Total Knee and Hip Replacement Physiotherapy

8/13/2019 Total Knee and Hip Replacement Physiotherapy

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Lying with your legs out infront, pull your anklestowards you and then awaybriskly

Pull your toes towards you andtighten your thigh muscle,straightening the knee firmlyagainst the bed.


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Place a rolled towel under your kneeon your operated leg. Pull your footand toes up, tightening your thighmuscles and straightening the knee(keep your knee on the cushion). Hold5 seconds - relax

Lying on your back, pull your toestowards you and tighten your

thigh muscle. With a straightknee lift your heel off the bedapproximately 20 cm. Hold for5-10 seconds

Lying on your back, bend andstraighten your operated leg.


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Pt MUST be able to SLR with no quads lag.

This means lifting the leg straight of the bedwith no bend in the knee.Pt MUST have 0 extension and at least 75flexion.

All pts get followed up in Out Pt Physio


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Most important is for the pt to straightentheir knee as they bring the weight onto thefoot.Pt will have a step to gait initially

Should progress in 2-3 days to a stepthrough gaitIf confident with frame but started oncrutches by PT, to mob with frameindependently but if time nursing staff toassist with crutches.


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Remember heaven! Remember hell!

Going up

Easy to remember goodleg goes to heaven upfirst Hold onto rail, place crutch in

other hand making a cross Step un-operated leg up Follow with operated leg Then bring the crutch up Repeat

Going downEasy to remember,operated ( bad leg) goes down tohell first . Hold onto rail, place crutch in

other hand making a cross Place the crutch on the next

step St tthe operated leg down Stethen un-operated leg down

R Repeat


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Main aims Gait re-education Walking aid progression Range of Movement (ROM) Swelling management Muscle Strengthening Balance and Proprioception Functional Based Outcome Measures


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Equal Weight BearingHeel to toeLeg length discrepancy

Trendelenburg Gluteus medius strengthening

2 elbow crutches to 1 elbow crutch 1 elbow crutch to 1 walking stick Outdoor and indoor mobility 1 walking stick to independent


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Hip Knee

Active ROM

Passive ROMScarKnee ROMTreatment Active movements Passive movement Swelling management Soft Tissue Work

Glutes, hamstring and hipflexor

Active ROMPassive ROMScarHip and Ankle ROMTreatment Active movements Accessory mobilisations PPMs and METs Swelling management Static bike Prone lying Soft Tissue work

Quads, hamstrings andgastroc


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IceCompressionElevationMobilityROM exercises


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Hip Knee

Hip FlexorsHip ExtensorsHip AbductorsHip Adductors

KneeSurgical approach willaffect which muscleswill be most weakened.

Knee FlexorsKnee Extensors


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Hip Knee

Bed based SG, SQ, hip flex and abdChair exercises Hip flex, knee ext

Standing Hip flex, abd, extResisted Theraband, static bike

Bed based SQ, IRQ, SLR, SG, knee

flexChair exercises Knee extStanding Squats, SLS, step upsResisted Theraband, static bike,

leg press


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SLSWobble boardHeel-toe gait

Backward walkingTandem stance


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StairsGaitPatient goal based

DrivingHobbies/ sport


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ROM

Oxford Muscle Grading

Gait

Others

Documents

Total Knee and Hip Replacement Physiotherapy