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Total Knee Replacement - Active Patient

The document outlines a rehabilitation protocol following total knee arthroplasty, divided into four phases: Immediate Postoperative Phase, Motion Phase, Intermediate Phase, and Advanced Activity Phase. Each phase has specific goals, criteria for progression, and a detailed list of exercises aimed at improving range of motion, strength, and functional activities. The rehabilitation process spans from Day 1 to 26 weeks post-surgery, emphasizing gradual recovery and return to normal activities.

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9 views3 pages

Total Knee Replacement - Active Patient

The document outlines a rehabilitation protocol following total knee arthroplasty, divided into four phases: Immediate Postoperative Phase, Motion Phase, Intermediate Phase, and Advanced Activity Phase. Each phase has specific goals, criteria for progression, and a detailed list of exercises aimed at improving range of motion, strength, and functional activities. The rehabilitation process spans from Day 1 to 26 weeks post-surgery, emphasizing gradual recovery and return to normal activities.

Uploaded by

dziamidka.alex
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Page 1 of 3

Rehabilitation Following Total Knee Arthroplasty


(Active Patient)

I. Immediate Postoperative Phase (Day 1 to 10)

Goals: 1) Active quadriceps muscle contraction


2) Safe (isometric control), independent ambulation
3) Passive knee extension to 0 degrees
4) Knee flexion to 90 degrees or greater
5) Control of swelling, inflammation, bleeding

Day 1 to 2

Weight Bearing - Walker/two crutches WBAT

CPM - 20 to 70 degrees as tolerated

ROM – 0-70°

Cryotherapy - Commercial unit used continuously or ice 20 min of each hour

Exercises:
* Ankle Pumps with leg elevation
* Passive knee extension exercise
* Electrical stimulation to quads
* Straight leg raises (SLR)
* Quad sets
* Knee extension exercise 90-30 degrees
* Hamstring stretches (gentle)

Day 4 to 10

Weight Bearing - As tolerated

CPM - 0 to 90 degrees as tolerated

ROM – 0-90°

Exercises:
* Ankle pumps with leg elevation
* Passive knee extension stretch – emphasis on full knee
extension
* Active assistive ROM knee flexion
* Quad Sets
* Straight leg raises
* Hip abduction/adduction
* Knee extension exercise 90-0 degrees
* Continue use of cryotherapy

Gait Training - Continue safe ambulation. Instruct in transfers

Copyright © by the Advanced Continuing Education Institute, LLC. AdvancedCEU.com.


All Rights Reserved. Any redistribution, alteration, or reproduction of any materials herein is strictly prohibited.
Page 2 of 3

II. Motion Phase (Week 2-6)

Goals: 1) Improve range of motion


2) Enhance muscular strength/endurance
3) Dynamic joint stability
4) Diminish swelling/inflammation
5) Establish return to functional activities
6) Improve general health

Criteria to enter Phase II


1) Leg control, able to perform SLR
2) Active ROM 0-90 degrees
3) Minimal pain/swelling
4) Independent ambulation/transfers

Week 2-4

Weight Bearing - WBAT with assisted device

ROM - Week 2: 100-105°


Week 3: 110-115°
Week 4: 125°+

Exercises:
* Quad Sets
* Knee extension exercise 90-0 degrees
* Terminal knee extension 45-0 degrees
* Straight leg raises (flexion/extension)
* Hip abduction/adduction
* Hamstring curls
* 1/4 Squats
* Stretching
- Hamstrings, Gastrocnemius, Soleus, Quads
* Bicycle ROM Stimulus
* Initiate pool program
* Continue passive knee extension stretch
* Continue use of cryotherapy
* Discontinue use of TEDS hose at 2-3 weeks
(physician's approval)
* Begin front lunge & lateral step up week 3
* Begin machine program (gentle) week 4
- Leg press
- Hip abduction/adduction

III. Intermediate Phase (Week 5-12)

Goals: 1) Enhancement of strength/endurance


2) Eccentric/concentric control of the limb
3) Cardiovascular fitness
4) Functional activity performance

Copyright © by the Advanced Continuing Education Institute, LLC. AdvancedCEU.com.


All Rights Reserved. Any redistribution, alteration, or reproduction of any materials herein is strictly prohibited.
Page 3 of 3

Criteria to enter Phase III


1) Range of motion 0-115 degrees
2) Voluntary quadriceps muscle control
3) Independent ambulation
4) Minimal pain/inflammation

Week 5-10

Exercises:
* Continue all exercises listed in Phase II
* Initiate progressive walking program
* Initiate endurance pool program
* Continue closed kinetic chain & machine exercises
* Progress to entire lower extremity strengthening
* Return to functional activities
* Emphasize eccentric/concentric knee control

IV. Advanced Activity Phase (Week 10-26)

Goals: 1) Allow selected patients to return to advanced level of function (recreational


sports)
2) Maintain/improve strength and endurance of lower extremity
3) Return to normal life style

Criteria to enter Phase IV


1) Full non-painful ROM 0-120/125 degrees
2) Strength of 4+/5 or 85% of contralateral limb
3) Minimal to no pain and swelling
4) Satisfactory clinical examination

Exercises:
* Continue maintenance program
* Quad Sets
* Straight Leg Raises (flexion/extension)
* Hip abduction/adduction
* 1/2 squats
* Lateral step ups
* Knee extension exercise 90-0 degrees
* Machine weights as tolerated
* Bicycle for ROM stimulus and endurance
* Stretching
- Knee extension to 0 degrees
- Knee flexion to 105 degrees
* Initiate gradual golf, tennis, swimming, bicycle, walking
program

Copyright © by the Advanced Continuing Education Institute, LLC. AdvancedCEU.com.


All Rights Reserved. Any redistribution, alteration, or reproduction of any materials herein is strictly prohibited.

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