Updated: 6/11/2021

TKA Postoperative Rehabilitation & Outpatient Management

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  • Introduction
    • Rehabilitation requires coordinated effort from
      • orthopaedic surgeon
      • physical therapist
      • occupational therapist
      • case manager
      • nursing staff
      • patient and patient's family
    • Care can be broken down into different phases including
      • inpatient extended care (rehab/SNF)
      • outpatient care
  • Inpatient Extended Care (Rehab)
    • Earlier discharge to rehab from hospital associated with improved outcomes
    • Discharge criteria to home similar to those in hospital
  • Outpatient Care
    • Physical therapy
      • 2-3 times per week for at least 2 weeks
      • focused on closed-chain concentric exercises
      • gradually advance from crutches to cane to unassisted
      • other modalities include but not limited to
        • aquatic therapy
          • buoyancy attenuates gravity/compressive forces in joint; provides resistance
        • balance training
          • proprioception and postural control
        • cryotherapy
          • correlation between local temp and synovial PGE2
        • neuromuscular electrical stimulation (NMES)
          • may override deficits in muscle activation caused by CNS impairments
    • Return to activities
      • low-impact closed chain exercises preferred
        • eliptical
        • biking
        • golf
          • handicap will show rise after TKA (stays same with THA)
      • impact activities may decrease longevity of implant
        • running is discouraged
    • Driving recommendations
      • 4 weeks after a right total knee
      • < 4 weeks after a left total knee
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(OBQ11.16) A 68-year-old right handed male golfer presents with significant left knee pain which has not been amenable to conservative management. A radiograph is shown in Figure A. He is interested in pursuing total knee arthroplasty (TKA). What can this patient expect with regards to his golf game after undergoing this procedure?

QID: 3439
FIGURES:
1

A significant rise in his handicap

49%

(2181/4495)

2

No change in his drive distance

34%

(1510/4495)

3

Decreased pain compared to undergoing a right TKA

12%

(531/4495)

4

A significant chance of having severe pain during play

3%

(122/4495)

5

Patients are required to use a cart while golfing

3%

(135/4495)

L 4 D

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