APTA GUIDELINES Bundle (free trial)

Total Knee Arthroplasty - A Guide for Physical Therapists

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Recommendations Preoperative   Design preoperative exercise programs for strength and flexibility ★★★★   Provide education to patients undergoing total knee arthroplasty (TKA) ★★★★   Do NOT use continuous passive motion devices (CPM) ★★★★ Postoperative   Encourage cryotherapy for pain management ★★★★   Teach importance of early mobility and appropriate progression of therapy ★★★★   Include motor function training ★★★★   Implement passive, active assistive, and active range of motion exercises ★★★★   Teach patients to position the operated knee in some degree of flexion (30 to 90 degrees), while resting to reduce blood loss and swelling in the first 7 days ★★★★   Use neuromuscular electrical stimulation (NMES) ★★★★   Design, implement and teach high-intensity strength training and exercise programs within 7 days after surgery ★★★★   Provide supervised PT management, and determine the optimal setting by the patients' safety, mobility, environmental, and personal factors ★★★★   Either group- or individual-based PT sessions ★★★★   Start PT management within 24 hours of surgery and prior to discharge ★★★★   Provide guidance to the care team and patient on safe and objective discharge planning, patient functional status, assistance equipment, and services needed to support a safe discharge from the acute care setting ★★★★ Outcomes Assessment   Collect the KOOS JR (Table 2) as a patient-reported outcome measure and both the 30-Second Sit-to-Stand and Timed Up and Go tests to demonstrate the effectiveness of care provided. These should be collected at a minimum at the first visit and upon conclusion of care from each setting. ★★★★

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