All patients will undergo Phase 1 of rehabilitation in the hospital and would be discharged during phase 2. In most cases they will go nearer clinic to begin in the middle of phase 2.
The intent of this physical therapy protocol is to provide the clinician with a guideline of the post-operative rehabilitation course of a patient who has undergone a total knee arthroplasty (TKA). It is by no means intended to be a substitute for one’s clinical decision making regarding the progression of a patient’s postoperative course based on their physical exam/findings, individual progress, and/or the presence of post-operative complications. If a clinician requires assistance in the progression of a post-operative patient, the clinician should consult with the referring surgeon.
This physical therapy protocol applies to primary total knee arthroplasty. In a revision total knee arthroplasty, or in cases where there is more connective tissue involvement, Phase I and II should be progressed with more caution to ensure adequate healing.
Criteria for progression to Phase 2:
- Ability to demonstrate Quadriceps contraction and/or perform a straight leg raise (SLR)
- Active knee range of motion (AROM) -10°-80°
- Minimal pain and inflammation
- Independent transfers and ambulation at least 100 feet with appropriate assistive device.
Phase II – Motion Phase (Day 3 – Week 6)
During this phase exercises our therapists can should do 6 sessions a week.
- Improve knee active range of motion active range of motion to greater or equal to 0-110 degrees
- Muscle strengthening of the entire operative extremity with emphasis on knee extensor and flexor muscle groups.
- Attention should also be directed toward any weakness present in the operative extremity as well as any generalized weakness in the upper extremities, trunk or contralateral lower extremity.
- Proprioceptive training to improve body/spatial awareness of the operative extremity in functional activities.
- Endurance training to increase cardiovascular fitness.
- Functional training to promote independence in activities of daily living and mobility.
- Gait training – with assisted devices ( to be done on flat surfaces and going up and down stairs)
- Decrease inflammation/swelling
- Return to functional activities
Phase III – Intermediate phase (week 7-12):
During this phase visits can be done by our physiotherapist either twice or thrice a week
- Maximize post-operative ROM (0-115 degrees plus)
- Good patella femoral mobility.
- Good strength all lower extremity musculature.
- Return to most functional activities and begin light recreational activities (i.e. walking)
Phase IV – Advanced strengthening and higher level function stage (week 12-16):
During this phase our physiotherapists can do one followup session per week.This can also be done once every 15 or 30 days depending on the requirements of the patients and their adherence to therapy. Most patients may not opt these sessions
- Return to appropriate recreational sports / activities as indicated
- Enhance strength, endurance and proprioception as needed for activities of daily living and recreational activities