Total Knee Replacement Physical Therapy Case Study - Part 1

Posted by Daniel Seidler on Thu, Feb 17, 2011 @ 05:24 PM

TKRSadie is a a 67 yo female patient with insignificant past medical history besides a 5 year history of R Knee osteoarthritis presents to WSPT 6 weeks post-op.

Sadie has minimal complaints of pain, but her knee will not extend fully (10 degrees shy of neutral) and she can flex (bend) it 95 degrees. She complains of limping when she walks, inability to rise from low surfaces and difficulty negotiating stairs (up and down). She lives with her husband in a 2-story private home with a laundry room in the basement.

Sadie completes her intake information and is taken into an assessment room by her physical therapist. Over the next 10-minutes, the PT takes a detailed history and documents the conversation in her computer software system.

TKR_ScarThe therapist then asks Sadie to roll her pants above her knees to observe for any swelling and examine the surgical site. It's noted that the sutures have healed well, the scar is a little adhered (tight) and the right surgical knee appears larger than the left. It is not warm or discolored. The PT measures both knees and finds that the girth of the right is 1.5cm larger than the left.

The PT quickly assesses lumbar range of motion (ROM) to clear any complications that may be arising from the spine. She proceeds to measure the ROM of both knees, hips, and ankles. She assesses sensation and tests both legs for strength. She then performs a Tinetti Balance and Gait Assessment to screen the patient for the risk of falling. This test involves standing balance activities and an assessment of Sadie's gait pattern and safety. Lastly, the PT observes Sadie performing several other functional activities like reaching for the ground, going up and down stairs, lifting a 5# object from a table overhead.

Once this assessment is complete, the PT explains her findings to Sadie, detailing her deficits in the areas of ROM, strength, balance, gait, and function. She explains her plan for how the Sadie can return to normal activity and makes sure this is in line with her goals and objectives. All of this is documented by the PT.

The session continues with Sadie warming-up further on a seated stepper.Seated Stepper

The PT explains that the objectives when on the stepper are to:

- Increase knee ROM

- Increase B LE strength

- Get the blood flowing and increase cardiovascular circulation

- Increase endurance


Today the stepper is a 10-minute warm-up and then the patient returns to the PTs assessment room for soft tissue scar mobilization and ROM exercises of the right Knee. She tolerates this very well so the PT gives her 3 exercises to perform several times daily at home:

- Straight leg raises

- Bridging

- Prone knee flexion

The patient has good understanding so the PT documents the exercises on a computer print-out for Sadie to take home with her. The session ends with TENS and ice on Sadie's right Knee to prevent any swelling and minimize any residual pain from today's session. After 10-minutes, Sadie schedules 3 appointments per week for the next 4-weeks.

Over the next month, Sadie will be expected to be an active participant in her treatment program, performing home exercises, coming prepared to her PT sessions and focusing on her sessions with the PT each time. If any issues arise or symptoms are not improving, Sadie is expected to discuss this with the PT so the plan can be amended or Sadie's MD can be notified.

If the PT's guidance is followed and Sadie is compliant with her personalized rehab plan, the chances of a full recovery are very likely. It's the physical therapists responsibility and goal to make every effort to safely return every Total Knee Replacement patient back to normal life - less painful and more functional than before their surgery.

Tags: physical therapy, arthritis, knee, TKR, knee replacement, aquatic therapy, rehab