Total Knee Replacement

Post Rehab Goals and Objectives:

The primary goal of the post rehab of the total knee is to maintain or increase range of motion and improve overall leg strength. The definition of overall leg strength is the legs ability to control the client's bodyweight. The fitness program must emphasize development of functional strength to improve capacity for the client's activities of daily living.

Description

Severe arthritics in the knee may lead to loss of range of motion, strength and function capacity. The loss of functional capacity is primary criteria for total knee replacement. The degenerative cascade for the arthritic knee begins with damage to one of the menisci usually the medial meniscus. Ultimately the cascade concludes with the total knee replacement (TKR). The client will have severe loss of articular cartilage (hyaline cartilage), swelling, joint instability and pain prior to the replacement. The total knee surgical procedure requires removal of distal portion of the femur, the femoral condyles and the tibial plateau. The total knee prosthesis is implanted into the shaft of the femur and tibia. The prosthesis may be cemented or porous. The cemented implant is fixed with cement. The porous implant is pressed into position and fixed by the growth of bone into the prosthesis. Healing is faster with the cemented implant but the porous implant has greater long-term stability.

Development of ankylosed (stiff) joint is common after total knee replacement. Immediately after replacement, range of motion activities are emphasized. Once range of motion is restored the goal is changed to increasing overall functional strength. Physical therapy is prescribed after hospital discharge. The therapy is designed to normalize range of motion and strength. The strength goal is to improve overall leg strength or the ability to support the client's body weight on the involved leg. This is essential for stair climbing, getting out of chairs and stepping off curbs. 100 degrees of knee flexion range of motion is required for climbing stairs and getting out of chairs.