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Total Knee Replacement Physical Therapy Protocol

Revision And Reaffirmation Plans

High Level Exercises Weeks 4-8 – Total Knee Replacement

This CPG represents a cross-sectional view of current treatment and may become outdated as new evidence becomes available. It will be reviewed in 5 years and will be updated in accordance with new evidence, changing practice, rapidly emerging treatment options, and new technology reaffirmed or withdrawn.

Inclusion & Exclusion Criteria

Publications were eligible for inclusion if they: examined postoperative exercise-based interventions in a rehabilitation setting they included participants who underwent primary unilateral TKA the study was performed in the United States of America, Canada, United Kingdom, or Australia and the level of evidence was III or higher based on the American Association of Orthopaedic Surgeons level of evidence classification . Studies were excluded if: they were written or published in a language other than English and the full text was not available they were systematic reviews, meta-analyses, study protocols for randomized controlled trials , feasibility or pilot studies, letters to the editor, surveys, or case reports . Two independent reviewers screened each title and abstract to determine whether the article met the inclusion and exclusion criteria. If the two reviewers agreed about the inclusion of a study, the study was selected for final analysis. If there was any doubt about a studys eligibility, a third reviewer was consulted.

Systematic review flowchart for study inclusion.

Continuous Passive Motion Machine

The PT will also help you use a continuous passive motion machine. This device moves the joint slowly and gently after surgery. It helps prevent a buildup of scar tissue and joint stiffness.

Youll probably use the CPM machine in the hospital and possibly at home, too. Some people leave the operating room with their leg already in the device.

Some pain, swelling, and bruising are expected after TKR surgery. Try to use your knee as soon as possible, but avoid pushing yourself too far too soon. Your healthcare team will help you set realistic goals.

What can you do at this stage?

Get plenty of rest. Your PT will help you get out of bed and walk a short distance. Work on bending and straightening your knee, and use a CPM machine if you need one.

On the second day, you might walk for brief periods using an assistive device. As you recover from surgery, your activity level will increase gradually.

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Three To Six Weeks After Your Knee Replacement

As you gain strength, youll rely lessor not at allon assistive devices such as canes.

Often, at this point, more low-impact activities may be introduced into your exercise regimen. In addition to walking, this includes swimming or riding a stationary bike.

Many of the exercises above will continue. Knee bends will concentrate on the goal of bending your knee to 120 degrees.

At this point, many are able to complete basic household chores and slowly get back to daily activities. If you have an office job or a job that doesnt require heavy lifting or climbing, you may be able to return to work.

Peer Review And Public Commentary

10 Exercises Before Knee Replacement Surgery

Following the formation of a final draft, the CPG review draft was subjected to a 4-week peer review for additional input from external content experts and stakeholders. More than 350 comments were collected via an electronic structured review form. All peer reviewers were required to disclose any potential conflicts of interest, which were recorded and, as necessary, addressed.

After modifying the draft in response to peer review, the CPG was subjected to a 2-week public comment period. Commenters consisted of members of the APTA Board of Directors , the APTA Scientific and Practice Affairs Committee , all relevant APTA sections, stakeholder organizations, and the physical therapy community at large. More than 194 public comments were received. Revisions to the draft were made in response to relevant comments.

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Physical Therapy After A Total Knee Replacement

If you have knee pain, your healthcare provider may refer you to physical therapy. There your physical therapist will use various treatments and exercises to help decrease your pain and improve your overall functional mobility.

If your knee pain is caused by knee osteoarthritis, you may be having difficulty bending and straightening your knee, and your knee may feel swollen from time to time. This stiffness and swelling may prevent you from walking normally.

Believe it or not, physical therapy does not help everyone with knee pain. Sometimes the loss of range of motion and weakness are too great, and the pain and swelling cannot be controlled. Your physical therapist should refer you back to your healthcare provider if this is the case. Many times, your healthcare provider may then refer you to an orthopedic surgeon who will determine if a total knee replacement surgery is necessary to help decrease your knee pain and improve your overall mobility.

If you do have a TKR, chances are you will likely require physical therapy and rehabilitation following the surgery. You can expect to be involved in physical therapy soon after your surgery, and you may require therapy for a few months following your total knee surgery.

How Long Do You Need Physical Therapy After A Knee Replacement

Of course, this will vary from patient to patient, depending upon your individual situation. However, in general, you can expect around 3 to 4 weeks of formal physical therapy from our experts.

Dr. Christian Eccles, our Fellowship-trained Hip and Knee Replacement surgeon, says Therapy is vital to obtaining the best functional outcome possible after a knee replacement as it can aid in pain control, improve motion, and expedite recovery.

Our patients typically are able to drive within 2 to 4 weeks, go back to work in 6 to 8 weeks, and golf in 6 to 12 weeks.

Your physical therapy exercises that you learn should be continued on your own for a minimum of two months after your surgery. They may also recommend some additional exercises such as riding a stationary bicycle after this period to help keep your knee flexible. This will also help build your muscle tone.

