Rehabilitation After Arthroplasty

Rehabilitation Goals & Principles - Rehab Roadmap

• Goals: ↓Pain, ↑ROM & strength, restore function (ADLs), prevent complications (DVT, dislocation), patient education.
• Principles: Early mobilization, progressive & individualized exercises, pain management, multidisciplinary team.
• Roadmap Phases:
  • I (Post-op): Pain/edema control, DVT prevention, assisted mobility, gentle ROM.
  • II (Recovery): Wean aids, ↑strength & ROM, functional tasks.
  • III (Return to Function): Advanced exercises, activity-specific training.

⭐ Early mobilization post-arthroplasty significantly reduces risks of DVT and improves functional outcomes. oka

Phases of Arthroplasty Rehab - Recovery Relay

⭐ Progression between rehabilitation phases is criteria-based, not strictly time-based, focusing on achieving functional milestones.

Joint-Specific Protocols (Hip & Knee) - Hip & Knee How-Tos

• Total Hip Arthroplasty (THR):
  • Focus: Early mobilization, Weight-Bearing As Tolerated (WBAT), Range of Motion (ROM), strengthening.
  • Posterior Approach Precautions: Avoid hip flexion >90°, adduction past midline, internal rotation for 6-12 weeks. Use abduction pillow.
  • Anterior Approach: Generally fewer restrictions; avoid forceful extension & external rotation.

  ⭐ For posterior approach THR, patients must avoid hip flexion >90°, adduction past midline, and internal rotation for 6-12 weeks to prevent dislocation.

• Total Knee Arthroplasty (TKR):
  • Goals: Full extension (0°), flexion >110-120° for Activities of Daily Living (ADLs).
  • Focus: Early mobilization, WBAT, pain/edema control (ice, elevation).
  • Key Exercises: Ankle pumps, quadriceps sets, heel slides, Straight Leg Raises (SLR), active knee extension, gentle assisted flexion. oka

Core Rehabilitation Techniques - Therapy Toolkit

• Early Phase (Days 1-7):
  • Cryotherapy & compression (e.g., Cryo/Cuff, Game Ready)
  • Pain management: multimodal analgesia
  • Gentle Range of Motion (ROM): passive (PROM), active-assisted (AAROM)
  • Isometric exercises (quadriceps, gluteal sets)
  • Ankle pumps, deep breathing exercises (DVT/PE prophylaxis)
  • Mobilization with assistive devices (walker, crutches)
• Intermediate Phase (Weeks 2-6):
  • Progressive ROM: active (AROM)
  • Strengthening: isotonic, closed-chain exercises (mini-squats, leg press)
  • Gait training: weaning off assistive devices
  • Proprioception & balance exercises
• Late Phase (Weeks 6+):
  • Advanced strengthening: open-chain exercises (cautiously), functional exercises
  • Sport/activity-specific training

⭐ Closed-chain exercises are generally preferred in early TKA rehab as they minimize tibiofemoral shear forces and enhance proprioception.

• Modalities: Neuromuscular Electrical Stimulation (NMES) for muscle activation, TENS for pain relief (adjunctive).

Complications, Precautions & Outcomes - Safety Signals & Scorecards

• Complications:
  • Early: DVT/PE, Infection, Dislocation.
  • Late: Loosening, Osteolysis, Wear.
• Precautions (Hip Post. Approach):
  • Avoid: Flexion >90°, adduction, internal rotation.
  • (📌 BCT: No Bends, Crossing, Twisting in)
• Outcomes & Scores:
  • ↑Function, ↓Pain.
  • Scores: HHS, OKS.
• ⚠️ Safety Signals:
  • DVT: Calf pain/swell/warmth (Wells).
  • Infection: Fever, redness, discharge.
  • Dislocation: Pain, deformity.

⭐ Sudden onset of calf pain, swelling, and warmth post-arthroplasty should raise immediate suspicion for Deep Vein Thrombosis (DVT).

High‑Yield Points - ⚡ Biggest Takeaways

• Early mobilization post-op is key to prevent DVT and enhance recovery.
• Weight-bearing (FWBAT vs. PWB) depends on prosthesis fixation (cemented vs. uncemented).
• CPM machine use shows limited benefit in routine TKA/THA recovery.
• Rehab goals: pain control, restoring ROM, muscle strengthening, achieving functional independence.
• DVT prophylaxis (mechanical & pharmacological) is a critical component.
• Specific THA precautions (e.g., posterior: avoid flexion >90°, adduction, internal rotation) prevent dislocation.