nonoperative leg

Rehabilitation:

0-3 weeks

Goals

  • 1. safe ambulation with walker, crutches or cane (level surface and stairs)
  • 2. range of motion 0-100 degrees
  • 3. independent transfers

Exercise

    • 1. Quad sets- tighten knee muscles of out stretched leg by pushing the back of the knee into the bed, hold 5 seconds
    • 2. Gluteal sets- squeeze buttocks together, hold 5 seconds
    • 3. Ankle pumps- pump ankles to move feet back and forth
    • 4. Heel slides- bend knee, sliding foot toward buttocks
    • 5. Hip abduction- slide leg out to side keeping the knee straight
    • 6. Knee flexion- sitting in firm chair, slide foot back bending knee as far as possible, hold 5 seconds
    • 7. Stationary Bike – can begin at 2 weeks

* First five exercises to be done lying on back and repeated 20 times.

3+ weeks

Goals

  • 1. Range of motion 0-120 degrees
  • 2. continue physical therapy for exercise instruction, gait training and scar/swelling management

Exercise

  • 1. Straight leg raises, no greater than 2 lbs. (flexion, abduction, adduction)
  • 2. Hamstring curls
  • 3. Heel raises
  • 4. Standing terminal knee extensions
  • 5. Standing hip flexion
  • 6. Standing hip abduction
  • 7. Bridges
  • 8. Short arc quad
  • 9. Pool therapy
12+ weeks

Goals

  • 1. safe ambulation on uneven surfaces with straight cane
  • 2. safe ambulation without assistive device or gait deviation on level surface
  • 3. independent with all ADLs
  • 4. independent with advanced home exercise program

Exercise

  • 1. Squats (as able)
  • 2. Single leg balance (challenges with airex, if able)
  • 3. Forward step ups (advance in 2 inch increments)
  • 4. Forward step downs (advance in 2 inch increments
  • 5. Leg press

Discharge Criteria:

  • Safe ambulation without assistive device
  • Ascend and descend stairs independently
  • Independent home exercise program
  • Normal ADL function

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