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Defining The Strength Of The Recommendations

Judging the strength of evidence is only a steppingstone toward arriving at the strength of a CPG recommendation. The operational definitions for the quality of evidence are listed in Table 2, and rating of magnitude of benefits versus risk, harms, and cost is provided in Table 3. The strength of recommendation, listed in Table 4, takes into account the quality, quantity, and trade-off among the benefits and harms of a treatment, the magnitude of a treatments effect, and whether there are data on critical outcomes. Table 5 addresses how to link the assigned grade with the level of obligation of each recommendation.

High Velocity & High Intensity Exercise

Guidelines to Achieve Maximal Knee Flexion (Bending) Range of Motion – Total Knee Replacement

Rehabilitation protocol

As individuals age, several neuromotor changes occur, which leads to skeletal muscle weakness and reduced power. In TKA recipients, muscular strength and power decrease by at least 24% when compared to the contralateral side . Experts believe more demanding rehabilitation protocols may help overcome these deficits. Recent research focuses on rehabilitation strategies that incorporate movement velocity, a component of power. Given its preferential activation of type 2 muscle fibers, high velocity exercise is thought to improve functional mobility . This form of exercise is defined as performing a muscle contraction as quickly as possible, or in 1 second or less. In contrast to HV, a LV muscle contraction is performed in two seconds or more. Evidence indicates that HV exercises can improve static and dynamic balance while decreasing quadriceps impairment .

On the other hand, high intensity rehabilitation solely focuses on strength, defined as the contraction force. This program includes progressive resistance exercises and rapid progression to weight-bearing exercises. Several authors have expressed that the progressive strengthening and functional exercises according to clinical milestones promote positive outcomes . What is not yet known is whether a PRE-program restores function to levels comparable to healthy age-matched controls. Four Level-of-Evidence I studies regarding HV and HI exercise were analyzed in this systematic review .

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Comprehensive Physical Therapy In Myrtle Beach And Horry County To Help You After Knee Replacements

There are few things more rewarding than seeing patients return to their everyday activities without pain or discomfort. For millions of Americans, knee replacements have helped them regain the life they once enjoyed before knee pain.

Conway Medical Center has become a leader in this life-changing surgery by utilizing the latest advancements in medical technology and pain management. We offer both total and partial knee replacement procedures by leading orthopedic experts who have the extensive expertise and experience to help you.

Want to know more? Just contact us.

Home And Outpatient Physical Therapy

If you are sent home, you may choose to have a home care PT visit you. This option is usually for people who can’t travel to an outpatient physical therapy center.

Your goal for home physical therapy is to make sure you can move safely in your home. You will keep working on knee ROM and strength. Walking and stair climbing may also be a part of your home physical therapy.

Scar tissue will form as your incision heals. Your PT may use gentle scar tissue massage and mobilization to help improve the mobility of your incision. This can help the skin and other tissues around your knee move more freely.

If you can travel to a physical therapy center, you may begin outpatient physical therapy. There, you will keep improving your knee ROM. You should be able to bend your knee to a 90 degree angle by the end of week 2.

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One To Two Weeks After Surgery

During this time, physical therapy concentrates on balance, range-of-motion and strengthening exercises. This may include:

  • Practice getting up from a sitting position
  • Knee straightening exercises
  • Supported knee bendswith the goal of eventually having the knee bend to a 90-degree angle
  • Walkingif you need to use a cane or walker, the physical therapist will work with you ensure youre using them properly

Pain Or Swelling After Exercise

Knee Replacement Recovery Timeline

You may experience knee pain or swelling after exercise or activity. You can relieve this by elevating your leg and applying ice wrapped in a towel. If you use ice, it should be placed on the knee for 20 minutes and then removed for 20 minutes this sequence should be repeated for about 2 hours.

Exercise and activity should consistently improve your strength and mobility. If you have any questions or problems, contact your orthopaedic surgeon or physical therapist.

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At An Outpatient Clinic

Once your mobility has improved enough for you to safely leave your home, your healthcare provider may refer you to outpatient physical therapy to continue your TKR rehabilitation. Your healthcare provider may request that you attend physical therapy at a specific clinic, or you can find a physical therapy clinic close to your home.

The main focus of outpatient physical therapy is to maximize your strength, ROM, and functional mobility. Therapeutic modalities may be used to help improve your muscular strength, control pain, or decrease swelling. Your physical therapist may also work on improving your overall endurance level by having your ride a stationary bike as a part of your rehabilitation program. Your surgical incision may be tight, and your physical therapist may perform specific scar mobilizations to help improve the mobility of the scar tissue in the front of your knee.

In general, you can expect to be back to normal in about 2-3 months following your total knee surgery. Everyone is different, so be sure to work closely with your healthcare provider and physical therapist to understand what to expect.

How To Shower After Knee Surgery

If the surgeon used waterproof dressings, you can shower the day after surgery. If they used dressings that arent waterproof, youll have to wait for 57 days before showering and avoid soaking for 34 weeks to let the incision heal fully, according to the American Association of Hip and Knee Surgeons .

