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Sometimes referred to as "mini-knee" replacements, the surgeon will replace either the medial or lateral compartment of the knee using metal and plastic parts similar to a TKA. This surgery is not as invasive and has faster recovery times as compared to the TKA. Patients with severe varus or valgus deformities may benefit from this procedure.

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Doctor will remove the damaged surfaces of the knee joint and resurface the knee joint with the prosthesis.

Metal and plastic parts are used to cap the ends of the bones that form the knee joint, along with the kneecap.

Most common: A cemented prosthesis attaches to the bone with surgical cement.

Uncommon: An uncemented prosthesis attaches to the bone with a porous surface onto which the bone grows to attach to the prosthesis. Old TKA's may have uncemented prosthesis.

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Emergency Referral:

Signs of DVT

Refer to Surgeon/Care Team:

Mechanical block or clunk

Lack of full knee extension by 4-6 weeks

Refer to MD:

AD required for ambulation after post-op week 6

General:

Avoid high impact activities (running/plyometrics)

Avoid twisting until 6-8 weeks p/o

WBAT

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Lauren Tiemeier, PT, DPT; Joann Walker, PT, DPT, SCS, OCS; Kathy Wayman, PT, DPT, SCS; Laura C. Schmitt, PT, MPT, PhD. "Total Knee Arthroplasty (TKA) Post-Op Clinical Practice Guideline" The Ohio State University. June 2020. 

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Complications

Signs of infection: redness, swelling, warmth, purulent drainage, fever

DVT: pain, swelling, skin discoloration, tenderness

Fat embolism: SOB, confusion, headaches, retinal changes, tachycardia

Prosthetic failure: new pain if the joint was previously well-functioning, decreased ROM, feelings of instability

Peroneal nerve injury: paresthesia, weakness, loss of sensation

Vascular injury: bruising, swelling, tenderness, pain

Arthrofibrosis: limited ROM, dull or sharp pain, stiffness, swelling, snapping or catching

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Knee injury and Osteoarthritis Outcome Score - Joint Replacement (KOOS-JR)

Designed to measure pain, stiffness, and ADLs after a TKA

Lower Extremity Functional Scale (LEFS)

Measures ability to perform common task at home, work, and school

Patient Specific Functional Scale (PSFS)

Measures difficulty of 3 patient selected activities

30 Seconds Chair Stand Test (30sCST)

Measures lower leg function, dynamic balance, and strength

Stair Climb Test

Measures functional strength, dynamic balance, and agility

Step Test

Measures lower extremity function, dynamic balance, and proprioception

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Phase I: 0-6 Weeks (until DC of AD)

Goals:

protect healing tissue

pain and edema control

DVT prevention

improve pain-free ROM

normalize muscle activation

ambulate independently w/out AD

independence in all ADLS

Exercises: 3x8-12 reps as a general goal to initiate strengthening

heel slides

SAQ/LAQ

SLR

ankle pumps

step ups

mini squats

Sit to stand

prone HS curls

heel raises

Phase II: 6-12 Weeks (DC of AD to Pain Free ADLs)

Goals:

restore full AROM and PROM

increase strength of LE musculature

normalize LE and postural control

normalize gait

pain-free in all ADLs

Exercises: 3x10-12 for strengthening

mini lunges

wall squats

step up/down

4 way hip

OKC knee ext

side steps with band

heel tabs

SLS balance

Phase III: 12-24 Weeks (Pain Free ADLs to Return to Recreation)

Goals:

correct movement patterns

improve balance

increase volume/intensity of aerobic activities

return to sport or desired level of function

Exercises: 3x8-10 since these exercises will be of higher resistance/intensity

split squats

star lunges

chops with cable for core and LE stability

2 up 1 down ecc knee ext

foam and perturbation balance training

sports/recreation-specific tasks

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Phase I (Immediate Post-Surgical Phase: Day 0-3)

Ability to demonstrate quadriceps contraction and/or perform a straight leg raise

AROM -10-80˚

Minimal pain and inflammation

Independent transfers and ambulation at least 100 feet with appropriate assistive device

Phase II (Motion Phase: Day 3-Week 6)

AROM 0-110˚

Good voluntary quadriceps control

Independent ambulation community distances (>/= 800 feet) without assistive device, deviations, or antalgia

Minimal pain and inflammation

Phase III (Intermediate Phase: Week 7-12)

AROM without pain, or plateaued AROM based on preoperative ROM status

4+/5 muscular performance based on MMT of all LE muscles

Minimal to no pain or swelling

Phase IV (Advanced strengthening and higher level function stage: Week 12-16)

Non-antalgic, independent gait

Independent step over step stair climbing

Pain free AROM

At least 4+/5 muscular performance based on MMT of all LE muscles

Normal, age appropriate balance and proprioception

Patient is independent with HEP

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WBAT after surgery

Minimize propping under knee after surgery to avoid contracture

No driving until cleared by physician

Walking without an assistive device should be cleared by physician

Return to work 4-6wks post-op depending on recovery

No dental work for 3-6 months after surgery

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Signs of DVT

Mechanical block or clunck

Lack of full knee extension

Yellow Flags

Persistent reactive pain or effusion following PT or functional movement tasks

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TUG

5XSTS

LEFS

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Phase I (wks 0-3)

ROM 0-100 knee flexion needed

WBAT w/ AD until full knee extension achieved and no apparent gait deviations

Exercises

Heel prop with towel, bag hangs, heel slides, wall slides, upright bike

Phase II (wks 3-6)

6 wks- reciprocal stair negotiation

Return to work by wk 6

Double leg STS without UE assist

Single leg balance X15 sec or greater or put socks on while standing

Strength

SLR-

LAQs

Side Stepping

Step up

STS

Wall sits

Balance

Double leg → SL

Eyes open/closed

Compliant surfaces

Aerobic

TM walking, elliptical, swimming

Phase III

Strength

Continue interventions from phases I and II, leg press, hamstring curl machine, knee extension machine, progres to SL CKC exercises according to pt tolerance,

Balance

Double leg → SL

Eyes open/closed

Compliant surfaces

Perturbations

chops/lifts/ball toss

Cardiovascular endurance specific to patient’s needs

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Criteria to progress to phase 2:

Normal gait without AD on level surface indoor

Full knee extension

No extensor lag during SLR

Able to perform double leg squat to 45 degrees without UE

To progress to phase 3

Ambulation >2 blocks without AD

Reciprocal gait on stairs by 6 weeks without UE

Symmetrical ROM

Double leg sit to stand without UE x 10 reps

Single leg balance >15 seconds

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Normal gait on all surfaces and able to walk 1+ mile without pain or reactive effusion

Dynamic neuromuscular control with multi-plane activities with no pain or effusion

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Most patients are able to return to their usual activities after 6 weeks as long as there are no complications and rehab goals are being met. It is recommended that high-impact activities such as running and jumping are avoided to prolong the longevity of the knee joint.

Criteria for Return to Sport

Physician clearance required

Strength: >90% compared to uninvolved LE

>90% BW with SL leg press

Demonstrates ability to simulate functional sport-specific movement

Patient reported outcome measures: Score >/= 90%