Dr.

Ali Makki
Total joint replacement, represents significant
advance in the treatment of painful and
disabling joint pathologies.

Can be performed on any joints of the body,

hip and knee total joint replacement by far the
most common.
Total hip replacement (THR) or total hip
arthroplasty (THA)

Replacement of the femoral head and the

acetabular articular surface.
Total knee replacement (TKR) or total knee arthroplasty
(TKA) :
Replacement of the articular surfaces of the
femoral condyles, tibial plateau, and patella; the
anterior cruciate ligament is excised, but the
posterior cruciate ligament may be saved in
cruciate-retaining systems.
The importance of Postoperative rehabilitation
in total joint replacement:

1/ pain-free
2/function of the joint and improve the
patient's quality of life.
Head lines kept in mind prior to start
rehabilitation
A. Pain Control:
Adequate analgesia for the patient should be a
priority during rehabilitation. It must be
remembered that these patients have undergone a
major joint reconstruction and may experience
moderate to severe pain.

Also kept in mind that, complications such as

infection and neurovascular injuries, can cause
postoperative pain.
B. Prevention of Thromboembolic
Complications:
1/ low–molecular-weight heparin (such as
enoxaparin) or warfarin.
2/Mechanical devices:
If the use of anticoagulation therapy is
contraindicated, mechanical devices,
including intermittent pneumatic stockings.
C. precautions to prevent posterior hip
dislocation following (THR) include:
Do not cross your legs.

Put a pillow between your legs if you lie on your side.

Do not turn your leg inward.

Sit only on elevated chairs or toilet seats.

Do not bend over from the hips to reach objects.

D. Restrictions on Weight Bearing and
Exercise
Patients with cemented joint replacements can
weight bear as tolerated (WBAT) unless the operative
procedure involved a soft-tissue repair or internal
fixation of bone.

Patients with cementless, or ingrowth, joint

replacements are put on partial weight bearing
(PWB) or toe-touch weight bearing (TTWB) for 6
weeks to allow maximum bony ingrowth to take
place.
E. knee immobilizer
after a total knee replacement until quadriceps
strength is regained; the use of the immobilizer
discontinued once the patient can do straight leg
raising (SLR) without difficulty.

Ambulating with weak quadriceps muscles can lead

to instability or giving way of the knee, which can
lead to pain and stress on the newly implanted
joint.
Total Hip Replacement Exercise Protocol
Preoperative (1-2 weeks prior to surgery
of hip replacement):

No hip flexion beyond 90°.

No crossing of the legs (hip adduction

beyond neutral).

No hip internal rotation past neutral.

Postoperative (day 1)
Initiation of bedside exercises - Such as:
ankle pumps,

quadriceps sets,

and gluteal sets.

Initiation of bed mobility and transfer training - Bed

to/from chair.
Postoperative (day 2):
Initiation of gait training with the use of
assistive devices, such as crutches and a
walker.
Continuation of functional transfer training.
Postoperative (days 3-5 or on discharge to
the rehabilitation unit):

Progression of ROM and strengthening

exercises to the patient's tolerance.

Progression of ambulation on level surfaces

and stairs .

Progression of activities of daily living (ADL)

training.
Postoperative (day 5 to 4 weeks):
Strengthening exercises - For example,
seated leg extensions.

side-lying/standing hip abduction.

standing hip extension and hip abduction.

knee bends, bridging.

Stretching exercises to increase the flexibility of hip

muscles.
seated leg extensions

side-lying/standing hip abduction

knee bends, bridging

Total Knee Replacement Exercise Protocol
Preoperative (1-2 weeks prior to surgery)

Education on the surgical process and

outcomes.

Instruction on a postoperative exercise

program.

Assessment of the home environment.

Postoperative (day 1)

Bedside exercises - For example, ankle

pumps, quadriceps sets, and gluteal sets.

Review of weight-bearing status.

Bed mobility and transfer training - Bed

to/from chair.
Postoperative (day 2)
Exercises for active ROM, active-assistive ROM
(AAROM), and terminal knee extension.

Strengthening exercises - For instance, ankle

pumps, quadriceps sets, gluteal sets, heel slides,
straight leg raises, and isometric hip adduction.

Gait training with an assistive device and

functional transfer training - Such as sit to/from
stand, toilet transfers, bed mobility.
Terminal knee extension

isometric hip adduction

Postoperative (days 3-5 or on discharge
to the rehabilitation unit)
Progression of ROM and strengthening
exercises to the patient's tolerance.

Progression of ambulation on level surfaces

and stairs.

Progression of ADL training

Postoperative (day 5 to 4 weeks)
Strengthening exercises - Including seated leg
extensions, standing hip abduction and
extension, knee bends, and short arc quads

Stretching of quadriceps and hamstring muscles

Progression of ambulation distance
Progression of independence with ADL
 Quadriceps . Set.
Lie on back with legs extended in bed
Tighten the quad.mus.on the front of leg
Push the back of knee into the bed
Hold for 5seconds
Perform 1 set of 10 repetitions 3times a day
 Glut. set
Lie on back with legs extended
Squeeze buttocks together
Hold for 5 seconds
Perform 1 set of 10 repetitions 3 times a day
 Ankle pump
Lie on back with legs extended
Support operated leg with a folded towel or pillow under ankle
Engage calf mus. And move ankle towards shin
Hold for 5 seconds
Move ankle away from shin
Hold for 5 seconds
10 repetitions 3 times a day
Getting out of Bed
• Slide your legs toward the edge of the bed; keep your operated leg
straight
• Push yourself up to your forearms and onto your hands
• Slide your legs so that your heels are over the edge of the bed
• Scoot your hips forward until both feet are on the ground
Getting into Bed
• Sit on the edge of the bed with both feet on ground
• Scoot your hips backwards as you keep your weight on your hands
• Lower yourself onto your forearms
• Slide your legs onto the bed; keep your operated leg straight
• Once in bed, keep your toes pointed up
Going Upstairs:
• Put one hand on the banister and
carry the crutch under the other arm
1/ Put your weight through your arms
and step up with your good leg
2/ Then step up with your operated leg
3/Then the crutch

Up with the good leg

Coming Downstairs:
• Place the crutch under one arm and the
opposite hand on the banister
1/ Start down the stairs with the crutches
first
2/ Then your operated leg
3/ Then your good leg

down with the operated leg