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.

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

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

Signs of DVT

Mechanical block or clunck

Lack of full knee extension

TUG 

5XSTS

LEFS

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

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

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

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%

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