Technologyassisted rehabilitation following total knee or hip. These rehabilitation guidelines are presented in a criterion based progression. Primary weight bearing as tolerated wbat revision 50% weight bearing x 6 weeks bed mobility and transfers heel slides, arom, aarom, prom as tolerated straight leg raise slr x 4 in standing short arc quads. This summary is an update of the total knee arthroplasty clinical summary by karla a.
Article in the journal of arthroplasty 183 suppl 1. Total knee arthroplasty rehabilitation protocol what. Rapid recovery protocol for perioperative care of total. Oct 08, 2014 tka rehabilitation using the kneehab for clinicians. Formal rehabilitation programs are often assumed to be required after total knee arthroplasty to optimize patient recovery. The longterm goals of arthroplasty, to relieve pain, increase function, provide stability, and obtain durability, are accomplished in the vast majority of cases. Knee extensor strength and knee extension range of motion rom are important predictors of physical function in patients with a total knee arthroplasty tka. Over 85% of total knee arthroplasty tka patients will recover knee function regardless of which rehabilitation protocol is adopted.
Rehabilitation protocol this rehabilitation protocol was developed for patients who have had a cemented total knee arthroplasty. To achieve these goals, any rehabilitation protocol must control pain, provide emotional support, improve ambulation, maximize rom, and develop muscle strength. This is understandable if we consider the techniques that were most popular at the time, which included the use of bptb, even in acute cases, performed in an open fashion, often after a diagnostic arthroscopy, and followed by a very cautious rehabilitation protocol with several weeks of. You have made the decision to have a total knee replacement to decrease your pain. Total or partial knee replacement rehab protocol regular exercise to restore your knee mobility and strength and a gradual return to everyday activities are important for your full recovery. Journal of imab annual proceeding scientific papers 2015, vol. Total knee arthroplasty protocol postop week week 46 initial evaluation evaluate history of injury premorbid activity level. Review tub transfers in total knee replacement rehabilitation. Pathwaycontrolled fasttrack rehabilitation after total knee. One high standard, three local partners for more information go to.
Outpatient rehabilitation guidelines for total knee arthroplasty. Postoperative instructions for total knee replacements. Patient will be weight bearing as tolerated with a rolling walking or other piece of medical equipment. Virtual reality intervention in postoperative rehabilitation after total. This article describes and evaluates a postoperative rehabilitation management protocol in terms of. Hospital inpatient versus homebased rehabilitation after. The method of its implementation depends on the mental, social and somatic status of the patient 16, 27. Each case can be very different depending on the goals of the patient, the age of the patient, the type of surgery etc. With the exception of comparisons with domiciliary services, no randomized trial has compared inpatient. Your orthopaedic surgeon and physical therapist may recommend that you exercise approximately 20 to 30 minutes two or three times a day and walk 30 minutes, two or three times a day du. February 12, 2011 total knee arthroplasty surgical approach.
Total knee replacement rehab protocol the stone clinic. Total knee arthroplasty rehabilitation protocol what makes the difference. February 12, 2011 total knee arthroplasty surgical approach medial parapatellar approach technique incision through the quad tendon proximal to the patella patellar eversion advantage good exposure of all 3 compartments disadvantage disruption of the. Total knee arthroplasty tka is the gold standard treatment for endstage knee osteoarthritis. The primary goal of this protocol is to protect the reconstruction while steadily progressing towards maximizing functional potential.
