This document, authored by Jared T. Lee, MD, outlines a rehabilitation plan for patients following a Total Knee Arthroplasty (TKA).
The document is divided into three phases:
- **Phase 1 (Weeks 0-2):** Focuses on reducing swelling and edema, minimizing pain, improving range of motion (ROM), preventing Deep Vein Thrombosis (DVT), and achieving independent ambulation. It includes weight-bearing as tolerated (WBAT), wearing Ted hose, and restrictions on driving until off narcotics. Therapeutic exercises include edema control, ROM restoration, NMES, isometric quadriceps strengthening, heel slides, straight leg raises (SLR), ankle pumps, stationary biking (no resistance), core strengthening, manual patellar and tibiofemoral mobility, and modalities as needed.
- **Phase 2 (Weeks 3-6):** Continues the goals of Phase 1, aiming for 0-120 degrees ROM and independence in Activities of Daily Living (ADLs). Restrictions remain WBAT and no driving until off narcotics. Therapeutic exercises progress to include single-leg balance, step-ups (forward and side), prone hamstring curls, heel raises, aquatic therapy (once the incision is healed), and focus on knee ROM, gait normalization, and hip strengthening and stability. Light swimming is allowed (no flip turns or breaststroke).
- **Phase 3 (Weeks 7-12):** Aims for full ROM, minimal pain, increased resistance exercises, and normalizing postural/pelvic and lower extremity control. Exercises progress to wall squats, mini lunges, single-leg step-ups and step-downs, 4-way hip exercises, leg press, open-chain knee exercises, advanced balance progressions, core strengthening, sport-specific tasks as indicated, and plyometric and agility drills. Discharge criteria include surgeon clearance, specific hamstring and quadriceps strength indices, Y-Balance anterior reach measurement, and no complaints of pain or instability.
The protocol provides details about restrictions, goals, and therapeutic exercises for each phase, with a progression from initial post-operative care to a return to activity and sports-specific tasks as appropriate.
