Total knee replacement rehab protocol
- All times are to be considered approximate, with actual progression based upon clinical presentation.
- 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.
- 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 until stitches are removed.
- Regular manual treatment should be conducted to the patella and all incisions so they remain mobile.
- Early exercises should focus on recruitment proper quadriceps set.
- No resisted leg extension machines (isotonic or isokinetic) at any point in the rehab process.
Week 1
- M.D./nurse visit after hospital discharge to change dressing and review home exercise program.
- Icing, elevation, and aggressive edema control (i.e. circumferential massage, compressive wraps).
Manual
- Soft tissue treatments and gentle mobilization to the posterior musculature, patella, and incisions to avoid flexion or patella contracture.
Exercises
- Initiate quadriceps/ gluteal sets, gait training, balance/ proprioception exercises.
- Straight leg raise exercises with proper quad set (standing and seated).
- Passive and active range of motion exercises.
- Well leg cycling and upper body conditioning.
Goals
- Decrease pain and edema.
- Range of motion <90 degrees (until stitches removed).
Weeks 2 - 4
- Nurse visit at 14 days for stitch removal and check-up.
Manual
- Continue with soft tissue treatments and gentle mobilization to the posterior musculature, patella, and incisions to avoid flexion or patella contracture.
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
- Decreased pain and edema.
- Range of motion < 10 degrees extension to 100 degrees.
Weeks 4 - 6
- M.D. visit at 4 weeks.
Manual
- Soft tissue treatments and gentle mobilization to the posterior musculature, patella, and incisions to avoid flexion or patella contracture.
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).
- Pool work outs once incisions completely closed.
Goals
- Gait without a limp.
- Range of motion < 5 degrees extension to 110 degrees.
Week 6 - 8
Manual
- Continue soft tissue treatments, joint mobilizations, patellar glides to increase range of motion.
Exercises
- 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
- Patients should be walking without a limp.
- Range of motion should be 0 to 115 degrees.
Weeks 8 - 12
Manual
- Continue soft tissue treatments, joint mobilizations, patellar glides to increase range of motion.
Exercises
- 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
- Range of motion with-in functional limits.
- Return to all functional activities.
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.