This was an open, randomized, prospective clinical study, comparing the fasttrack rehabilitationa pathwaycontrolled. We describe an accelerated rehab protocol ar instituted at a community based hospital. Sounds like a rather sensible protocol, backed up by that objective improvement if pt input is minimised. The goal of the following exercises is to regain range of motion while limiting pain and inflammation. Total knee arthroplasty tka postop rehabilitation protocol. Total knee arthroplasty protocolbrigham and womens hospital phase i. Bell, pt, dpt, and anna shovestul, pt, dpt, originally published on ptnow october 25, 2011. Increased utilization demands improvements in resource allocation with continued improvement in patient outcomes. Marsh brook rehabilitation service wentworthdouglass hospital durham. Teach postoperative knee exercises and give patient handout. General time frames are given for reference to the average, but individual patients will progress at different rates depending on. Initiate gentle strengthening exercises with the primary goal of activating the quadriceps. This is typically done by your primary care physician and will need to be completed within 30 days of surgery. Pain management and accelerated rehabilitation for total hip and total knee arthroplasty.
Make sure that your patient has a follow up appointment for a wound check. Post operative total knee replacement protocol brian white, md. The parallelgroup randomized activecontrolled clinical study was conducted to compare the effectiveness of two inhospital range of motion rom exercise programs following total knee arthroplasty tka. Many patients lack sufficient strength, rom, or agility to step over tub for showering. Patients who have had a prior patellectomy or failed total knee replacement may require modifications in regards to the progression of weight bearing and knee motion as discussion in this.
This patient appears to have benefited from rehabilitation following tka revision. Implementation of an accelerated rehabilitation protocol for. Tka rehabilitation using the kneehab for clinicians. The effect of continuous passive motion and sling exercise. Sands rehabilitation protocol total knee replacement kenneth sands, md total knee arthroplasty rehabilitation protocol phase 1. Gait and postural control after total knee arthroplasty diva. Review bed to chair transfers, bathroom transfers, tub transfers with tub chair at home.
This document will serve as a general guideline for physical therapy. To investigate fasttrack rehabilitation concept in terms of a measurable effect on the early recovery after total knee arthroplasty tka. Brian burnikel with steadman hawkins clinic of the carolinas discusses the rehabilitation program that has been developed with proaxis. Total knee replacement manual and therapyrehab protocol. This illustrated guide includes exercises and activities designed to restore muscle strength and mobility to your knee following total knee replacement.
However, the relationship between the two knee measures remains unclear. This is understandable if we consider the techniques that were most popular at the time, which included the use of bptb, even in acute cases, performed in an open fashion, often after a diagnostic arthroscopy, and followed by a very cautious rehabilitation protocol with several weeks of immobilization in a cast or brace. The definitive treatment for advanced joint destruction in the late stages of rheumatoid arthritis can be successfully treated with total joint arthroplasty. Rehabilitation protocol following total knee arthroplasty. Tricompartmental knee arthroplasty rehabilitation using alterg antigravity treadmill. Unilateral total knee arthroplasty tka primary surgery. Pencho kosev, tsvetan sokolov, ivalinka pavlova, boyan valentinov, jordan andonov, neli petrova. Update on accelerated rehabilitation by ptnow staff. Contact ohio state orthopaedic surgery adult reconstruction division 614293. Achieving the painless tha or tka is within reach using regional anesthesia and multimodal pain control techniques that avoid the. Place tub chair as far back in tub as possible, facing the faucets. Rapid recovery protocol for perioperative care of total hip. Progression through each phase of rehabilitation is based on clinical criteria and time frames as appropriate. Total knee arthroplasty considerations in rheumatoid arthritis.
February 12, 2011 total knee arthroplasty surgical approach medial parapatellar approach technique incision through the quad tendon proximal to the patella patellar eversion advantage good exposure of all 3 compartments disadvantage disruption of the extensor mechanism subvastus approach technique. Acl reconstruction with meniscal repair all inside acl reconstruction with meniscal repair inside out acl reconstruction with meniscal root repair. Make sure you check with the surgeon before you start using any protocol. Total knee arthroplasty rehabilitation protocol dos all patients participate in a comprehensive joint program protocol which addresses pre and post operative pain control and rehabilitation. Pain management and accelerated rehabilitation for total. Manual patellar mobility, manual tibiofemoral mobility. If you have had a tkr or are expecting to have one, you may benefit from physical therapy after surgery to help you regain your normal mobility. Brian burnikel with steadman hawkins clinic of the carolinas discusses the rehabilitation program. Continuous passive motion cpm is frequently used to increase rom and improve postoperative recovery despite little conclusive scientific evidence. The focus of any rehabilitation protocol should be to control pain because this is the variable the surgeon can. Total knee replacement rehabilitation guidelines the following is a detailed outline of the rehabilitation regime for patients who have had a total knee replacement by dr.
