Authors

Prof Leo Pinczewski MBBS, FRACS

Dr Keran Sundaraj MBBS, MSc (Trauma), FRACS, FAOA

Dr Lucy Salmon BAppSc(Phty), PhD

Emma Fitzgibbon, BAppSc (Phty)

Contents

Prehabilitation

Stage 1 (Days 1-5 )

Stage 2 (Weeks 2-6)

Stage 3 (6 weeks – 6 months)

Stage 4 (6 months – 1 year) 

Prehabilitation 

Aims

• Strengthening of knee musculature

• Maintain or improve knee range of motion

• Familiarisation of postoperative exercises (see Mater booklet)

Treatment Guidelines

• Low impact exercise eg. Walking, bike, swimming

• Range of motion exercises eg lunges, hamstring & calf stretches

• Strengthening exercises eg SLR, IRQ, SQ

Stage 1 (Days 1-5 )

• Postoperative pain relief & wound care

• Swelling reduction

• DVT prophylaxis

• Early mobilisation from Day 1

• Restoration of knee range of motion

• Functional muscular recovery

Treatment Guidelines

• Ice, elevation, analgesia, wound dressing

• Anticoagulation to prevent blood clots

• Mobilise full weight bearing as tolerated progressing from a frame to crutches or a walking stick by day 5

• Range of motion exercises eg heel slides, lunges, active flexion, calf & hamstring stretches

Stage 2 (Weeks 2-6)

Aims

• Continuation of postoperative pain relief, wound care, swelling reduction & DVT prophylaxis

• Continuation of strengthening & range of motion exercises

• Gait retraining

• Commencement of a walking program

Treatment Guidelines

• Continuation of anticoagulation & analgesic regime

• Ice and elevation

• Removal of dressing yourself at 10-14 days - a photo can be sent to the office via text

• Progression of exercises to improve strength, endurance & range of motion

• Gait retraining from walking stick to no aid

• Can commence hydrotherapy after 2 weeks once wound is well healed

• Review with surgeon at 6 weeks with radiographs

 Stage 3 (6 weeks – 6 months)

Aims

• Continuation of exercises as above and progression to more functional activities

• Wean off analgesia

• Swelling reduction

Treatment

• Progression of walking programme aiming to achieve a 45 min brisk walk

• Gradual return activities such as golf and tennis

• Replace basic ROM and strengthening exercises with functional activities as above

• Return to driving once comfortable & narcotic analgesia eg oxycontin or endone is ceased

• Continuation of mild analgesia at 6 months as required

• Swelling and warmth in knee resolves mostly by 6 months. Antero-lateral numbness reduces but persists indefinitely

 Stage 4 (6 months – 1 year) 

Aims

• Continuation of above

Treatment Guidelines

• Review with surgeon at 1 year postoperatively with radiographs