Postoperative Rehabilitation After TKA and THA

Postoperative Rehabilitation After TKA and THA

Prepared by Dr. Abdulkadir POLAT

---

Overview

Postoperative rehabilitation is essential after total knee arthroplasty (TKA) and total hip arthroplasty (THA) to restore mobility, improve strength, optimize range of motion (ROM), and reduce complications such as stiffness, thromboembolism, and functional decline. Protocols should be individualized based on patient factors, surgical approach, fixation, and intraoperative findings.

---

A) Postoperative Rehabilitation After Total Knee Arthroplasty (TKA)

Goals

• Early safe mobilisation and WBAT (weight bearing as tolerated) when permitted
• Restore ROM and quadriceps activation
• Improve gait mechanics and functional independence
• Prevent stiffness and thromboembolic events

---

Phase-Based Protocol

Day 0–1 (Immediate Post-op)

Key aims: early mobility, swelling control, activation

• WBAT (unless surgeon-specific restrictions apply)
• Exercises:
  • Quadriceps sets
  • Straight leg raise (as tolerated)
  • Ankle pumps
• Ice + compression for pain and swelling
• Early ambulation with assistive device (walker)

---

Week 1–2

ROM target: 0–90°

• Progress gait:
  • Walker → transition toward cane as tolerated
• Focus areas:
  • Improved quadriceps control
  • Edema control and pain-guided activity progression

---

Week 3–6

ROM target: 110–120° (patient-dependent)

• Functional training:
  • Stair training
  • Balance and proprioception exercises
• Strength progression:
  • Closed-chain strengthening (as tolerated)
  • Continued quadriceps and hip strengthening

---

Week 6–12

Goal: functional independence

• Independent/basic ADLs
• Structured walking programme
• Progressive strengthening and endurance training

---

After 3 Months

Generally allowed (low-impact):

• Walking
• Swimming
• Cycling

Typically avoided (high-impact):

• Running
• Jumping
• Contact sports

OrthoRico note: Return-to-sport decisions vary by implant type, patient factors, and surgeon preference; prioritize low-impact activity for implant longevity.

---

B) Postoperative Rehabilitation After Total Hip Arthroplasty (THA)

Goals

• Protect the hip during early healing
• Restore gait, hip abductor strength, and functional independence
• Reduce risk of dislocation (especially with posterior approach)
• Gradual return to low-impact activity

---

Approach-Based Precautions

Posterior Approach Precautions

• Avoid hip flexion > 90°
• Avoid internal rotation
• Avoid adduction across midline

Anterior Approach Precautions

• Avoid excessive extension + external rotation

OrthoRico note: Some surgeons use “minimal precautions” protocols depending on stability, implant choice, and patient factors—follow the operating surgeon’s guidance.

---

Phase-Based Protocol

Day 0–1 (Immediate Post-op)

• WBAT (unless specified otherwise)
• Ambulation with walker
• Early activation:
  • Gluteal activation
  • Quadriceps activation

---

Week 1–4

• Hip abductor strengthening (progressive, pain-guided)
• Stair training
• Controlled ROM within precautions
• Gait training and posture correction

---

Week 4–8

• Aerobic conditioning:
  • Stationary bike
  • Pool therapy (when wound healed and allowed)
• Balance training and progressive resistance exercises

---

Month 2–3

• Independent daily activities
• Return to work (depending on job demands)
• Progressive endurance and strength

---

After 3 Months

Generally allowed (low-impact):

• Walking
• Cycling
• Swimming
• Golf

Typically avoided:

• Running
• High-impact sports
• Contact sports

---

Key Clinical Pearls (OrthoRico Style)

• Early mobilisation and structured rehab reduce stiffness and improve functional recovery.
• For TKA, early ROM + quadriceps control are the main early priorities.
• For THA, abductor strength and gait quality drive mid-term recovery.
• Hip precautions depend on surgical approach, stability, and surgeon preference.
• Return-to-sport should remain low-impact-focused for long-term implant survival.

---

References

1. American Academy of Orthopaedic Surgeons (AAOS). Total Knee Replacement Exercise Guide / Total Hip Replacement Exercise Guide. AAOS patient and clinical rehabilitation resources.
2. Pozzi F, Snyder-Mackler L, Zeni J. Physical exercise after knee arthroplasty: A systematic review of controlled trials. Eur J Phys Rehabil Med. 2013;49(6):877–892.
3. Artz N, et al. Effectiveness of physiotherapy exercise following total knee replacement: Systematic review and meta-analysis. BMC Musculoskelet Disord. 2015;16:15.
4. Larsen JB, et al. Early mobilization after total hip and knee arthroplasty—evidence and implementation. Acta Orthop. 2008;79(2):160–167.
5. Husted H, et al. Fast-track hip and knee arthroplasty: Clinical and organizational aspects. Acta Orthop. 2010;81(2):1–6.
6. van der Weegen W, et al. Hip precautions after posterior-approach THA: A systematic review on dislocation risk and precautions. Acta Orthop. 2016;87(2):1–8.
7. Healy WL, Sharma S, Schwartz B, Iorio R. Athletic activity after total joint arthroplasty. J Bone Joint Surg Am. 2008;90(10):2245–2252.