Exercise prescription following joint replacement

Question 1

Which are the most commun?

Answer 1

Knee & Hip replacement (around 1 million each)

Question 2

Who is affected by those surgeries

Answer 2

• Women>Men <=> OA is higher in women
• <65 yo

Question 3

Why is it important to do exercise post surgery?

Answer 3

• Pain reduction
• To minimize disability
• Restore ROM, function, strengh, mobility
• Encourage mvt & decrease risk of DVT

Question 4

Rehabilitation phases

Answer 4

1. Early phases
2. Late phase

Question 5

Early phase for THR

Answer 5

2-16 weeks

Question 6

Early phase for TKR

Answer 6

3-16 weeks

Question 7

Late phase for THR

Answer 7

12 weeks to 8 months

Question 8

Late phase for TKR

Answer 8

12 weeks to 12 months

Question 9

What’s the average hospital length of stay after surgery?

Answer 9

5 to 6.50 days (UK)

Question 10

How to assess the pain during exercise?

Answer 10

Numeric pain rating scale

Question 11

What are the reccommended post acute rehab interventions?

Answer 11

• Therapeutic & functional exercises
• Gait traaining
• CV training
• Electrical/thermal modalities
• Manual therapy
• Patient education topics

Question 12

Dosage for exercises

Answer 12

Frq : 3-4 x/day
Reps : 8-12
Sets : 1-4
Rest : 2-3 min between sets
-> Incr. as rehab stages progress

Question 13

Exercise prescription for TKR

Answer 13

• Activity based focused
• Early mobilization
• Standart physiotherapy

Question 14

Early goals for TKR

Answer 14

• Control pain/swelling
• Gait w/ appropriate gait aid
• Prevent medical complication
• 90° flexion & full extension!!

Question 15

Late goals for TKR

Answer 15

• Full active knee extension
• Knee flexion at least 110° (functional range?)
  -Resume o f normal activities

Question 16

Common strength deficits after a TKR

Answer 16

-quads/hamstrings
-hip flexors/add
-calf muscles (2ndary to long term gait deviation)

Question 17

Which function are difficult after a TKR?

Answer 17

Sit-to-stand -> using hip flexors & extensors to compensate

Question 18

How much time is needed to regain post-op strength? (TKR)

Answer 18

3-6 months (quads & hamstrings)

Question 19

When to start rehabilitation after TKR?

Answer 19

Soon after surgery (early bed exercises for day 1 post op++)

Question 20

Examples of exercises for early stage of rehab in TKR

Answer 20

• Ankle pumps
• Isometric quads
• AROM knee flexion
• Static hamstrings
• Inner range quads
• Passive knee extension
  -Passive knee extension w/pt supine

Question 21

Exemples of intermediate exercise in TKR
(2/3 weeks post op)

Answer 21

• Mini squats
• Heel raises
• AROM knee flexion standing
• Single leg stance balance
• Single heel raise
• Step ups/downs