Patient has recent less than 1 year old x rays to include ap, lateral, merchant 3. Physiotherapy exercises following total knee replacement. Total knee arthroplasty tka rehabilitation protocol south shore. An increasing number of total knee arthroplasties tkas are performed each year. Getting ready for surgery check list get a preoperative physical exam before surgery, a preoperative physical is necessary.
Pdf the effect of early progressive resistive exercise therapy on. In addition, guidelines vary considerably between institutions, which often. Total knee arthroplasty protocol the following protocol should be used as a guideline for rehabilitation progression, but may need to be altered pending the nature and extent of the surgical procedure, healing restraints or patient tolerance. Patient backs up to the tub, sits on the chair, and then lifts the leg over. Immediate postoperative phasedays 110 goals active quadriceps muscle contraction safe isometric control, independent ambulation passive knee extension to 0 degrees knee flexion to 90 degrees or greater control of swelling, inflammation, and bleeding days 1. Rehabilitation following total knee arthroplasty tka continues to pose a challenge for both patients and providers. Accelerated rehabilitation following total joint replacement tjr surgery has become more common in contemporary orthopaedic practice. The rehabilitation process was initially aimed at all patients with tka, while now the fasttrack care program is applied strictly individually, specifically to each patient. General time frames are given for reference to the average, but individual patients will progress at different rates depending on their age, comorbidities, presurgical range of.
Total knee arthroplasty tka is one of the most common orthopedic. Brigham and womens hospital protocol the intent of this physical therapy protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient who has undergone a total knee arthroplasty tka. The primary goal of this protocol is to protect the reconstruction while steadily. The knee is composed of the distal end of the femur, proximal portion of the tibia, and the patella. Total knee arthroplasty has been shown to be a wellproven modality that can provide pain relief and restoration of mobility for those with debilitating knee arthritis. Patients are weight bearing as tolerated with the use of crutches, a walker or a cane to assist walking until they are able to demonstrate good walking mechanics, then full weight bearing. Patients who have had a prior patellectomy or failed total knee replacement may require modifications in regards to the progression of weight bearing and knee motion as discussion in this protocol.
It has a medial and lateral meniscus in between the femur and tibia to cushion the joint, absorb and transmit weighbearing forces. Total knee arthroplasty rehabilitation surgical indications and considerations anatomical considerations. Demonstrate good neuromuscular control for daily functional activities. Rehabilitative guidelines after total knee arthroplasty. All times are to be considered approximate, with actual progression based upon clinical presentation. Physical therapy is often recommended for treatment of pain and dysfunction associated with. It is important for rheumatologists and orthopedic surgeons alike to. Rehabilitation guidelines for unilateral total knee. Proposed rehab protocol for total knee replacement. The intent of this physical therapy protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient who has undergone a total knee arthroplasty tka at brigham and womens hospital bwh. Perform bed mobility and transfers with least amount of assistance, ambulate with assistive device for 25100 feet and ascenddescend stairs as appropriate, regain at least 80 of parom knee flexion and less than or equal to 10 extension, independently perform slr exercises.
