PRE-OPERATIVE VISIT FOR KNEE REPLACEMENT with Dr. LaReau PATIENT NAME: D.O.B.: DIAGNOSIS: L / R Knee Pain (Pre-op TKA visit) DATE of SURGERY: SUBJECTIVE: Knee Outcome Survey Activities of Daily Living: Percentage: % Knee Pain: /10 OBJECTIVE: AROM Knee Flexion AROM Knee Extension Quadricep Strength RIGHT LEFT Single leg stance: (average of 3) Eyes open: seconds seconds Eyes closed: seconds seconds Timed up and go: Gait training: fit to pt, gait and stair train, vend appropriate device Immobilizer: educate in wear for two weeks post op at night time and thereafter if needed per MD, fit to patient, and vend Review and provide MD instructions and home modifications (see attached) Review and practice home exercises
SHORT TERM GOALS: Immobilizer has been fit to patient and vended. Patient is independent in don and doffing Pt. is able to walk 100 feet with RW / walker / crutches safely without loss of balance. Pt. is able to walk up and down 4 steps with device independently. Pt. has been educated in HEP, importance of regaining knee ROM, and has practiced each exercise. Handout was given Reviewed post-op instructions, patient given handout for home review Home modifications have been reviewed with patient and recommendations have been given (see handout) RANGE OF MOTIONS GOALS i. EXTENSION 1. 1 week post op: 10-0 degrees 2. 2 weeks post op: 5-0 degrees 3. 4 weeks post op: 0 degrees 4. 6 weeks post op: 0 degrees 5. ** Extensionator brace will be given to you if your motion is greater than 10 degrees short of extension at 2 weeks and 5 degrees short of full extension at 4-6 weeks post operatively ii. FLEXION 1. 1 week post op: 90 degrees 2. 2 weeks post op: 100 degrees 3. 4 weeks post op: 110 degrees 4. 6 weeks post op: 120 degrees 5. **Flexionator brace will be given to you if your flexion is less than 90 degrees at 4-6 weeks post operatively
ASSESSMENT: Patient has completed pre-operative knee visit where objective measures were taken,immobilizer was fit to patient and vended, patient was gait and stair trained using appropriate device which was fit to patient and vended, patient became familiar with MD post-operative instructions, home exercises to perform prior and after surgery, along with home modification handout was reviewed and provided for home review. PLAN: Patient is being discharged from PT secondary to successfully completing pre-op visit, now awaiting surgical procedure. Signature: Date: Therapist printed name:
HOME EXERCISES TO BE PERFORMED PRIOR TO AND AFTER SURGERY KNEE FLEXION STRETCHING - Sitting in chair bend surgical knee as far as you can. - Lift leg with hands and bend knee further - Should be a gentle stretch; 60 sec hold 10x. Gradually bending knee further each
- Lying on back holding a bath towel wrapped around knee - Bend knee using the towel until you feel a stretch - Hold 60 seconds, perform 10 times - Seated on the edge of a stable chair - Using your good leg bend the surgical knee - Hold for 60 seconds, perform 10 times
- Lying on bed or couch pushed along wall, feet on wall - Bend surgical knee with non-affected leg, gliding feet along wall until feel of stretch in surgical knee - Hold 60 sec. (Should be a gentle stretch). Perform 10x, each time trying to gain more knee Bend - To return to resting position. Lift feet off of the wall. Using good leg, hooked under surgical ankle, straighten surgical knee returning to resting position.
KNEE EXTENSION STRETCHING - Lying on back with surgical ankle propped on towel roll or pillow or couch arm - Relax the knee into straightened position - Gradually increase hold as tolerated, 3-15 minutes -Seated with surgical foot propped on another chair - Surgical knee usupported in straightened position - Gradually increase hold as tolerated, 3-15 minutes Be sure the foot and ankle are relaxed for both exercises to allow the best stretch in the knee
QUADRICEPS STRENGTHENING - Lying on back with towel roll under surgical knee - Push knee into towel activating quadriceps (thigh muscle) - Hold for 10 seconds, perform these 2 sets of 15 repetitions - Be sure the foot/ankle are relaxed and you are not using your glut/buttock - Same exercise in standing with towel or ball along the wall
HOME MODIFICATIONS FOR KNEE SURGERY Suggestions to prepare your home prior to surgery FLOORS q Pick up throw rugs and make sure there is no clutter on the floor. LIGHTING q Make sure you have appropriate lighting especially at night. q Sylvania Dot-it LED light purchased at Home Depot (Battery operated stick on wall tap light) q Night-light in bathroom BATHROOM q Bathroom: Remove rugs, have appropriate lighting and night-light, place bath and shower safety tread in base of tub q Purchase medical equipment prior to surgery if recommended by MD or PT. See equipment below. q Consider installing a hand held shower head for increased ease of showering. q Use a chair with a back support for getting ready in am. (drying hair, shaving,.) SHOES q Use a slide in shoe with a proper heel cup (e.g. no sandals). KITCHEN q Cupboards: Organize easy to reach shelf in kitchen. Stock up on frozen / easy preparation foods CLOTHES q Loose fitting workout pants will be the easiest to get on and off Post-Op Equipment ( assistance to obtain these will be provided to you in the hospital) q Shower Safety Tread q Hand held shower head q Shower Stool *Home Depot has all the above equipment. This is just a suggestion. One can check with a local medical device supply company if they choose or discuss any needs with a social worker at the hospital.
Knee Outcome Survey-Activities of Daily Living Scale Irrgang JJ, Snyder-Mackler L, Wainner RS, Fu FH, Harner CD. Development of a patient-reported measure of function of the knee. Journal of Bone & Joint Surgery - American Volume 1998; 80-A (8):1132-1145. PATIENT NAME: DATE: / / Instructions: The following questionnaire is designed to determine the symptoms and limitations that you experience because of your knee while you perform your usual daily activities. Please answer each question by checking the one statement that best describes you over the last 1 to 2 days. For a given question, more than one of the statements may describe you, but please mark only the statement which best describes you during your usual daily activities. Symptoms: To what degree does each of the following symptoms affect your level of daily activity? (Check one answer on each line) I Do Not Have the Symptom (5) I Have the Symptom But It Does Not Affect My Activity (4) The Symptom Affects My Activity Slightly (3) The Symptom Affects My Activity Moderately (2) The Symptom Affects My Activity Severely (1) The Symptom Prevents <e From All Daily Activities (0) Pain Stiffness Swelling Giving Way, Buckling or Shifting of Knee Weakness Limping
Functional Limitations with Activities of Daily Living: How does your knee affect your ability to? (Check one answer on each line) Activity is Not Difficult Activity is Minimally Difficult Activity is Somewhat Difficult Activity is Fairly Difficult Activity is Very Difficult I am Unable to Do the Activity Walk Go up stairs Go down stairs Stand Kneel on the front of your knee Squat Sit with your knee bent Rise from a chair 1). How would you rate the current function of your knee during your usual daily activities on a scale from 0 to 100 with 100 being your level of knee function prior to injury and 0 being the inability to perform any of your usual daily activities? 2). How would you rate the overall function of your knee during your usual daily activities? (Please check the one response that best describes you) Normal Nearly normal Abnormal Severely abnormal
3) As a result of your knee injury, how would you rate your current level of daily activity? (Please check the one response that best describes you) Normal Nearly normal Abnormal Severly abnormal SCORE: Symptoms: + Activities of Daily Living: = divided by 70 if all answers are completed. (65 if missing 1) %