what is the physical therapy protocole for total hip and total knee replacement?!
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Total hip replacement protocol
* Preoperative 1-2 weeks prior to surgery
o Preoperative education of the surgical process and outcomes
o Instruction on a postoperative exercise program
o Instruction on total hip precautions (based on posterior surgical approach to the hip)
+ No hip flexion beyond 90°
+ No crossing of the legs (hip adduction beyond neutral)
+ No hip internal rotation past neutral: With the anterior hip approach, the patient can cross the legs and internally rotate the hip. Positions that involve extreme hip extension and external rotation will dislocate the hip.
o Assessment of the home environment
* Postoperative day 1
o Bedside exercises are initiated (eg, ankle pumps, quadriceps sets, gluteal sets)
o Review of hip precautions and weight-bearing status
o Bed mobility and transfer training (ie, bed to/from chair)
* Postoperative day 2
o Gait training is initiated with use of assistive devices (eg, crutches, walker).
o Continue functional transfer training
* Postoperative day 3-5 (or on discharge to rehabilitation unit)
o Progression of ROM and strengthening exercises to the patient's tolerance
o Progression of ambulation on level surfaces and stairs (if applicable) with the least restrictive device
o Progression of ADL training
* Postoperative day 5 to 4 weeks
o Strengthening exercises (eg, seated leg extension, sidelying/standing hip abduction, standing hip extension and hip abduction, knee bends, bridging)
o Stretching exercises to increase flexibility of hip muscles
o Progression of ambulation distance
o Progression of independence with ADL
Measurement of leg lengths
Leg lengths are measured meticulously during the preoperative phase to prevent postoperative leg-length discrepancy. Measurement is performed radiologically and clinically by measuring the actual leg lengths. However, during the operative process, leg lengths can change, depending on how the prosthesis was fixed or stabilized or depending on how much bone needed to be removed, among other surgical considerations. In the postoperative phase, it is important, therefore, to correct any leg-length discrepancy by using appropriate orthoses or heel lifts. Correction of any discrepancies has a direct impact on the gait pattern, as well as on the development of low back pain (LBP).
Total knee replacement exercise protocol
* Preoperative 1-2 weeks prior to surgery
o Education on the surgical process and outcomes
o Instruction on a postoperative exercise program
o Assessment of the home environment
* Postoperative day 1
o Bedside exercises (eg, ankle pumps, quadriceps sets, gluteal sets)
o Review weight-bearing status
o Bed mobility and transfer training (ie, bed to/from chair)
* Postoperative day 2
o Exercises for active ROM, active-assistive range of motion (AAROM), and terminal knee extension
o Strengthening exercises (eg, ankle pumps, quadriceps sets, gluteal sets, heel slides, straight leg raises, isometric hip adduction)
o Gait training with assistive device and functional transfer training (eg, sit to/from stand, toilet transfers, bed mobility)
* Postoperative day 3-5 (or on discharge to rehabilitation unit)
o Progression of ROM and strengthening exercises to the patient's tolerance
o Progression of ambulation on level surfaces and stairs (if applicable) with the least restrictive device
o Progression of ADL training
* Postoperative day 5 to 4 weeks
o Strengthening exercises (seated leg extensions, standing hip abduction and extension, knee bends, short arc quads)
o Stretching of quadriceps and hamstring muscles
o Progression of ambulation distance
o Progression of independence with ADL
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