Total Knee Arthroplasty Physical Therapist Guide

Publication Date: June 16, 2020
Last Updated: November 8, 2022

Recommendations

Preoperative

Design preoperative exercise programs for strength and flexibility. (M)
300164
Provide education to patients undergoing TKA. (BP)
300164
Do NOT use continuous passive motion devices. (W)
300164

Postoperative

Encourage cryotherapy for pain management. (M)
300164
Teach importance of early mobility and appropriate progression of therapy. (BP)
300164
Include motor function training. (S)
300164
Implement passive, active assistive, and active range of motion exercises. (BP)
300164
Teach patients to position the operated knee in some degree of flexion (30 to 90 degrees), while resting to reduce blood loss and swelling in the first 7 days. (W)
300164
Use neuromuscular electrical stimulation. (M)
300164
Design, implement and teach high-intensity strength training and exercise programs within 7 days after surgery. (M)
300164
Provide supervised PT management, and determine the optimal setting by the patients’ safety, mobility, environmental, and personal factors. (M)
300164
Either group- or individual-based PT sessions. (W)
300164
Start PT Management within 24 hours of surgery and prior to discharge. (M)
300164
Provide guidance to the care team and patient on safe and objective discharge planning, patient functional status, assistance equipment, and services needed to support a safe discharge from the acute care setting. (M)
300164

Outcomes Assessment

Collect the KOOS JR (Table 2) as a patient-reported outcome measure and both the 30-Second Sit-to-Stand and Timed Up and Go tests to demonstrate the effectiveness of care provided. These should be collected at a minimum at the first visit and upon conclusion of care from each setting. (BP)
300164

Recommendation Grading

Overview

Title

Physical Therapist Management of Total Knee Arthroplasty

Authoring Organization

American Physical Therapy Association

Endorsing Organization

American Academy of Orthopaedic Surgeons

Publication Month/Year

June 16, 2020

Last Updated Month/Year

October 17, 2024

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

This clinical practice guideline (CPG) is based on a systematic review of published studies with regard to the physical therapist management of patients undergoing total knee arthroplasty. In addition to providing practice recommendations, this guideline also highlights limitations in the literature, areas that require future research, intentional vagueness, and quality improvement activities.

This guideline is intended to be used by all qualified and appropriately trained physical therapists involved in the management of patients undergoing total knee arthroplasty (TKA). It is also intended to serve as an information resource for decision makers and developers of practice guidelines and recommendations.

Target Patient Population

Adult patients with knee osteoarthritis undergoing primary total knee arthroplasty (TKA)

Target Provider Population

Physical therapists involved in the management of patients undergoing total knee arthroplasty (TKA)

PICO Questions

  1. In patients with osteoarthritis of the knee, where total knee arthroplasty (TKA) has been decided, does preoperative physical therapy affect postoperative outcomes?

  2. In patients with osteoarthritis of the knee selected for total knee arthroplasty (TKA), which postoperative range of motion (ROM) interventions are associated with improved patient reported outcomes?

  3. In patients with osteoarthritis of the knee selected for total knee arthroplasty (TKA), which postoperative, non-pharmacological pain interventions are associated with improved patient reported outcomes?

  4. In patients with osteoarthritis of the knee selected for total knee arthroplasty (TKA), which postoperative physical activities are associated with improved patient reported outcomes?

  5. In patients with osteoarthritis of the knee selected for total knee arthroplasty (TKA), which postoperative movement pattern retraining interventions are associated with improved patient outcomes?

  6. In patients with osteoarthritis of the knee selected for total knee arthroplasty (TKA), which swelling/edema management strategies exhibit effective swelling reduction in patients, postoperatively?

  7. In patients with osteoarthritis of the knee selected for total knee arthroplasty (TKA), does postoperative use of neuromuscular electronic stimulation around the knee/quadriceps area improve postoperative patient reported outcomes?

  8. In patients with osteoarthritis of the knee selected for total knee arthroplasty (TKA), does postoperative strength training significantly improve postoperative patient reported outcomes?

  9. For patients with osteoarthritis of the knee selected for total knee arthroplasty (TKA), which postoperative discharge planning protocols are associated with improved patient reported outcomes?

Inclusion Criteria

Male, Female, Adult, Infant

Health Care Settings

Ambulatory, Long term care, Outpatient, Operating and recovery room

Intended Users

Nurse, nurse practitioner, occupational therapist, physical therapist, physician, physician assistant

Scope

Management, Rehabilitation

Diseases/Conditions (MeSH)

D019645 - Arthroplasty, Replacement, Knee, D010810 - Physical and Rehabilitation Medicine, D059825 - Physical Therapists

Keywords

physical therapy, TKA, Knee replacement, total knee replacement (TKR), total knee arthroplasty (TKA), PT

Source Citation

Diane U Jette, Stephen J Hunter, Lynn Burkett, Bud Langham, David S Logerstedt, Nicolas S Piuzzi, Noreen M Poirier, Linda J L Radach, Jennifer E Ritter, David A Scalzitti, Jennifer E Stevens-Lapsley, James Tompkins, Joseph Zeni Jr, for the American Physical Therapy Association, Physical Therapist Management of Total Knee Arthroplasty, Physical Therapy, , pzaa099, https://doi.org/10.1093/ptj/pzaa099