High tibial osteotomy physical therapy (Correction of bowlegs)

General considerations

  • Nonweightbearing status for 4 weeks post-op. After 4 weeks, partial weightbearing progressing to 50% as tolerated until 8 weeks.
  • Patients will be in a hinged rehab brace without range of motion restrictions for 4 weeks.
  • If associated meniscus transplant, then ROM at 30-70 degrees actively and passively for 4 weeks
  • It is imperative to avoid any valgus stress on the joint for 4-6 weeks post-op.
  • If associated meniscal transplant, patients will be instructed to come out of the brace once a day for gentle stretching into extension as tolerated to avoid a flexion contracture.
  • No resisted leg extension machines (isotonic or isokinetic).
  • Regular manual treatment should be performed to decrease the incidence of fibrosis.
  • No high-impact activities for 4 months post-op.
  • Use of a CPM for 6 hours a day for 4 weeks if associated articular cartilage grafting. This is for cartilage healing only and not as much for increasing range.
  • M.D. follow-up visits at Day 1, Day 8-10, 1 month, 4 months, 6 months, and 1 year post-op.
  • Use of bone stimulator 30 minutes per day for 3 months unless otherwise instructed.

Week 1

  • M.D. visit day 1 post-op for dressing change and home exercise review.
  • Icing and elevation with ankle pumps all day long. Gait training based upon weightbearing status.

Exercise

  • Isometric quad, hamstring, gluteal and adduction sets. Cautious passive range of motion exercise.
  • Straight leg raises into flexion and extension only for 4 weeks. No abduction or adduction for 4 weeks.
  • Hip, abdominal, and foot/ankle exercises, well-leg stationary cycling, and upper body conditioning.

Manual

  • Soft tissue treatments to decrease edema and for pain control. Electric stimulation for muscle reeducation.

Goals

  • Decrease pain, edema.
  • Gait non-weightbearing X 4wks.

Weeks 2 - 4

  • M.D. visit at 8-10 days post-op for suture removal and check-up.
  • Hip exercises (active or manual/PNF patterns), increasing intensity isometrics, lower extremity exercises, active-assisted range of motion exercises.
  • Continue with soft tissue treatments, pain control, modalities as needed.
  • Cardiovascular conditioning (i.e. well-leg stationary bike, UBE, pool workouts).

Goals

  • Decrease pain, edema.
  • Gait non weightbearing X 4wks.

Weeks 4 - 6

  • M.D. visit at 4 weeks post-op; will progress to partial weightbearing and wean off the use of rehab brace.
  • Continue with soft tissue treatments and stretching for range of motion and improving scar mobilization.
  • Continue increasing functional exercises (i.e. squats, modified/step lunges, light Shuttle/leg press).
  • Stationary bike with both legs as tolerated.

Goals

  • Gait partial weightbearing 20-50%.
  • Initiate stationary bike.

Weeks 6 - 8

  • Increasing intensity functional and closed-chain focused exercises (i.e. adding light resistance).
  • Patients should be walking without a limp and range of motion should be at 80%.

Goals

  • Gait partial weightbearing 20-50%

Weeks 8 - 16

  • Full knee range of motion.
  • Cautiously add lateral training exercises.
  • Low impact activities until 16 wks. Progress to home program focusing on sport/activity-specific exs.

NOTE: All progressions are approximations and should be used as a guideline only. Progression will be based on individual patient presentation, which is assessed throughout the treatment process.


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