Total Knee Arthroplasty Physical Therapist Guide

Publication Date: June 16, 2020

Recommendations

Preoperative

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

Encourage cryotherapy for pain management. (M)
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Teach importance of early mobility and appropriate progression of therapy. (BP)
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Include motor function training. (S)
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Implement passive, active assistive, and active range of motion exercises. (BP)
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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)
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Use neuromuscular electrical stimulation. (M)
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Design, implement and teach high-intensity strength training and exercise programs within 7 days after surgery. (M)
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Provide supervised PT management, and determine the optimal setting by the patients’ safety, mobility, environmental, and personal factors. (M)
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Either group- or individual-based PT sessions. (W)
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Start PT Management within 24 hours of surgery and prior to discharge. (M)
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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)
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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)
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Recommendation Grading

Disclaimer

Overview

Title

Physical Therapist Management of Total Knee Arthroplasty

Authoring Organization

Endorsing Organization

Publication Month/Year

June 16, 2020

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adult, Infant

Health Care Settings

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

Intended Users

Physical therapist, occupational therapist, nurse, nurse practitioner, physician, physician assistant

Scope

Rehabilitation, Management

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