NPTE FF: REHAB PROTOCOLS Flashcards
Hip Arthroplasty
ANTERIOR/ANTEROLATERAL THA
Dislocation precautions to AVOID:
- AVOID hip flexion > 90degs
- AVOID hip ext, add, ER past neutral
- AVOID combo of abd/flex/ER
Overall LOWER dislocation risk vs Posterior approach
Hip Arthroplasty
POSTERIOR/POSTEROLATERAL THA
Dislocation precautions to AVOID:
- AVOID add past neutral
- AVOID hip IR past neutral
- AVOID hip flex >90 degs
HIGHEST risk for dislocation
Hip Arthroplasty Protocols
Phase I: MAX PROTECTION
Remember your “Rule of 6”
- Education to pt/caregiver to avoid precautions
- Usually WBAT
- Ankle pumps prevent DVT
- Monitor for possible infx
- Maximimze functional mobility (bed mob, transfer training, approp trunk mechanics when sit to stand to avoid violating precautions
- Strengthen UEs
- Avoid hip flex contracture**
THA Protocols
Stage 2: Typ begins 4-6wks post-op
- Regain strenght/mm endurance
- Strengthen hip Abd’s and ER’s
- Improve CV/Pulm endurance
- Restore ROM w/in dislocation precautions
- Improve postural stab, balance, gait
THA Protocols
Stage 3: Begins around 12wks post-op
- Extended rehab/modify activities if necessary
- Ensure good strenght of hip Abd’s and ERs (mentioned in Stage 2 also
- RTS and higher lvl acts
Total Knee Arthro (TKA)
FACTS:
- Relatively HIGH success rate
- LOWER risk vs THA
- Usually WBAT UNLESS cementless fixation used (uncommon)
TKA Protocols
Stage I: Weeks 1-4
- Control post-op swelling
- Minimize pain
- Control for DVT + infx
- Inc ROM to 0-90 (EXT PRIORITY!!)
- 3/5 to 4/5 quad strength
- Amb w/ or w/out AD
- Establish HEP**
Interventions:
- Ankle pumps, Quad/HS/Abd/Add setting, Gait, Patellar mobs
TKA Protocols
Stage II: Weeks 4-8
- Reduce swelling
- ROM 0-110
- 4/5 to 5/5 strength ALL LE mm’s
- UNrestricted ADL function
- Improve balance, functional mob, NMSK control
Interventions:
- Patellar mobs, LE stretching, CKC strength + PREs, Tibiofem jt mobs (if needed), proprio training, Aerobic ex (cycle, swim, walking)
TKA Protocols
Stage III: Week 8 onward
- Dev maintenance program
- Community amb
- Improve CV endurance/aerobic fitness
Interventions:
- SAME as stage II w/ progressions, Progress balance and adv’d functional acts, Ex’s specific to sport or higher lvl activity
Total Shoulder Arthro
All facts first…
MOST important thing to note w/ TSA is whether or not RTC repair performed
- If YES–> sling needed for @ least 4-6wks
- If NO–> sling weaned off same day as sx
2 most prominent forms of TSA:
1. INTACT RTC TSA
2. Reverse TSA
TSA
MOST important thing to note w/ TSA?
Whether or not RTC repair performed
- If YES, sling @ least 4-6wks
- If NO, sling weaned off same day as sx
2 most prominent forms of TSA?
- Intact RTC TSA
- Reverse TSA
INtact RTC TSA Protocols
Phase I: Weeks 0-4
- Elevation of arm restricted to < 120degs
- ER restricted < 30degs (w/ arm @ side)
- Grade I/II oscillations
- AROM scapular + elbow
PROM/AAROM - AAROM in supine first 3 weeks
- Week 4, transition to sitting/standing
- NO active IR for @ LEAST 6wks–protects subscap repair
- Pendulums + LIGHT NWB isometrics of shoulder mm’s in scapular plane
INtact RTC TSA Protocols
Phase II: Weeks 4-12
- Continue AROM
- NO GH EXT past neutral (up to 6wks)
- Gradually inc GH rotation
- GENTLE stretching after 6-8wks
- Improve function of RTC and scap stabilizers
- SUBmax iso’s of GH mm’s w/ LIGHT WB thru UE
- Delay resisted rotation for several weeks (if NON-intact RTC)
- Progress to low-resistance dynamic strength
INtact RTC TSA Protocols
Phase III: 12+ weeks
- Combined add/IR/Ext permitted
- Progress end range self stretches
- Progressive resistive ex’s in functional patterns
- CKC stabilization
