REHABILITATION FOLLOWING TOTAL KNEE ARTHROPLASTY

This protocol is to be used as a guideline. The program should be tailored to each patient individually, based on their age and health status.

WEEKS 0-2

GOALS:
1. Decrease pain and swelling.
2. Ability to perform quad sets, SLR with calf touch.
3. Independent with exercise program.
4. 0 extension passively.
5. 90 flexion passively.

NOTE: Terminal extension to 0 is key on ROM goals. Therefore, elevation of the leg will be accomplished by putting a pillow or roll under the heel of the foot, never under the knee, to assist in reducing swelling and in an attempt to maintain full terminal extension during early rehabilitation.

EXERCISES:
1. Continuous passive motion (CPM) machine for flexion and extension
2. Ankle pumps and circles with heel elevated.
3. Sitting swings over side of table
4. Heel slides with towel assist.
5. Gluteal sets with heel elevated
6. Patella mobilizations, superior and inferior
7. Quad sets with heel elevated
8. Towel crush exercises
9. Short arc with small towel roll
10. SLR in all directions, forward lift position attempt calf touch on return to table
11. Prone hangs with passive stretch for extension
12. Wall slides and/or sitting knee flexion stretch
13. Prone and standing hamstring curls
14. Gait training with emphasis on heel strike with crutches or walker
15. Ice and modalities for pain and swelling.

WEEKS 2-4

GOALS:
1. Full extension activity.
2. 100 or greater of knee flexion.

EXERCISES:
1. Continue with all above exercises
2. Emphasize active and passive extension, supine and prone lying, and utilize mechanical advantage machine in the sitting position.
3. Continue with knee flexion ROM sitting, chair facing wall, Thera -Band assistance at end of mat table, sitting off mat table to stool or lowering self in a sitting position on steps.
4. Begin hydrotherapy program when wound closed to assist in regaining proprioception balance, strength and ROM.
5. Thera-Band terminal extension exercises supine, with Thera-Band press backs, prone with quad terminal extension press backs, supine Thera-Band leg press, standing press back and step-outs, prone lying knee supported flare kicks.
6. Manual resistive exercises for flexion and extension.
7. Hamstring curls for strengthening of flexion in the prone and standing positions, lower extremity strengthening including quarter squats, calf raises, and then with bicycle for ROM front to back to full circumference, lower extremity stretching of hamstrings, quads, hips flexors, adductors, ITB, and gastrocs avoiding stressors across the joint.
8. Weight shift activity, balance activity including single leg and then single leg with Thera-Band kicks in 4 directions, progressing from parallel bars to independent home program anticipation.
9. Closed kinetic chain lateral step-ups, forward step-ups.

WEEKS 4-6

GOALS:
1. Full extensions, active and passive.
2. 110 or greater of knee flexion.
3. Discontinue use of assistance devices.

EXERCISES:
1. Continue with above exercise program.
2. Add Body Masters leg extension, leg curls, leg press, and Biodex utilizing both isotonic and isokinetic strengthening.
3. Gait training progressions for independent ambulation including increased proprioception drills.

WEEKS 6-12

GOALS:
1. Full extension, active and passive.
2. 120 or greater of knee flexion.
3. Independent ambulation without assistive device and ability to perform ADL’s without assistance.

EXERCISES:
1. Continue exercises above.
2. Progress with gait training activities
3. Add functional training and increase complexity of proprioception walking drills.