It should be noted that this protocol gives general guidelines for progression of therapies after tka. Acl reconstruction with meniscal repair all inside acl reconstruction with meniscal repair inside out. The purpose of this study was to examine whether changes in knee extensor strength mediate the association between changes in knee extension rom. The goals of any rehabilitation protocol should be to control pain, improve ambulation, maximize range of motion, develop muscle strength, and provide emotional support. An outpatient knee relplacement is an advanced alternative to traditional inpatient care to resurface the damaged compartments of your knee. Rehabilitation guidelines for unilateral total knee arthroplasty. The patients guide to outpatient total knee replacement. Total knee and unicompartment arthroplasty revised august 2008 postop days 1 7 ted hose x 6 weeks walker or crutches. Total knee arthroplasty protocol brigham and womens. Implementation of an accelerated rehabilitation protocol. All kinematic data was acquired via qualisys track manager version 2. These can be acquired in our physical therapy department.
Total knee arthroplasty protocol brigham and womens hospital. A recent delphi panel on rehabilitation after tka recommended that. Department of orthopedics and traumatology, mhat ruse, ruse, bulgaria. Outpatient total joint replacement improving the patient. Patient has preoperative medical clearance by primary care or internal medicine 4. Total knee arthroplasty rehabilitation protocol what makes. An incision is made down the front of the leg from midthigh. Specific changes in the program will be made by the physician as appropriate for the individual patient. Weekbyweek rehab protocol for total knee replacement. These guidelines should be administered under the supervision of a physical therapist. A total knee replacement tkr surgery is typically done when severe arthritis causes knee pain, limited motion, and extreme difficulty with walking.
Knee extension range of motion and selfreport physical. I certainly agree with the noweights, at least in the first month or so. Knee replacement surgery has undergone a rapid and significant growth over the past three decades strongly supported by new technologies and innovations, the development of resistant biomaterials, a better understanding of knee biomechanics combined with major improvements in intraoperative management. Tka rehabilitation using the kneehab for clinicians youtube. Most patients report successful longterm outcomes and reduced pain after tka, but recovery is variable and the majority of patients continue to demonstrate lower extremity muscle weakness and functional deficits compared to agematched control subjects. Total knee replacement rehabilitation physiotherapy treatment. Total or partial knee replacement rehab protocol mark w. Patients are in private rooms in an area of the hospital dedicated to joint replacement.
Minimal to no reactive pain and swelling with adls and pt exercises. Outpatient rehabilitation guidelines for total knee. The use of therapeutic exercises and manual stretching for a patient following a total knee arthroplasty tka revision. Total knee replacement tka post operative protocol this protocol provides you with general guidelines for recovery and rehabilitation after a total knee arthroplasty.
Your orthopaedic surgeon and physical therapist may recommend that you exercise approximately 20 to 30 minutes two or three times a day and walk 30 minutes. Total knee replacement rehab protocol complimentary consultation. Total knee replacement exercise guide orthoinfo aaos. The following is a protocol for postoperative patients following total knee arthroplasty tka rehabilitation. The use of therapeutic exercises and manual stretching for. Inpatient rehabilitation is a costly rehabilitation option after total knee arthroplasty and, in australia, is utilized most frequently for privately insured patients. May 27, 2012 to investigate fasttrack rehabilitation concept in terms of a measurable effect on the early recovery after total knee arthroplasty tka. Regarding rehabilitation setting, home and clinicbased rehabilitation protocols have. To evaluate the effectiveness and safety of technologyassisted rehabilitation following total hipknee replacement thrtkr.
Pathwaycontrolled fasttrack rehabilitation after total. Also, obtain a copy of the operative report from the surgeon. Immediate postoperative phasedays 110 goals active quadriceps muscle contraction safe isometric control, independent ambulation passive knee extension to 0 degrees knee flexion to 90 degrees or greater control of swelling, inflammation, and bleeding days 12 weightbearing. While multiple rehabilitation protocols have been suggested for tka. Homebased rehabilitation with a novel digital biofeedback. The intent of this physical therapy protocol is to provide the clinician with a guideline of the postoperative rehabilitation course. Early highintensity rehabilitation following total knee arthroplasty.