TOTAL KNEE REPLACEMENT (TKR)

Pre – Operative Physiotherapy Management

Objectives:

• Prepare the patient physically and mentally for surgery.
• Enhance post-operative recovery potential.
• Educate on post – surgical expectations and rehabilitation process.

1. Patient Education

• Understand the procedure: Explain the TKR process, expected outcomes, and the importance of rehabilitation.
• Goals of Physiotherapy: Discuss the role of physiotherapy in enhancing recovery and restoring function.

2. Assessment

• Initial Evaluation: Assess range of motion (ROM), strength, gait, balance, and functional mobility.
• Set Baseline Measurements: Document knee flexion an extension, strength levels, and any functional limitations.

3. Exercises

Range of Motion Exercises:

• Heel Slides: To improve knee flexion.
• Straight Leg Raises: Strengthen quadriceps.

Strengthening Exercises:

Quadriceps Isometric Contractions: To maintain muscle tone.

• Bridging Exercises: To strengthen hip extensors.
• Aerobic Conditioning: Encourage low-impact aerobic activities (e.g., walking, stationary biking) to improve overall fitness.
• Balance Training: Simple balance exercises to enhance stability.

4. Functional Training

• Transfer Training: Teach safe techniques for getting in and out of bed and chairs.
• Gait Training: Practice walking with any assistive devices (e.g., walker) to improve confidence.

5. Home Exercise Program

Provide a personalized home exercise program to maintain activity levels and prepare for post-operative rehabilitation.

Post – Operative Physiotherapy Management

Objectives:

• Control pain and swelling.
• Restore range of motion and strength.
• Enhance mobility and functional independence.

1. Immediate Post-Operative Phase (Days 1 – 7)

Goals:

• Promote early mobility.
• Prevent complications.

Activities:

• Pain Management: Utilize ice therapy and medications as prescribed.
• Education: Reinforce information about the surgery and recovery process.
• Positioning: Keep the leg elevated to reduce swelling.

Gentle ROM Exercises:

• Ankle Pumps: To encourage circulation.
• Heel Slides: Initiate early knee flexion.

Strengthening:

• Isometric Quadriceps Exercises: Hold contractions for several seconds.

Mobility Training:

• Begin walking with assistive devices, focusing on weight-bearing as tolerated.
• Transfer training: Reinforce safe transfer techniques.

2. Early Recovery Phase (Weeks 1-2)

Goals: 

• Increase range of motion and strength.

Activities:

• Continue Ice Therapy and elevate the leg as needed.

Active ROM Exercises:

• Heel Slides: Aim for increased flexion.
• Sitting Knee Extension: Gradually extend the knee while seated.

Weight Bearing:

• Encourage gradual weight-bearing as tolerated.

Strengthening Exercises:

• Bridging: Enhance hip and core stability.
• Leg Raises: Focus on straight leg raises.
• Gait Training: Reinforce a normal walking pattern with assistive devices.

3. Intermediate Recovery Phase (Weeks 3-4)

Goals:

• Improve strength.
• Functional mobility.

Activities: 

• Continue ROM Exercises: Aim for 90-100 degrees of flexion.

Strengthening Exercises:

• Step-ups: Gradually increase height for progression.
• Wall Slides: Enhance knee flexion strength. 

Cardiovascular Conditioning:

• Stationary Bike: Start low resistance biking to promote endurance.

Balance Exercises:

• Introduce more challenging balance activities (e.g., single-leg stands).

Functional Activities:

• Begin practicing stair climbing and sit-to-stand transitions.

4. Advanced Recovery Phase (Weeks 5-12)

Goals:

• Restore strength.
• Endurance.
• Functional independence.

Activities:

• Progressive Strength Training: Use resistance bands and weights for exercises.
• Aerobic Conditioning: Continue low-impact activities (e.g., swimming, walking). 

Functional Training:

• Complex movements (e.g., squats, lunges) and daily activities.
• Gait Training: Focus on normalization gait without assistive devices.
• Sport-Specific Activities: Gradual reintroduction based on patient’s lifestyle.

Key Considerations:

• Individualization:Tailor rehabilitation plans based on the patient’s progress and specific needs.
• Pain Management:Regularly assess and manage pain levels throughout recovery.
• Education:Reinforce the importance of adherence to the exercise program and strategies for joint protection.
• Monitoring Progress:Regular assessments of strength, ROM, and functional capabilities to adapt the rehabilitation plan.