Penrose Physical Therapy
Jan 2016
Jennifer Penrose
Jennifer Penrose

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

Adapted from Total Knee Arthroplasty Protocol of Department of Rehabilitation Services, Brigham & Women’s Hospital, Boston, MA

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