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Updated: Jul 1 2024

TKA Postoperative Rehabilitation & Outpatient Management

  • 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
        • in appropriately selected patients, outpatient physical therapy and self-directed therapy are associated with comparable ROM and rates of manipulation under anesthesia 
      • 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
    • Medications
      • preoperative opioid use associated with elevated risk of chronic postoperative opioid use
    • Return to activities
      • low-impact closed chain exercises preferred
        • eliptical
        • biking
        • golf
          • slight increase in handicap following TKA and THA 
          • drive distance may slightly increase after THA, but reduced following TKA 
      • 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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