knee- osteoarthritis- total knee arthroplasty
This document provides a detailed, phase‑based rehabilitation protocol for patients after total knee arthroplasty (TKA). It is organized into four sequential phases: (I) Immediate Post‑operative (Days 1‑10), (II) Motion Phase (Weeks 2‑6), (III) Intermediate Phase (Weeks 7‑12), and (IV) Advanced Activity Phase (Weeks 14‑26). For each phase the protocol lists specific goals (e.g., quadriceps activation, ROM targets, swelling control, functional return), criteria required to progress to the next phase, weight‑bearing instructions, use of modalities such as continuous passive motion (CPM), cryotherapy, compression, and a progressive exercise regimen that evolves from basic isometric and range‑of‑motion activities to functional strengthening, pool work, and sport‑specific drills. The document emphasizes safe ambulation, independent transfers, and gradual increase of strength, endurance, and cardiovascular fitness, culminating in a return to recreational sports for selected patients.
Topics
Immediate Post‑operative Phase (Days 1‑10): Foundations of Quadriceps Activation and Swelling Management
Outlines goals, weight‑bearing status, CPM settings, ROM limits, cryotherapy use, and a core set of early exercises (ankle pumps, quad sets, straight‑leg raises, electrical stimulation, passive knee extension, hamstring stretch).
Criteria for Advancing from Immediate Post‑operative to Motion Phase
Specifies functional thresholds required to move to Phase II: leg control with SLR, active ROM 0‑90°, minimal pain/swelling, and independent ambulation/transfers.
Motion Phase (Weeks 2‑6): Expanding ROM, Strength, and Functional Mobility
Details Phase II goals, weight‑bearing guidance, and a two‑segment exercise progression (Weeks 2‑4 basic strengthening and ROM; Weeks 4‑6 addition of step‑ups, lunges, pool program). Includes continued modalities (cryotherapy, compression) and discontinuation of TEDS hose.
Intermediate Phase (Weeks 7‑12): Advanced Strength, Eccentric Control, and Cardiovascular Conditioning
Presents Phase III goals, entry criteria (ROM ≥110°, voluntary quad control, independent ambulation), and exercise progression that adds progressive walking, endurance pool work, lunges, half‑squats, and higher step‑up heights, emphasizing eccentric/concentric knee control.
Advanced Activity Phase (Weeks 14‑26): Return to Sport and Full Functional Independence
Describes Phase IV goals, entry criteria (full painless ROM 0‑115°, strength 4+/5 or 85% of contralateral limb, minimal pain/swelling), and a comprehensive exercise set (quad sets, SLR, hip abduction/adduction, half‑squats, lateral step‑ups, bike for ROM/endurance) plus gradual re‑introduction to golf, tennis, swimming, cycling, and walking.
Weight‑Bearing and Mobility Guidelines Across Rehabilitation Phases
Summarizes the progression from walker/crutches WBAT in Phase I, to assisted device WBAT in early Phase II, to unrestricted weight‑bearing as tolerated in later phases, linking mobility status to functional goals.
Modalities for Swelling and Inflammation Control
Covers consistent use of cryotherapy (continuous unit or hourly ice), compression, and elevation throughout all phases, and the timing of discontinuation of certain modalities (e.g., TEDS hose).