Total knee arthroplasty

Question 1

Indication for TKA

Answer 1

OA
Inflamed synovium (rheumatoid arthritis)
Post traumatic arthritis

Question 2

TKA rehab phase 1 goals

Answer 2

1-2 weeks

Control postoperative swelling
Minimize pain
Knee range of motion 0-90°
muscle strength 3 to 4/5
ambulation with or without use of an AD
Establish home exercise program

Question 3

Phase 1 interventions

Answer 3

passive range of motion as indicated
Ankle pumps to reduce risk of DVT
Bed mobility and transfers
Heel slides in supine or sitting
Muscle setting exercises quad sets
Gravity assisted knee extension in supine
NMES
gentle stretches for hamstrings calf and IT band
Compression to control effusion
Pain modulation modalities
gait Training
Manual therapy

Question 4

phase 2 rehab goals

Answer 4

3-6 wks

Diminish swelling and inflammation
increase ROM 0-115
Increased weight-bearing tolerance
Muscle strength 4-5/5
Return to functional activities
Adhere to home exercise program

Question 5

phase 2 interventions

Answer 5

Incision mobilization after suture removal
Progressive, passive stretches
Stationary bike or peddler
Pain-free progressive resisted exercise
Proprioceptive training
Manual therapy
Closed, kinetic chain, strengthening, mini squats
gait training
Protective, progressive aerobic exercise, like cycling without resistance, walking or swimming

Question 6

phase 3 goals

Answer 6

6 weeks and beyond

progress ROM 0-115° to a functional range for patient
Enhance strength and endurance and motor control
Increase cardiovascular fitness
Develop maintenance program and educate patient on importance of adherence and joint protection

Question 7

phase 3 exercises

Answer 7

continue interventions of previous phase advance as appropriate

Implement exercise is specific to functional tasks

Improve cardio, respiratory and muscle endurance with bicycling walking or aquatic programs

Question 8

Red flags with TKA rehab

Answer 8

DVT
Pulmonary embolism
Infection
-Fever, chills, redness, tenderness, swelling drainage