Total Knee Arthroplasty Physical Therapist Guide

Publication Date: June 16, 2020

Recommendations

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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Table 1. Prognostic Factors (★★★★ unless otherwise specified)

Having trouble viewing table?
Positive: Negative: Varying Effects:
  • Preoperative Range of Motion Preoperative Strength
  • High BMI
  • Depression
  • Greater Degree of Comorbidity
  • Tobacco Use (★)
  • Lack of Support System (★)
  • Diabetes
  • Sex

Table 2. Knee Injury and Osteoarthritis Outcomes Score for Joint Replacement (KOOS JR) Surveya

Having trouble viewing table?
Score None
(+0)		 Mild
(+1)		 Moderate
(+2)		 Severe
(+3)		 Extreme
(+4)
Stiffness: “How severe is your knee stiffness after first waking in the morning?
Pain: “What amount of knee pain have you experienced the last week during the following activities?”
Twisting/pivoting on your knee
Straightening knee fully
Going up or down stairs
Standing upright
Function/daily living: “For each of the following activities, please indicate the degree of difficulty you have experienced in the last week due to your knee.”
Rising from sitting
Bending to the floor/pick up an object
Number of checks
Raw scores

Total (0–28)



Raw Score Interval Score Raw Score Interval Score Raw Score Interval Score Raw Score Interval Score Raw Score Interval Score
0 100.000 6 70.704 12 57.140 18 42.281 24 24.875
1 91.975 7 68.284 13 54.840 19 39.625 25 20.941
2 84.600 8 65.994 14 52.465 20 36.931 26 15.939
3 79.914 9 63.776 15 50.012 21 34.174 27 8.291
4 76.332 10 61.583 16 47.487 22 31.307 28 0.000
5 73.342 11 59.381 17 44.905 23 28.251

a https://www.hss.edu/hoos-jr-koos-jr-outcomes-surveys.asp
© Hospital for Special Surgery