TKA Rehab Protocol

TOTAL KNEE ARTHOPLASTY REHAB PROTOCOL

INPATIENT STATUS                                                                                                                 GOALS PRIOR TO D/C

1.     > 70 degrees of knee flexion

2.     <-10 degrees of knee extension

3.     Independent with all transfers

4.     Educated on individual home exercise program: should be able to repeat 4 exercises w/o assistance

5.     Independent with ambulatory device; 50 feet with SBA

Day 1

1.     Transfer from supine – sit (bed – chair) BID

2.     Instruct in importance of Cryotherapy

Day 2

1.     Continue transfers to include standing with walker

2.     Begin ambulation as tolerated.  Verify WB status before ambulating

3.     Begin general strengthening exercises:

A.    Quad sets

B.    Gluteal sets

C.    Hamstring sets

D.    Ankle pumps

E.    SLRs (eccentrically for hip flexion if patient can not perform concentrically)

F.     Heel slides

  4.  Begin manual PROM for flexion – BID

  5.  Increase CPM to 90 degrees as tolerated

  6.  Instruct in self ROM exercises – flexion and extension

Day 3

1.     Continue general strengthening exercises/AROM exercises

2.     Increase ambulation to a useful distance, i.e. bathroom, chair

3.     Increase CPM to 90 degrees as tolerated

4.     Continue PROM/AROM (push flexion) – BID

5.     Ensure patient has individual ambulatory device for home and outpatient PT arranged.

OUTPATIENT STATUS

GOALS FOR OUTPATIENT REHABILITATION D/C

1.     Terminal knee extension

2.     Functional amount of flexion - >110 degrees

3.     Normalized gait with/without device

4.     Increase strength – 20 reps of all exercises

Week 1

1.     Verify all exercises patient was doing as Inpatient and modify for Home Program

A. Should be independent with all mat exercises to include SLRs, SAQs, Heel slides, and wall slides

2.     Verify any precautions given by surgeon

3.     Focus on ROM – AROM/AAROM/PROM

A.   Extension – use heel prop in supine

1.     Add weight as tolerated

2.     Heat PRN

B.    Flexion – Technician assisted

1.     Wall slides if tolerated

2.     CPM on Biodex for more aggressive approach

3.     Bike

   4.  Total gym (level 7 – 9)

   5.  Begin partial squats with balance support

   6.  Standing knee flexion with balance support

   7.  Patellar mobilization when scar is stable

   8.  Electrical Stimulation PRN

 9.  Cryo PRN

Week 2

1.     Begin aggressive strengthening

A.   Quad machine

B.    Hamstring machine

C.    Total Gym at higher levels

D.   Leg Press

E.    Bike (resistance as tolerated)

Week 3 – 4

 1.  Begin Treadmill for gait if prosthesis is cemented

A.   Retro can be use if patient is lacking extension

B.    Emphasize heel – toe gait

2.     Concentrate on any lacking in ROM

3.     Cryo PRN

4.     D/C walker/crutches to cane (quad or standard) as permitted by surgeon                                                                                                                                 

DAY of D/C

1.     Recommended activities to continue

A.   Stationary bike

B.    Stationary skiing – Nordic track

C.    Walking

D.   Swimming

E.    Water aerobics

F.    Ballroom dancing

G.   Golf