Weeks 1-4
- PROM/AAROM/AROM – stretching for flexion (>90°) and extension
- Stationary bicycle – partial revolutions, increasing to full revolutions, without resistance
- Isometrics – quadriceps, hamstrings, glutes
- SLR in 4 planes (flexion, abduction, adduction, extension)
- Patella femoral and tibial femoral joint mobilization as indicated
- Gait training with and without assistive device – weaning off between 2-4 weeks post-op
- Achieve full knee extension by week 4; notify surgeon if knee flexion contracture happening
Weeks 4-6
- Continue as above
- Add sit to stand and other chair exercises to increase flexion during functional activities
- Front and lateral step-ups and step-downs
Criteria for progression to next phase:
- AROM 0-110°
- Good voluntary control of quadriceps Independent ambulation without assistive device or gait abnormalities
- Minimal pain/inflammation
Weeks 7-12
- Progress current exercises by including resistance and increasing repetitions
- Provide open and closed chain exercises as appropriate
- Begin and progress balance and proprioception activities
Criteria for progression to next phase:
- AROM 0-115°
- 4+/5 MMT of all lower extremity musculature
- Minimal to no pain or swelling
Week 12-16
- Continue progression of current exercises
- Begin return to specific recreational activities: i.e. golf, walking, biking)
Criteria for discharge:
- Normal gait, not antalgic
- Independent with stairs, with step over step climbing
- Pain-free AROM
- Strength at least 4+/5 for all lower extremity MMT
- Normal, age-appropriate balance and proprioception
- Independent with home program
References:
Adapted from Total Knee Arthroplasty Protocol of Department of Rehabilitation Services, Brigham & Women’s Hospital, Boston, MA
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