Total Knee Arthroplasty

Patient presentation: maximum protection weeks 1-4

- Enters rehab 1-2 day post-op

- Post-op compression bandage

- Post op pain controlled

- ROM 10-60 deg

- WBAT

Patient presentation: moderate protection weeks 4-8

- Minimum pain

- Full WB'ing except with uncemented

- ROM 0-90 deg

- Joint effusion controlled

- Impaired balance and functional mobility

- Diminished muscle function and CP endurance

Patient presentation: minimum protection beyond 8 weeks

- Muscle function = 70%

- No symptoms of pain or swelling

- Impaired balance and functional mobility

Key examination procedures: max protection phase

- Pain

- Monitor for hemarthrosis

- ROM

- Patellar mobility

- Muscle control

- Soft tissue palpation

Key examination procedures: mod protection phase

- Pain assessment

- Joint effusion = girth

- ROM

- Patellar mobility

- Gait analysis

Key examination procedures: min protection phase

- Pain assessment

- Muscular strength testing

- Patellar alignment/stability

- Gait analysis

- Functional status

Goals: max protection phase

- Control swelling

- Minimize pain

- ROM 0-90

- 3-4/5 squad strength

- Ambulate with or without AD

- Establish HEP

Goals: mod protection phase

- Reduce swelling

- ROM 0-110 or greater

- FWB

- 4-5/5 quad strength

- Unrestricted ADL function

- Improved balance, neuromuscular control, and functional mobility

- Adherence to HEP

Goals: min protection phase

- Develop maintenance program and educate patient on importance of adherence including methods of joint protection

- Community ambulation

- Improve CP endurance/aerobic fitness

Interventions: max protection phase

- Pain modulation modalities

- Compression wrap

- Ankle pumps (DVT)

- AAROM & AROM

- Muscle setting

- Patellar mobs

- Gait training

- Flexibility program

- Trunk/pelvis stabilization

Interventions: mod protection phase

- Patellar mobs

- LE stretching

- Closed chain strengthening

- Limited range PRE

- Tibfem joint mob

- Proprioceptive training

- Stabilization and balance exercises

- Protected aerobic exercise- swimming, cycling, walking

Interventions: min protection phase

- Continue as previous phase, advance as appropriate

- Progression of balance and advanced functional activities

- Implement exercise specific to identified deficits and expected functional tasks

Criteria to progress from max protection phase

- Minimal swelling and pain

- Well healed incision with no signs of infected

- Independent basic ADLs and ambulation with appropriate AD

- Full or nearly full active knee extension and 90 deg flexion

Exercise precautions following TKA: integrity of surgical incision

Watch for signs of excessive tension on wound such as drainage or skin blanching

Exercise precautions following TKA: postpone SLR for how long after cemented arthroplasty and how long after cementless/hybrid

- Cemented = 2 weeks

- Cementless = 4-6 weeks

Exercise precautions following TKA: PCL implanted, avoid what to reduce risk of posterior dislocation of knee?

Hamstring strengthening in sitting position

Exercise precautions following TKA: postpone unsupported or unassisted WB'ing activities until strength of these muscles are sufficient to stabilize the knee

- Quads

- Hamstrings

Criteria to progress from mod protection phase

- Full extension, no extensor lag

- 110 deg knee flexion

- Quad/hamstrings and hip muscle strength at least 70% (or 4/5) of uninvolved

- Minimal to no pain during exercises and ambulation with or without a cane

Activities post TKA: highly recommended

- Stationary cycling

- Swimming, water aerobics

- Walking

- Golf

- Ballroom/square dancing

- Table tennis

Activities post TKA: recommended if previously participated

- Road cycling

- Speed walking

- Low impact aerobics

- Cross-country skiing

- Table tennis

- Double tennis

- Rowing, canoeing

- Bowling

Activities post TKA: not recommended

- Jogging, running

- Basketball

- Volleyball

- Singles tennis

- Baseball/softball

- High impact aerobics

- Stair-climbing machine

- Handball, squash

- Football, soccer

- Gymnastic, tumbling

- Water-skiing