Total Joint Replacement — Total Knee Arthroplasty (TKA)

Orthopedic & Sports Medicine Specialists (OSMS)

Weight-Bearing

FWB unless otherwise specified from POD1; independent ambulation with AD PRN Phase II; DC assistive device when appropriate LE motor control achieved (no quad lag with SLR, no signs of quad inhibition)

Key Restrictions

Avoid kneeling x6 months; avoid jarring/twisting movements while weight-bearing; do not get incision wet 7-10 days; return to high-impact exercises (running/jumping) discouraged; knee swelling common up to 18 months post-op

Timeline & Phases

Post-Op (0-2 wks): FWB unless otherwise specified, full extension and 90 deg flexion by 2 wks, formal PT initiated during hospital stay (2-3x/week for 3-6 months), acute pain management, reduce swelling with ice/cryotherapy, avoid kneeling x6 months, avoid jarring/twisting while WB, DC incision wet-exposure x7-10 days, DC assistive device with appropriate LE motor control, ROM beginning immediately post-op at 0-60 deg advancing 10 deg daily (goal 90 deg by 2 wks), PROM/AAROM/AROM, quad activation, hip/glute open chain strengthening, crutch/gait training, weight-shifting/single leg balance, NMES to quadriceps, liberal ice use, ankle dorsiflexion while supine, stationary bike for ROM (no resistance), rocking chair for knee flexion; progress to Phase II once 90 deg flexion achieved, incision well-healed, quad control achieved, pain tolerable; Phase II (2-6 wks): independent ambulation with AD PRN, 120 deg motion expected by wk 6, continue quad/hamstring strengthening, increase functional exercise/balance/coordination/endurance, maintenance of uninvolved side, transition from oral narcotics to NSAIDs, mini-squats/modified step-ups/leg presses, ankle/hip/UE strengthening, heat modalities allowed after 6 wks, stationary bike with resistance/swimming/Nu-step/elliptical/Stairmaster/Nordic Track; Phase III (6+ wks): full symmetric knee extension, lifelong preservation of knee function, preserve ROM using stationary bike (outdoor as weather permits), advance aerobic training as tolerated (walking, swimming, golf, hiking, Stairmaster, weight training, elliptical), advanced plyometrics, return to sports allowed after 4 months, cross-country skiing/doubles tennis/gardening/downhill skiing allowed for experienced patients, antibiotic prophylaxis for dental procedures, lifelong exercise commitment encouraged

Notes

OSMS Rehabilitation Guidelines; pre-operative strength and ROM maximization emphasized as crucial to good outcome; knee swelling common for up to 18 months post-op, treat aggressively with ice/rest