CENTER FOR ORTHOPAEDICS AND SPINE CARE PHYSICAL THERAPY PROTOCOL REHABILITATION FOLLOWING TOTAL KNEE ARTHROPLASTY BENJAMIN J.

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1 Immediate Pstperative Phase (Day 1 t 10) Gals: Day 1 t 2 Active quadriceps muscle cntractin Safe (ismetric cntrl), independent ambulatin Passive knee extensin t 0 degrees Knee flexin t 90 degrees r greater Cntrl f swelling, inflammatin, bleeding Walker/tw crutches WBAT CPM ROM 0-70 Crytherapy Cmmercial unit used cntinuusly r ice 20 min f each hur Ankle Pumps with leg elevatin Passive knee extensin exercise Electrical stimulatin t quads Straight leg raises (SLR) Quad sets Knee extensin exercise degrees Hamstring stretches (gentle) 20 t 70 degrees as tlerated Day 4 t 10 As tlerated Lake Frest

2 CPM ROM 0-90 Active assistive ROM knee flexin Ankle pumps with leg elevatin Passive knee extensin stretch Quad Sets Straight leg raises Hip abductin/adductin Knee extensin exercise 90-0 degrees Cntinue use f crytherapy 0 t 90 degrees as tlerated Gait Training Cntinue safe ambulatin. Instruct in transfers Mtin Phase (Week 2-6) Gals: Criteria t enter Phase II Leg cntrl, able t perfrm SLR Active ROM 0-90 degrees Minimal pain/swelling Independent ambulatin/transfers Imprve range f mtin Enhance muscular strength/endurance Dynamic jint stability Diminish swelling/inflammatin Establish return t functinal activities Imprve general health Lake Frest

3 Week 2-4 WBAT with assisted device Quad Sets Knee extensin exercise 90-0 degrees Terminal knee extensin 45-0 degrees Straight leg raises (flexin/extensin) Hip abductin/adductin Hamstring curls 1/4 Squats Stretching Hamstrings, Gastrcnemius, Sleus, Quads Bicycle ROM Stimulus Cntinue passive knee extensin stretch Cntinue use f crytherapy Discntinue use f TEDS hse at 2-3 weeks (physician's apprval) Week 4-6 Cntinue all exercises listed previusly Initiate: Frnt and lateral step-ups (minimal height) 1/4 frnt lunge Pl prgram Cntinue cmpressin, ice, elevatin fr swelling Intermediate Phase (Week 7-12) Gals: Prgressin f ROM (0 t 120 degrees and greater) Lake Frest

4 Enhancement f strength/endurance Eccentric/cncentric cntrl f the limb Cardivascular fitness Functinal activity perfrmance Criteria t enter Phase III Range f mtin degrees Vluntary quadriceps muscle cntrl Independent ambulatin Minimal pain/inflammatin Week 7-10 Cntinue all exercises listed in Phase II Initiate prgressive walking prgram Initiate endurance pl prgram Return t functinal activities Lunges, 1/2 squats, step ups (2" t start) Emphasize eccentric/cncentric knee cntrl Advanced Activity Phase (Week 14-26) Gals: Allw selected patients t return t advanced level f functin (recreatinal sprts) Maintain/imprve strength and endurance f lwer extremity Return t nrmal life style Criteria t enter Phase IV Full nn-painful ROM degrees Strength f 4+/5 r 85% f cntralateral limb Minimal t n pain and swelling Satisfactry clinical examinatin Lake Frest

5 Quad Sets Straight Leg Raises (flexin/extensin) Hip abductin/adductin 1/2 squats Lateral step ups Knee extensin exercise 90-0 degrees Bicycle fr ROM stimulus and endurance Stretching Knee extensin t 0 degrees Knee flexin t 105 degrees Initiate gradual glf, tennis, swimming, bicycle, walking prgram Cpyright 2004 by the Advanced Cntinuing Educatin Institute, LLC. All Rights Reserved. Any redistributin r reprductin f any materials herein is strictly prhibited. Lake Frest