Joint Replacement Exercise Prescription

Question 1

Importance of Exercise Post-Op

Answer 1

Minimizes disability
Pain reduction
Decreases risk of DVT and other negative effects of immobilization.
Restore ROM, strength, mobility (counteract muscle atrophy).
Improve QoL and function.
Return to ADLs and recreational activities.

Question 2

Recommended Post Acute Rehab After THR/TKR

Answer 2

Strength training, home exercise, dynamic balance, stair climbing, STS.
Gait training: correct use of walking aid, correction of altered gait pattern.
Ice.
Manual therapy.
Patient education: monitoring for complications, position/movement restrictions.

Question 3

Dosage

Answer 3

Frequency: 3-4 x per day.
Reps: 8-12
Sets: 1-4
Rest: 2-3 minutes

Question 4

TKR - Early Phase Goals

Answer 4

Control pain/swelling (ice/compression).
Gait with appropriate walking aid. Prevent complications (DVT).
90° flexion, full extension the aim.
1-4 weeks.

Question 5

TKR - Late Phase Goals

Answer 5

Full active knee ext. At least 110° knee flexion. (4-8 weeks)
Resume normal activities. (>8 weeks)

Question 6

TKR - Muscles presenting strength deficit

Answer 6

Quads, hamstrings, hip ext. hip abd. calf muscles.
STS can be altered (using more hip flexors, extensors)

Question 7

TKR - Early Phase Exercises

Answer 7

Ankle pumps (prevent DVT)
AROM knee flexion (to increase knee flexion)
Passive knee extension.
Isometric quads.
Static hamstrings.

Question 8

TKR - Intermediate Phase Exercises (2-3 weeks post op)

Answer 8

Mini squats (quad strength)
Heel raises (calf strength)
AROM knee flexion in standing.
Single leg stance (balance, proprioception)

Question 9

THR - Muscle deficits

Answer 9

Abductors (glut med, min, TFL)
Extensors (glut max, hamstrings)

Question 10

THR - Standard Physiotherapy

Answer 10

Strengthening of hip abd and ext.
Strengthening of hip and knee flexors.
Education on hip precautions and exercise progression.
Gait retraining, stairs practice.
ROM for hip abd, ext, flex.

Question 11

THR - Maximum protection phase (1-4 weeks)

Answer 11

Prevent DVT, dislocation.
Ankle pumps
Deep breathing exercises
Patient education (hip precautions)
Bed exercises (AAROM, AROM, static exercises)
Hip knee strengthening in standing (no resistance)
Trunk stability and Balance

Question 12

THR - Moderate Protection (4-8 weeks)

Answer 12

Regain strength (hip abd, ext.)
Restore ROM
Improve cardiopulmonary endurance
Aim for 30 min walk 2-4/week.
Trunk stability and balance.
Gait training and functional mobility (progression to 1 crutch and then to none).

Question 13

THR - Minimum Protection (12 weeks post op)

Answer 13

Return to functional activities.
Task specific exercises.
Advanced proprioception and balance exercises.

Question 14

THR - Early Phase Exercises

Answer 14

Hip abd supine, standing. (increase strength + ROM)
Heel slides. (increase ROM)
Hip flex in standing (not above 90°!)
SLR
Static glute

Question 15

THR - Moderate prot. Exercises

Answer 15

Mini squats
Hip abd side lying (> 6 weeks)