Exercise Prescription Following Joint Replacement

Question 1

Give the timing of early phase rehab for THR

Answer 1

2-16 weeks

Question 2

Give the timing of early phase rehab for TKR

Answer 2

3-16 weeks

Question 3

Give the timing for late phase rehab in THR

Answer 3

12 weeks to 8 months

Question 4

Give the timing for late phase of rehab in TKR

Answer 4

12 weeks to 12 months

Question 5

Give examples of outcome measures after TKR and THR

Answer 5

Numeric Pain rate scale
Goniometry for AROM (especially in TKR)
Gait visual observation $
Tredelenburg’s test
Manual muscle testing

Question 6

What are the post acute rehab interventions recommended after THR and TKR ?

Answer 6

• Therapeutic and functional exercises : strength training (TKR), stretching (THR), home exercises, dynamic balance, stair climbing, rising/lowering to chair etc.
• Gait training : correct use/progression of walking aids, ensure proper weight bearing status on operated extremity, etc.
• Cardio vascular training
• Electrical/thermal modalities (eg: icing)
• Manual therapy
• Patient’s education : monitoring for complications, positions/movements restrictions

Question 7

What were the findings of research as to the difference between one on one and group cessions ?

Answer 7

No difference in gait and self reported function

Question 8

What is the dosage of exercise for inpatients

Answer 8

Same as outpatients :

Timing: starting day 1 post op (or else according to surgeon’s notes)
Frequency: 3-4 times a day
Reps: 8-12
Sets: 1-4
Rest: 2-3 mn between sets
Progression : progressive loading according to goals

Question 9

What is the dosage of exercise for outpatients ?

Answer 9

Same as inpatients:

Timing: 1 week after discharge
Frequency: 3-4 times a day
Reps: 8-12
Sets: 1-4
Rest: 2-3 mn between sets
Progression: progressive loading according to goal

Question 10

What are the basic characteristics of TKR rehab ?

Answer 10

• activity base focus
• early mobilization
• lack of evidence as to which type of exercise is the best
• standard physiotherapy

Question 11

What are the early phase goals in TKR ?

Answer 11

• Control pain and swelling (ice and compression)
• Gait with appropriate gait aid device
• prevent complications (eg: deep vein thrombosis)
• achieve 70° to 90° of flexion and full extension
• education patient

Question 12

What are the late goals of TKR rehab ?

Answer 12

• achieve full active knee extension
• achieve full active knee flexion (110°)
• resume normal activities