TKA protocol (Full Version)

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KAK -> TKA protocol (October 23, 2006 7:52:00 AM)

I received a referral from am out of town ortho that specializes in total joints (all his practice does). The patient brought along the doctors? protocol. I found it uniquely restrictive in that the patient is only allowed to go up/down steps 1x/day, no legs weights for one year post op, no passive ROM, limit recreational walking to one mile (forever). Has anyone else come across such restrictions? I have a call into a PT who works with them ? I?m curious as to the rational?

The no leg weight thing especially threw me because I normally strengthen them right off the bat. It says closed chain exercises for strengthening are OK, but no squats or wall slides (or steps). Apart from functional sit to stand and high rep unweighted exercises, I?m a bit at a loss as to how to address quad strength. I considered lunges, but I don?t see much difference between that and a squat. He is a bit too large and unsteady for stool scoots. Any thoughts? -> Re: TKA protocol (October 23, 2006 7:57:00 AM)

That's weird. But, there is probably some reason, even if not a valid one. He may have gotten sick of treating inflamed knees from overagressive PT, or saw better outcomes in persons with this protocol than doing a typical PT routine. He may be trying his own "thing", or read something in a journal that the rest of us have not seen yet. The best thing to do is communicate with this physician, develop a relationship, and find out where his thinking comes from. And, of course, let us all know the results!

John Duffy, PT OCS

Synergy -> Re: TKA protocol (October 23, 2006 6:48:00 PM)

Just as I was about to type a response stating the doctor sounds like a moron, I read Duffy's response. Well thought out and great advice. Get on the horn with the patient's doctor and let us know the rationale he offers.

srcase -> Re: TKA protocol (October 23, 2006 8:01:00 PM)

Could be related to the type of fixation used and/or the integrity of the underlying bone ??

jma -> Re: TKA protocol (October 24, 2006 4:28:00 PM)

Yes, please let us know what the surgeon said about his support for the protocol.

KAK -> Re: TKA protocol (October 24, 2006 5:33:00 PM)

I ended up talking with the PT who works with this group?s patients and I?m assuming helped develop the protocol. The rationale is several fold. First, the patient can self-assist to their heart?s content; the docs do not feel a PT pushing on the patient is either necessary or helpful. She told me it is the exception that by 3 weeks the patients are not at 130 degrees. Secondly, they had a high failure rate which has been reduced with this protocol. Thirdly, they don?t feel weights do much good and prefer functional strengthening. So? there we have it.

nari -> Re: TKA protocol (October 24, 2006 6:09:00 PM)

Sounds like a rather sensible protocol, backed up by that objective improvement if PT input is minimised.
I certainly agree with the no-weights, at least in the first month or so; that is the general rule here.
Limiting walking to one mile forever seems peculiar. Maybe they can back up that reasoning somehow??


jma -> Re: TKA protocol (October 24, 2006 7:18:00 PM)

Hmm. Upon reading the initial post again, I too saw the walking one mile, (forever)? If that were the case, there would be no need to replace the replacement until well over its lifetime. Sounds impractical to me, unless the patient was not able to ambulate that far prior to surgery.

srcase -> Re: TKA protocol (October 24, 2006 7:36:00 PM)

The no squats or steps seems anti-functional to this just initially??

KAK -> Re: TKA protocol (October 25, 2006 9:20:00 PM)

Nari,jma and Sarah,
The protocol was specific to recreational walking (for exercise). I?m thinking they don?t want folks going out and ?power? walking 3 miles/day. It wasn?t clear weather the one set of steps per day was temporary or not. I got the impression that NO ?repetitive squats or wall slides? as exercises were permanent restrictions.

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