Preoperative Instruction
Preoperative instruction improves postoperative outcomes, satisfaction, and surgical success for patients.
Preoperative physical therapy evaluation facilitates home exercise programs, including ROM and flexion exercises, strength training, and gait training with a walker. Because preoperative ROM is an important predictive target for postoperative ROM after TKA, preoperative ROM flexion and extension exercises are emphasized.
Preoperative training includes the overall goals of inpatient physical therapy, use of the CPM machine, early therapeutic protocols, functional progression, and use of mobility aids.
Phase I 1-7 days
Rehabilitation focuses on pain control, edema reduction, gradual flexion and extension of the knee
Ankle dorsiflexion and plantarflexion, quadriceps and gluteus isometric exercises
The CPM machine is used with an initial angle of 30 degrees, gradually increasing the angle, or under the direction of a physician, and can be discontinued after 2 consecutive days of active knee flexion over 90°.
Maintain passive extension position for 10-15 minutes each time, 4-6 times per day
Move the patella: push the patella up and down and left and right by hand, 4 times a day, 1 to 2 sets of 4 directions, 15 sets each.
Apply cold compresses to control swelling.
Phase 2: 2-3 weeks
Criteria.
The strength of the quadriceps is freely controlled and can do straight leg raises with relative ease
Able to fully passively straighten the knee joint
Passive flexion and extension of the knee joint to 0-90 degrees
Good patellofemoral movement
Reduced swelling of the knee joint
Treatment measures
Continue the above exercises
Increase prone knee flexion exercises after reaching 90 degrees of knee flexion
Terminal knee extension muscle strength exercises: knee extension in the range of near extension (0~20 degrees)
Strength exercises, 4 times a day, 1~2 sets of 20 each, with 2 minutes rest between sets
Resistance ankle plantarflexion training: against external resistance, toes are stepped down with force .
Knee mobility exercises: passive knee flexion 0~100 degrees, active knee flexion 0~80 degrees
Phase 3: 4-6 weeks
Standard: Active knee flexion and extension mobility 0~90 degrees
Further reduction of knee swelling
Treatment measures.
1, patella release
2. Passive knee flexion and extension mobility: 0~105 degrees, active mobility: 0~90 degrees;
3. Prone knee flexion and standing knee flexion exercises can be performed
4. Muscular strength training: 1.
1, straight leg raise: resistance can be resistance, resistance from 0.5 pounds (or 250 grams) gradually increased to 5 pounds (2.5 kg)
2, hip abduction, abduction, back extension resistance training: resistance from 0.5 pounds (250 grams) gradually increased to 5 pounds (2.5 kg)
3, micro-squat training (0 ~ 30 degrees), each lasting 30 seconds, each group of 20 repetitions, 3 groups per day
4.Weight-bearing and balance training: train under the guidance of the rehabilitation therapist. Partial weight-bearing training of the affected limb in the parallel bar (starting from 25%), weight shifting back and forth, left and right training
This is a rather idealized guideline, and the actual process can rarely be fully achieved on time, but it is a standard, and we are working towards it!