Total knee replacement (TKR)

Is an orthopedic surgical procedure where the articular surfaces of the knee are
replaced by an artificial ones.
Knee joint:
◦ Knee joint consists of three bones: lower part of the femur , the upper part of the Tibia
and the patella. They are kept together by ligaments and are surrounded by a capsule.
In between there is a meniscus at the lateral and medial side which act as a shock
absorber.
When Surgery Is Recommended?
◦ Severe knee pain or stiffness that limits your everyday activities.
◦ Moderate or severe knee pain while resting.
◦ Chronic knee inflammation and swelling that does not improve with rest, P.T or
medications.
◦ Knee deformity.

Rehabilitation:
General considerations:
1- Early emphasis is on achieving full extension equal to the opposite leg as soon as able.
2- No passive or active flexion range of motion greater than 90 degrees until stitches are removed.
3- No resisted leg movement machines.
4- Patients are weight bearing as tolerated with the use of assistive device to assist walking until they
are able to demonstrate good walking mechanics, or until discontinued by Doctor.
WEEK 1:
◦ Goals:
◦ Prevent vascular complications.
◦ Allow soft tissue healing.
◦ Control pain, inflammation, and swelling.
◦ Emphasis full knee extension, and flexion <90.
PROTOCOL:
1- Monitor wound healing for signs and symptoms of infection.
2- Breathing ex.
3- RICE
4- PROM.
5- Therapeutic exercises in supine:
- ankle pumps.
- passive and active assist heel slides.
- quadriceps and gluteal sets.
- short arc quadriceps.
- SLR.
◦ In sitting:
 - Passive/Active Assist knee extension
- Knee flexion <90.
- Upper limb strengthening(crutch muscles triceps, pectorals, deltoids, lats).
◦ Functional Exercises
1- Transfer lying to sitting, and seated to standing.
2- Gait training on flat surface, and stair climbing with an assistive device and weight bearing as
tolerated or according to the doctor.
Considerations in this phase :
◦ Continuous Cryotherapy for 72 hours after surgery, or at least 5 times/day.
◦ Patients are encouraged to use cryotherapy for 20 minutes before and after their
independent exercise program.
◦ Monitor for signs of DVT
◦ No exercises with weights or resistance.
◦ Avoid torque or twisting forces across the knee joint especially when WB on involved
limb.

WEEK 2 – 4:
◦ Goals:
◦ Reduce pain, inflammation, and swelling.
◦ Increase ROM.
◦ Increase strength.
◦ Normalize gait pattern.
◦ Improve proprioception
PROTOCOL:
1- Continue as in week1
2- Increase flexion ROM>90.
3- Isometric quad, Hamstring, and adductors.
4- Long arc quad.
5- Bridging.
6- SLR in all planes.
7- Stationary bicycle, partial circles to full.
8- Start Balance exercise.
◦ Functional:
1- Continue training with assistive device. Wean from walker to crutches to cane.
2- Encourage all normal phases of gait pattern using appropriate device.
3- Ascend and descend the stairs
WEEK 4-6:
◦ Goals:
◦ Normal gait without limping.
◦ Full knee extension and 110o flexion.
◦ Good strong muscles.
PROTOCOL
 1- Continue the previous exercise.
2- Sit to stand exercise to increase knee flexion and strengthen the muscles.
3- Hamstring curls.
4- Heel raises.
5- Front and lateral step up and step down.
6- Supported 1/4 front lunge.
WEEK 7-12:
◦ Goals:
◦ Return to function.
PROTOCOL:
◦ Progress previous exercises by increasing resistance and repetitions.
◦ Initiate overall exercise and endurance training (walking, swimming, progress biking).
Criteria for Discharge:
◦ Independent gait.
◦ Independent reciprocal stair climbing
◦ Pain-free AROM and ADL.
◦ Good lower extremity strength>=4\5.
◦ Patient is independent with home exercise program.