Joint Replacement - Physiotherapy Protocol
Preoperative physiotherapy
- Static quadriceps exercises
- Active knee bending
- Straight leg raising
Post operative physiotherapy
| Day of surgery |
Supports |
| Pelvic bridging exercises |
Compression Bandage |
| Ankle mobilization |
Knee immobiliser if fixed flexion present |
I POD
1. Continuous Passive Motion (CPM): 0-30° (If fixed flexion deformity present concentrate to get 0° extension)
2. Static quadriceps exercises Tubipress for foot and ankle if
3. Sit upto 90 deg edema present
4. Ankle mobilization
II POD
- CPM: 0-40 deg
- Sit with legs on chair with 2 pillows Hinged knee brace if
- Active with assisted knee flexion and a. Severe varus/valgus preoperatively
extension exercises b. Revision TKR
- Stand Full weight bearing with frame
- Walking Full weight bearing with frame
III POD
1. Active knee bending from edge of the couch
2. CPM 0-50 deg
3. FWB walking – twice daily
4. Static quadriceps exercises
5. Ankle mobilization
IV day
Continue the same exercises (CPM 0-70 deg)
V day
Continue the same exercises (CPM 0-70 deg)
Active knee flexion 90 deg
VII day
Surgery for opposite knee if bilateral. If not,
1. FWB with frame (thrice daily)
2. Sitting on the Chair
10th day
1. Continue the same exercises
2. Discharge
Discharge advice :
Exercises program:
i. Sitting position : Static Quadriceps exercises
Under the knee put one towel (rolled) press the towel and hold it for
10 seconds and relax. Do 10 times every one hour in the day time
ii. Sitting position (Ankle mobilization )
Do ankle up and down 10 times every one hour in the day time
iii. Lying position : (SLR)
Do straight leg raising
Morning and afternoon and evening 5 to 10 times
iv. Lying position
Do active knee flexion extension exercises (morning and afternoon and evening 5 to 10 times
v. Knee bends in the chair
Sit in a chair on edge of the couch
Active knee flexion and extension exercises
Do 10 to 15 times every 3 hours once in the day time
Discharge advice:
- Sit 90 deg with legs hanging
- Walk FWB with / without knee brace with walker
- Use western toilet or chair commode
- To do active knee bending exercises
- Static quadriceps exercises
- Straight leg raising
- Active ankle mobilization exercises
- To take bath after 3 days of wound is healed well ( to discuss with your doctor)
- To wear crepe bandage for both knees
- To continue knee brace if specifically instructed to do so by your doctor.
Review at one month post discharge Review at 3 months
- Walk without support/ elbow crutches Walk unlimited
- Continue static quadriceps exercises Climb stairs without support
- Active knee bending exercises Can bend down to pick up object from floor
- Straight leg raising Can travel outstation in car/train/flight
- Stair climbing
- Outdoor walking
- Can sleep on the sides and prone
TOTAL KNEE REPLACEMENT
Do’s |
Don’ts |
Do sit on high chair |
Do not sit on low chairs and sofas |
Use western closets which is seated at higher
Level
|
Never use Indian closets (toilet) |
Please ensure to tell about knee replacement
In every hospital visiting including dental
Extraction |
Do not sit on floor |
Make sure you get antibiotic prophylaxis
Whenever necessary |
Do not squat or sit cross legged |
Note
To report immediately if there is severe pain, redness, swelling in the operated knee joint or fever
The surgery has the risks of bleeding, blood clot formation, and injury to nerves and vessels, all of which can result in the most severe cases in loss of the limb or life. The most recent data suggests that artificial knee joint components should have a life span between ten and twenty years. The components can be replaced if they wear out. However, in general, the best results come from the first operation.
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