eeTOTAL KNEE REPLACEMENT (T.K.R.) PHYSIOTHERAPY PROTOCOL PRE-OPERATIVE Patients should be evaluated prior to surgery, including: • Assessment of joint range of motion, muscle strength, mobility and general function • Respiratory assessment and treatment if necessary • Explanation of post-operative physiotherapy management, including respiratory and circulatory exercises • Teaching patient independence with bed mobility and transfers • Pre-operative activity and exercise programme to include quadriceps strengthening – there is evidence that this improves function post-operatively (McHugh et al, 2008) • Neuromuscular stimulation (NMT) if appropriate - there is evidence that this improve quadriceps function pre-operatively (Walls et al, 2008) • Education - pre-operative education can reduce anxiety and improve post-operative outcomes, especially with respect to pain, functioning and length of hospital stay (McDonald et al, 2007). In Cappagh this is achieved through attendance at a multi-disciplinary pre-assessment clinic. POST-OPERATIVE • Check operation notes and post-operative physiotherapy and mobility instructions. Day 1 • Assess respiratory status and treat if necessary • Encourage circulatory exercises • Correct position in bed – knee extended in Robert Jones bandage to minimise swelling (no pillows under knee). +/- heel raise. • Review bed transfers mobility
Physiotherapy January 2009
• Isometric exercises for quadriceps, hamstrings, gluteals +/- straight leg raises • CPM, if appropriate (remove bandages to apply) – there is some evidence that CPM combined with physiotherapy can produce small short-term increases in knee flexion, but no evidence that it influences pain, knee extension, long-term knee flexion, complications or length of stay (Milne et al, 2003, Grella, 2008) • Stand and mobilise with frame, if BP well controlled and power and sensation adequate on non-operated side Day 2 • Mobilise with frame, encouraging knee flexion in swing phase. •...
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