MSC - Post-op Rehab for Joint Replacement

What are the principles of post-op rehab?

- protocols are guidelines
- they are criterion-based and not time-based
- tissues should be protected initially, but loading/stress will allow collagen formation

What is included in prehab?

- education
- addressing post-op expectations
- social support
- plan treatment
- exercise training
- evidence of improved strength, function, and patient-reported outcomes

What are the phases of rehab?

1. maximal protection
2. moderate protection
3. minimal protection
4. return to activity

What occurs in the first stage of rehab?

- restrictions for WB, ROM and muscle contraction
- control pain and swelling
- poor motor control

What occurs in the second stage of rehab?

- controlled pain and swelling
- close to normal ROM

What occurs in the third stage of rehab?

- unrestricted ADL function

What are the goals for the pre-operative phase of a TSA?

- education
- independence with donning/doffing sling
- HEP
- precautions

What is the treatment for the pre-operative phase of a TSA?

- measure post-op sling
- instruct on donning/doffing sling
- instruct in self-care with sling
- instruct about precautions
- cryotherapy
- ROM and strength exercises

What are the goals of TSA post-op phase 1 (weeks 0-4)?

- pain and oedema control
- PROM to 120 deg of elevation, ER to 30 deg
- HEP
- light ADLs

What are the precautions of TSA post-op phase 1?

- avoid unnecessary lifting, beyond normal ADL
- limit ROM in IR and extension

What are the treatment strategies of TSA post-op phase 1?

- sling immobilisation (only light ADLs and therapy ex.)
- pendulum exercise
- passive ROM to active-assisted ROM ex for F/ER
- pain relief
- scapula strengthening
- cryotherapy

What are the goals of TSA post-op phase 2 (weeks 4-10)?

- pain 0/10 with ADL
- PROM elevation to 150 deg, ER to 45 deg

What are the precautions of TSA post-op phase 2?

- avoid painful activities in ADLs
- limit ROM in IR and extension

What are the treatment strategies of TSA post-op phase 2?

- PROM, active-assisted, active ROM for F/IR
- humeral head control ex.
- pool exercises
- isometrics
- ball stabilisation
- weight shifting

What are the goals of TSA post-op phase 3 (weeks 10-16)?

- pain control 0/10
- advanced ADLs
- PROM elevation to 160 deg, IR to T12
- normal scapulohumeral rhythm
- MMT 4/5
- independent HEP

What are the precautions of TSA post-op phase 3?

- avoid painful activities in ADLS
- avoid ROM that encourages scapular hiking

What are the treatment strategies of TSA post-op phase 3?

- flexibility ex (towel stretch)
- hydrotherapy
- isometrics
- scapular stabilisation
- theraband ex.
- rows, chest press (light weight)

What are the goals of TSA post-op phase 4 (weeks 16-22)?

- maximise ROM
- adequate strength and flexibility for ADLs
- normal scapulohumeral rhythm
- return to work

What are the precautions of TSA post-op phase 4?

- avoid painful ADLs
- avoid lifting heavy objects

What are the treatment strategies of TSA post-op phase 4?

- address deficits in ROM, flexibility, strength
- posterior capsule/towel stretch
- dumbbell exercises
- neuromotor control ex.
- sports-specific training

What are prevention strategies in phase 1 of TKA post-op rehab (weeks 0-2)?

- cryotherapy after exercise
- compression dressing
- ankle exercises to prevent DVT
- DBE

What are ROM and strength exercises in phase 1 of TKA post-op rehab?

- quads and glutes (SLR)
- seated knee extension
- passive and active-assisted knee flexion/extension

What are functional exercises in phase 1 of TKA post-op rehab?

- WBAT
- gait training with crutches
- transfers (lying, seating, standing, car)

What are prevention strategies in phase 2 of TKA post-op rehab (weeks 3-6)?

- patellar mobs if necessary
- quads/hamstring STM if necessary

What are ROM and strength exercises in phase 2 of TKA post-op rehab?

- isometrics of quads, glutes, adductors, hamstrings
- active-assisted knee flexion/extension
- heel raises, calf stretches, mini squats, hamstring curls
- hydrotherapy

What are functional exercises in phase 2 of TKA post-op rehab?

- WBAT
- progress to cane
- physical activity

What are prevention strategies in phase 3 of TKA post-op rehab (weeks 7-12)?

- patellar mobility
- quads/hamstring flexibility
- wound care/massage

What are ROM and strength exercises in phase 3 of TKA post-op rehab?

- core stability
- squats/SLS
- resisted LL exercises
- active and assisted ROM

What are functional exercises in phase 3 of TKA post-op rehab?

- driving
- no aid for gait
- lateral stepping, heel toe walking
- exercise bike
- physical activity

Which exercises recommended once good outcome is achieved for TKA post-op?

- regular walking
- exercise bike
- hydrotherapy
- gentle gym workouts/low impact aerobics
- golf
- dancing

What are the precautions for an anterior approach THA?

- no hip extension past 20 degrees
- no hip external rotation past 50 degrees

What are the precautions for a posterior approach THA?

- no hip flexion past 90 degrees
- no hip internal rotation or adduction past neutral

What are the general precautions post THA?

- WBAT with device
- no crossing legs, except ankles
- use good bending/lifting mechanics
- keep hips above knees when sitting
- avoid deep chairs

What are prevention strategies in phase 1 of THA post-op rehab (weeks 0-2)?

- cryotherapy
- compressive dressing
- ankle exercises for DVT
- DBE

What are ROM and strength exercises in phase 1 of THA post-op rehab?

- quads and glutes
- SLR
- seated knee extension
- active hip ROM in supine: <90 degrees flexion, abduction, extension in standing

What are functional exercises in phase 1 of THA post-op rehab?

- WBAT
- gait training with crutches
- transfers: lying, seating, standing, car

What are ROM and strength exercises in phase 2 of THA post-op rehab (weeks 3-6)?

- pelvic tilts
- bridges
- standing ROM exercises
- STS/mini squats/step-ups/lunges

What are functional exercises in phase 2 of THA post-op rehab?

- gait training with no aids
- exercise bike
- hydrotherapy

What are ROM and strength exercises in phase 3 of THA post-op rehab (weeks 7-12)?

- SLS
- bridges
- resistance training of LL muscles
- gym program

What are exercise recommendations after recovery of THA?

- plyometric
- stationary bicycling
- golf
- ballroom dancing
- doubles tennis
- walking
- swimming