Total Knee Post Op Protocol

Physician name: Blake Schultz, MD

Office: 2224 Walsh Tarlton Lane, Suite 200, Austin, TX 78746
Phone: 512-485-0546, opt 2(direct), 512-439-1000

www.Blakeschultzmd.com– Visit for FAQ’s

General orders

  • Physical therapy frequency: 6 visits in the first 14 days. Call physician if more than 6 visits are required.
  • Post-op appointment around 14 days of the surgery date.
  • Assist with scheduling of out-patient physical therapy before discharging from home healt
  • Anticoagulant: ASA 81 mg BID, unless otherwise stated
  • TED hose: thigh high, leave on until post-op visit.
  • Dressing: Aquacel dressing. Will be removed  at the post-op appointment. Replace if 50% soiled.
  • Weight bearing precautions: WBAT.
  • Assistive device: rolling walker / TED hose.
  • Shower / bathing: cover incision when showering — do not soak.

Evaluation visit

  • ADL and Home safety assessment
  • Ambulation with walker, Stair training with step-to pattern.
  • Begin post-op therapeutic exercise as below.

Post-op exercises

  • Supine: ankle pumps, multi-angled quad sets (straight leg, towel under knee, towel under heel), short arc quads, heel slides, hip abduction, SLR x 4 (focus on strong quad set and eliminating quad lag).
  • Stretching — knee extension: active / passive therapist stretch, towel roll under heel in supine, hamstring stretching.
  • Stretching — knee flexion: active / passive supine therapist stretch, seated knee flexion.
  • Standing: hip extension, hip abduction, hip flexion, heel raises.
  • ADL retraining.

1 week post-op

  • Progress ambulation to cane when the patient achieves 75%+ weight bearing.
  • Gait training for increasing weight shift and weight bearing onto the TKR lower extremity with fully extended knee, decreasing circumduction, increasing knee flexion with ambulation.
  • Continue post-op exercises and progress as able (see interventions below).
  • Achieve full knee extension.
  • Good / stable quad set and quad control.

1–2 weeks post-op, or PRN once goals have been met

  • Begin transition to outpatient therapy or discharge (if appropriate).
  • Continue all above therapeutic exercise and progress.
  • Begin balance / proprioceptive training.

Progressive therapeutic exercises

  • Stationary bike pedals.
  • Progressive quad strengthening.
  • PNF patterns with resistance above knee.
  • CKC knee extension with manual resistance (leg press).
  • CKC terminal knee extension with resistance (standing).
  • Resistance to SLR in all planes (resistance applied above knee until strong quad set and no quad lag noted).
  • Gait training: backwards walking and / or heel walking to promote full extension.

Note: specific doctor orders take precedence over standard protocol. The therapist is to use professional judgment and discretion when assigning new interventions and progressing treatment according to the patient’s ability.

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