Medical Exercise Specialists…..total joint replacements will become a bigger part of your practices over the next 20 years. This is a continuation of the earlier blog post working with a total knee replacement client. Weight bearing status is important when working with TKRs. Upon discharge from the hospital the client is usually weight bearing to tolerance. After the surgery, the physician wants the client up within the first 24 hours walking with a walker weight bearing to their tolerance.
After the replacement, the knee is severely swollen with significant pain. The knee is usually wrapped and partially immobilized in extension. Pain management and safe ambulation are the focus in the hospital. Discharge occurs within 24 - 48 hours of the surgery. Depending on the client's home situation and family support, along with their weight bearing and ambulatory status, the client will go home or to a skilled nursing facility (SNF). If the client is discharged to their home, home PT or outpatient PT may be prescribed.
In this video we review Cornell's ambulatory status with a walker, straight cane as well as independent ambulation without an assistive device. Remember, the use of assistive devices is determined by the therapist and/or physician. When you obtain a new total knee replacement client contact the physician or therapist for the client's weight bearing status. Prior to the client starting with you the client should have: 1) minimum of 90 degrees of knee flexion and full knee extension (lack of knee extension is common); 2) minimal pain of 4 or less on the pain scale and 3) minimal swelling. Minimal swelling is key. As a MedXPRO, exercise is helpful but may not be as effective to reduce swelling as electric stim, massage, aquatic training, and NSAIDs. These must be administered by a licensed medical professional save the aquatic training. As you can see there are very specific roles and responsibilities for each professional in the client's chain of care from the surgeon, to the therapist, to the MedXPRO.
Have you worked with a total knee replacement? If yes, please share your outcomes and a summary of your exercise programming.
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