No hip internal rotation or adduction past neutral
General precautions
WBAT, with use of assistive device (AD) as needed (crutches, walker)
No crossing legs (crossing ankles OK)
Use good bending/lifting mechanics (keep back straight and bend at knees)
Keep hips above knees when sitting, avoid sitting in deep chairs ROM/Manual Therapy
Cemented replacement- WBAT
Non-cemented replacement; TDWB for first 6 weeks
Total knee replacement
Need at least 90 degrees of flexion to get in/out of car prior to leaving acute care hospital
Interventions focus on increased knee flexion, quadricep and hamstring strengthening progressing from isometric to concentric
Cemented- WBAT with AD
Non-cemented, TDWB with crutches or walker for first 6 weeks
Anterior cruciate ligament (ACL) surgical repair
Weeks 1-2: Isometrics activities for quads only
Brace locked in extension during this time
WBAT with use of axillary crutches
Weeks 2-6: Closed Chain Activities
More flexion is allowed (this is MD dependent)
Weeks 7-8:
Graft for ACL is at its most vulnerable for failure
Week 8:
Brace is completely unlocked (can move through full range) ◦ Open chain activities initiated
Full return to sports is 6-9 months
Posterior cruciate ligament (PCL) repair
Weeks 1-4: Partial weight bearing (PWB) with crutches
Brace locked in extension
Interventions: Isometric for quad control, patellar mobilizations
Open chain activities with avoidance of posterior translation of tibia on femur
Weeks 4-6:
Weight bearing as tolerated (WBAT) with crutches, brace unlocked for gait in controlled environment only
Transition to closed chain activities
Weeks 6-8: WBAT with crutches, brace unlocked for all activities
Closed and open chain activities
Week 8+: brace discontinued (as allowed by surgeon).
Patient may discontinue crutches if they demonstrate the following:
No quadriceps lag with SLR o Full knee extension o Knee flexion AROM 90-100 degrees o Normal gait pattern (may use 1 crutch/cane until gait normalized)
Balance/proprioception activities
Meniscus repair
Weeks 1-3: PWB with axillary crutches
Braced donned and locked in extension
Interventions: Patellar mobilization and quad strengthening starting with isometrics and progressing to concentric
Weeks 3-6: WBAT with axillary crutches and unlocking of brace
Interventions: Focused on increasing 120 degrees of flexion, normal gait, and full extension
Weeks 6+: WBAT with no brace
Strength and balance activities to promote return to prior functional status
Spinal surgeries
Limiting bending, lifting, and twisting for up to 6 weeks after surgery •Not sitting for more than 30–40 minutes at a time
Taking frequent short walks every day, gradually increasing distance •Climbing stairs based on comfort level
Not lifting more than 15 lbs for 12 weeks
Avoiding extension beyond 10 degrees
Wear brace as appropriate
Total shoulder arthroplasty
Weeks 1-3:
Neutral rotation, shoulder abduction pillow in 30-45 abduction, no sleeping on surgical side, no lifting, no excessive movements of shoulder
Interventions: PROM (pendulum exercises) progressing to AAROM of shoulder flexion only
Weeks 4-6:
Sling remains in place with weaning initiated
Interventions: PROM ER and ABD-; AAROM- shoulder flexion, shoulder elevation; strengthening of rotation cuff through isometric activities
Weeks 7-8:
Discontinue sling; no lifting
Interventions: Full ROM in all plane; Strengthening rotator cuff
Surgical failure most likely at this time when increased strengthening occurs
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