Physical Therapy Haven

Phase I: Immediate Post-Surgical Phase (Days 0-3)

• Goals: Perform bed mobility and transfers with least amount of assistance, ambulate with assistive device for 25-100 feet and ascend/descend stairs as appropriate, regain at least 80° of P/AROM knee flexion and less than or equal to -10° extension, independently perform SLR exercises 
• Precautions: WBAT w/ assistive device, monitor wound healing and signs of DVT and PE, no resistive exercises, avoid twisting motions across knee 
• Exercises: A/AA?PROM exercises, isometric quadriceps, hamstring, and gluteal exercises, gait and transfer training, SLR exercises, soft tissue massage
• Criteria to move to Phase II: Ability to perform SLR, AROM -10°-80°, independent in transfers and ambulation of at least 100 feet with appropriate device, minimal inflammation 

?Phase II: Motion Phase (Day 3 - Week 6)

• Goals: Improve AROM to at least 0-110°, discontinue assistive device use, return to functional activities, improve strength, endurance, and proprioception, decrease inflammation and swelling
• Precautions: Monitor wound healing and signs of infection, WBAT w/ assistive device as appropriate
• Exercises:
  • Weeks 1-4: AA/A/PROM, stationary cycling, SLR in 4 planes, progress quad/hamstring/gluteal isometric exercises, patellar and tibial-femoral mobilizations, gait training to wean off of assistive device
  • Weeks 4-6: Progress above exercises, initiate front and lateral step ups, 1/4 front lunges
• Criteria to move to Phase III: AROM 0-110°, good voluntary quad control

Phase III: Intermediate Phase (Weeks 7 - 12)

• Goals: Improve AROM to least 0-115°, good strength in all LE musculature, return to most functional activities, good patella femoral mobility
• Exercises: Progress above exercises with resistance, begin endurance and balance/proprioception program, progress open/closed chain exercises as appropriate
• Criteria to move to Phase IV: Pain-free AROM, 4+/5 of all LE musculature, minimal to no pain and swelling

Phase IV: Advanced Strengthening and Higher Level Functioning (Weeks 12 - 16)

• Goals: Return to appropriate recreational activities, improve strength/balance/proprioception/endurance as needed for ADL's
• Exercises: Progress above exercises, inititate return to recreational activities
• Criteria for discharge: Independent, non-antalgic gait, pain-free AROM, at least 4+/5 strength in LE, normal balance/proprioception, independent step over step stair climbing, independent in HEP

Total Knee Arthroplasty Protocol. Brigham and Women's Hospital Web site. http://www.brighamandwomens.org/Patients_Visitors/pcs/rehabilitationservices/Physical%20Therapy%20Standards%20of%20Care%20and%20Protocols/Knee%20-%20TKR%20protocol.pdf.