Unicompartmental (partial knee) replacement rehab protocol
- All times are to be considered approximate, with actual progression based upon clinical presentation.
- Patients are full weight bearing with the use of crutches, a walker or a cane to assist walking until they are able to demonstrate good walking mechanics.
- Early emphasis is on achieving full extension equal to the opposite leg as soon as able.
- No passive or active flexion range of motion greater than 90 degrees for the first two weeks to avoid stress on sutures/stitches.
- No two-legged biking or flexion exercises for at least two weeks. Well-leg biking is okay.
- Regular manual treatment should be conducted to the patella and all incisions so they remain mobile.
- Early exercises should focus on recruitment of the quadriceps.
- No resisted leg extension machines (isotonic or isokinetic) at any point in the rehab process.
Week 1
- Nurse visit day 2 for dressing change.
- Icing, elevation, and aggressive edema control (i.e. circumferential massage, compressive wraps) for 15 minutes every 2 hours.
Manual
- Soft tissue mobilization to the surrounding and posterior musculature, and to the patella to avoid flexion or patella contracture.
- Focus on extension for knee range of motion.
Exercises
- Straight leg raise exercises (standing and seated), passive and active range of motion exercises.
- Initiate quadriceps gluteal sets, gait training, balance/proprioception exercises.
- Well leg cycling and upper body conditioning.
Goals
- Decrease pain/swelling.
- Passive range of motion <90 degrees (secondary to stitches) x 2 weeks.
- Full weight bearing.
Week 2 - 4
- Nurse visit at 14 days for suture removal and check-up.
Manual
- Continue soft tissue mobilizations, decrease edema/pain.
Exercises
- Continue with home program, progress flexion range of motion, gait training, soft tissue treatments, and Balance /proprioception exercises.
- Incorporate functional exercises as able (i.e. seated/standing marching, hamstring carpet drags, hip/gluteal exercises, and core stabilization exercises).
- Aerobic exercise as tolerated (i.e. bilateral stationary cycling as able, upper body ergometer).
Goals
- Decrease pain/swelling.
- Tolerate bilateral stationary cycling.
- Active range of motion 0-90 degrees.
Week 4 - 6
- M.D. visit at 4 weeks post-op.
Manual
- Continue soft tissue mobilizations, decrease edema/pain. Joint mobilizations for range of motion as needed.
Exercises
- Increase the intensity of functional exercises (i.e. progress to walking outside, introducing weight machines as able).
- Continue balance/proprioception exercises (i.e. heel-to-toe walking, assisted single leg balance).
Goals
- Normal gait pattern.
Week 6 - 8
- Add lateral training exercises (i.e. lateral steps, lateral step-ups, step overs) as able.
- Incorporate single leg exercises as able (eccentric focus early on).
Goals
- Active range of motion 0 to 110 degrees.
- Passive range of motion 120 degrees.
Week 8 - 12
- Completion of Sports Test I at 12 weeks.
- Begin to incorporate activity specific training (i.e. household chores, gardening, sporting activities).
- Low impact activities until week 12.
- No twisting, pivoting until after week 12.
- Patients should be weaned into a home/gym program with emphasis on their particular activity/sport.
Goals
- Road cycling.
- Walk downstairs with reciprocal gait.
- Full range of motion.
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.
