Joint Replacement PO Instructions

Physical Therapy Protocol

Total Knee Arthroplasty

  1. Home health P.T 3x/wk for 3 weeks.
  2. Use CPM 2 hours 3x q d increase CPM setting as tolerated starting at degree at hospital discharge.
  3. HEP of ankle pumps, quad sets, glute sets, SLRs, heel slides, knee flex and extension, long arc quads, short arc quads, and hamstring curls.
  4. WB status post-op usually as tolerated unless otherwise written.
  5. Ice/Moist heat 15-20 min/hr PRN for pain reduction and swelling control
  6. TED hose should be worn daily (including at night) until first post op visit.
  7. Progress to cane per hospital discharge orders (as tolerated).
  8. Post op appointment in office 2 wks after surgery

Total Hip Arthroplasty

  1. Home health P.T. 3x/wk for 3 weeks.
  2. HEP ankle pumps, quad sets, glute set, SLRs, heel slides, knee flexion and extension, long arc quads, short arc quads, hamstring curls. No side-lying hip abduction/SLR’s but supine hip abduction ok within THR precautions.
  3. THR precautions in place per hospital discharge orders.
  4. Abduction pillow or other pillow between legs at all times per hospital discharge orders.
  5. WB status is usually as tolerated unless otherwise written.
  6. Progress to cane per hospital discharge orders (as tolerated).
  7. Post op appointment in office 2 weeks after surgery.

Additional Treatments That May Be Used:

  1. Patellar mobilization.
  2. Stationary bike- start at 5 minutes and progress as tolerated.

General Considerations:

  1. Patient may shower per hospital discharge orders.
  2. Refer internal medicine issues to PCP.
  3. Preferred communication is telephone messages at 314-909-1359.

Notify Dr. Collard If:

  1. Temperature of 101.5 degrees or higher. Take Tylenol GR 10 PO PRN fever.
  2. Wound edges are separating.
  3. Significant redness develops well beyond the incision line.
  4. Significant increase in pain and/or swelling at the incision line.
  5. Any drainage.
  6. Bright red blood.
  7. Morbid increase in pain.
  8. Positive Assessment for DVT/PE
  9. No increase in knee ROM in one week’s time.

Total Hip Replacement Instructions and Precautions

  1. You should use your walker, crutches or cane as instructed by your therapist until you are told to discontinue them. Continue to use a pillow between your legs at night during the first 6 weeks after surgery. Other hip precautions: Avoid flexing past 90 °, avoid aggressive external rotation and avoid crossing the midline with the operated leg for about two months after surgery.
  2. You may wean the removal of your elastic stockings as your leg swelling continues to subside. If you continue to have swelling you should continue to wear the stocking.
  3. The therapist may have started you on some exercises, and you should continue these as tolerated. If it hurts, do not do the exercises until the pain subsides.
  4. You may drive a car when off of the narcotics and cleared by Dr. Collard, usually between 2-3 weeks after surgery.
  5. You should continue your care under your normal primary care physician.
  6. As the recovery of your hip continues to advance, you can reduce the daily exercises to several times a week. You basically can lead a normal life. However, remember that your hip is an artificial device, even if it feels normal. As with any artificial device, it is subject to possibilities of failure if you over-stress it. Therefore, I would recommend that you:
    1. Avoid lifting or carrying weights over 40 pounds.
    2. Avoid being overweight. If you are, please make an effort to lose weight.
    3. Avoid running or jumping exercises as your primary mode of exercise.
    4. Avoid strenuous sports. However, you may swim or use a stationary bicycle.
    5. Avoid moving the hip beyond the arc of movement that the hip allows you to move it freely. Do not move the hip beyond the arc of motion that is pain-free.

Lastly, if you develop an infection anywhere in your body, contact your family doctor because it should be treated adequately. There is a remote chance of such an infection spreading into the hip joint through the blood stream. For the same reason, if dental work, urinary work, or abdominal procedures are planned, we recommend antibiotics before and after these procedures to safeguard your total hip from infection.

Total Knee Replacement Instructions and Precautions

  1. You should continue range of motion exercises that were previously instructed to you by physical therapy. You may be using a continuous passive motion machine at home as well.
  2. You may begin resisted activities with weights as instructed by therapy, but do not lift more than 15 pounds with the operated leg.
  3. 7-10 days after your wound is completely dry you may bathe and wash the area over the incision. You can also apply cream or Vitamin E to soften the skin. Stop if skin becomes macerated.
  4. It is normal for the area around the incision not to feel normal to touch. This feeling may persist for some time or may be permanent.
  5. At times the knee prosthesis may make a click or a sound; this is normal.
  6. If you leg swells, please use the elastic stockings until the swelling subsides. If you develop calf pain please call the office.
  7. You may climb stairs with assistance and may weight-bear as tolerated with your walker or crutches, unless otherwise instructed, bearing full weight on operated leg.
  8. Do not allow anyone to forcibly bend or straighten your knee.
  9. Usually you may start to drive your car when you are off the narcotics and cleared by Dr. Collard, usually between 2-3 weeks after surgery.
  10. You should remember that your total knee replacement is an artificial device and is subject to mechanical failure if you over-stress it. In order to reduce the likelihood of that, I would advise you to avoid running or jumping as your primary activity to stay in shape. You may swim, ride a bicycle, or walk as exercise. You may play golf at your leisure. Lastly, if you develop an infection anywhere in your body, contact your family doctor because it should be treated adequately. There is a remote chance of an infection spreading into your knee joint through the blood stream. For the same reason, if dental work or genitourinary manipulations are to be performed, we recommend antibiotics before and after these procedures to safeguard your total hip from infection.
  11. If you have any questions, please contact our office. It is important that your knee be examined periodically. Even if you are doing well you should see me at least annually from your surgical date.