The PT may ask you to use a regular toilet rather than a bedpan and ask you to try to climb a few steps at a time. You may still need to use the CPM machine.

Work on achieving full knee extension at this stage. Increase knee flexion by at least 10 degrees if possible.

What can you do at this stage?

On day two, you can stand up, sit, and change locations. You can walk a little further and climb a few steps with help from your PT.

If you have waterproof dressings, you can shower the day after surgery. The PT may ask you to use a regular toilet in preparation for returning to your activities of daily living.

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What Is Physical Therapy

Physical therapy is a health care service that helps you restore body movement and your physical functionality through non-invasive methods.

For example, a physical therapist may help someone learn to walk again following a stroke or injury. For those who have had a knee replacement, a physical therapist is an important part of the healthcare team. By working closely with your physical therapist, you can regain the range of motion in your leg, helping you return to the activities you once enjoyed.

Sitting Supported Knee Bends

2 Key Exercises to Rapid Recovery for Total Knee Replacement
  • While sitting at your bedside or in a chair with your thigh supported, place your foot behind the heel of your operated knee for support.
  • Slowly bend your knee as far as you can. Hold your knee in this position for 5 to 10 seconds.
  • Repeat several times until your leg feels fatigued or until you can completely bend your knee.
  • This exercise should take 2 minutes.

Sitting supported knee bend

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Why Is Physical Therapy Important After Knee Replacement Surgery

Regaining your range of motion and strength after total knee replacement surgery is critical to regaining your ability to do the things that are important to you. You will start the following exercise program soon after your surgery. Your physical therapist will help you with the exercises initially and you will be expected to continue the exercises as instructed. As you recover, some exercises will be discontinued and others may be added. Please let your therapist or surgeon know if you are having difficulty with your exercises.

Total Knee Replacement Recovery And Rehabilitation

When you have total knee replacement surgery, recovery and rehabilitation is a crucial stage. In this stage, youll get back on your feet and return to an active lifestyle.

Each surgeon may have different protocols, and each persons recovery is unique. This article outlines a general recovery timeline.

The 12 weeks following surgery are very important for recovery and rehab. Committing to a plan and encouraging yourself to do as much as possible each day will help you heal faster from surgery and improve your chances of long-term success.

Read on to learn what to expect during the 12 weeks after surgery and how to set goals for your healing.

Rehabilitation begins right after you wake up from surgery.

Within 24 hours after surgery, a physical therapist will help you to stand up and walk using an assistive device. Assistive devices include walkers, crutches, and canes.

A nurse or occupational therapist will help you with tasks such as changing the bandage, dressing, bathing, and using the toilet.

The PT will show you how to get in and out of bed and how to move around using an assistive device. They may ask you to sit at the side of the bed, walk a few steps, and transfer yourself to a bedside commode.

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Physical Therapy Discharge Planning

It is the consensus of the work group that physical therapists should provide guidance to the care team and patient on safe and objective discharge planning, patient functional status, assistance equipment, and services needed to support a safe discharge from the acute care setting. Evidence Quality: Low Recommendation Strength: Moderate.

Prognostic Factors: Body Mass Index Depression Preoperative Rom Physical Function And Strength Age Diabetes Comorbidities And Sex

Total Knee Arthroplasty (TKA)

Physical therapist management should take into consideration the following factors when determining prognosis, treatment, and informed decision making and expectation setting with patients undergoing TKA:

  • Higher BMI is associated with more postoperative complications and worse postoperative outcomes.
  • Depression is associated with worse postoperative outcomes.
  • Preoperative ROM is positively associated with postoperative ROM but has minimal, if any, effect on physical function and quality of life.
  • Preoperative physical function is positively associated with postoperative physical function.
  • Preoperative strength is positively associated with postoperative physical function.
  • Age is associated with mixed patient-reported, performance-based, and impairment-based outcomes.
  • Diabetes is not associated with worse functional outcomes.
  • A greater degree of comorbidity is associated with worse patient-reported outcomes.
  • Sex is associated with both positive and negative effects on postoperative outcomes.

Evidence Quality: High Recommendation Strength: Moderate.

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Advanced Exercises And Activities

Once you have regained independence for short distances and a few steps, you may increase your activity. The pain of your knee problems before surgery and the pain and swelling after surgery have weakened your knee. A full recovery will take several months. The following exercises and activities will help you recover fully.

Stair Climbing And Descending

Stair climbing is an excellent strengthening and endurance activity that also requires flexibility.

  • At first, you will need a handrail for support and will be able to go only one step at a time.
  • Always lead up the stairs with your good knee and down the stairs with your operated knee. Remember, “up with the good” and “down with the bad.”
  • You may want to have someone help you negotiate stairs until you have regained most of your strength and mobility.
  • Do not try to climb steps higher than the standard height and always use a handrail for balance.
  • As you become stronger and more mobile, you can begin to climb stairs foot over foot.

Stair climbing and descending using a crutch

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