PT PROTOCOLS

What to Expect in Physical Therapy (PT) After Total Joint Replacement

Total Knee Arthroplasty (TKA)

  • 1st day in PT (evaluation)
    • please arrive 15-20 minutes early to complete required paperwork
    • the physical therapist (PT) will perform an evaluation to determine your needs for therapy
      • the PT will obtain measurements of knee motion and flexibility and lower extremity strength
      • the PT will assess your gait and correct as needed for proper mechanics with a walker or cane
      • a home exercise program will be developed specific to your needs, and all exercises will be reviewed with the therapist or aide. These exercises will be performed daily at home
      • depending on how you are feeling that day, a gym program may be started for you, which includes performing exercises using the clinic equipment
      • at the end of your session, a cold pack will be issued for 15 minutes
      • plan to spend about 60-75 minutes in the clinic your first day
  • Follow-up visits
    • after a total knee replacement, the patient can expect to continue physical therapy sessions 2-3x/wk for an average of 3 months*
    • each follow up session averages 60-75 minutes
    • during each session, you will work 1 on 1 with the PT for about 25-30 minutes to work on stretching, strengthening and functional exercises, gait training (including progression from a rolling walker -> cane -> no assisted device) etc
    • the patient will also work with the PT aides for an average of 20-30 minutes to perform a gym program designed by your PT, specifically for your needs
    • after all exercises are complete, ice will be applied to the knee for 15 minutes
    • on a monthly basis, a progress note will be written to discuss the plan of care with the patient and the physician
  • General time-lines/goals*
    • after the start of PT, most patients will use a rolling walker for about 2 weeks. Then a cane will be used for the following 4-8 weeks
    • after starting PT, most patients will start going up stairs with a normal pattern in 3-6 weeks, and down stairs with a normal pattern in 8-12 weeks
    • sleeping for 6+ hours without significant disruptions occurs after about 8 weeks from surgery
    • driving can usually be resumed after 2-4 weeks (left leg surgery) or 4-6 weeks (right leg surgery), pending MD instructions and pain medication use
    • the knee should have motion of 90 degrees of bending when starting physical therapy
    • the knee should have motion of 120 degrees of bending in about 8-12 weeks (it takes about 110 degrees to make a full cycle on a stationary exercise bike)
    • the knee should have full extension (achieve a fully straightened position) in 4-8 weeks


Total Hip Arthroplasty (THA)

  • 1st day in PT (evaluation)
    • please arrive 15-20 minutes early to complete required paperwork
    • the physical therapist (PT) will perform an evaluation to determine your needs for therapy.
      • the PT will obtain measurements of hip motion and flexibility and lower extremity strength
      • hip surgery precautions will be reviewed based on your surgical approach:
        • anterior: no hyper extension, no external rotation (ie: crossing your ankle to the opposite thigh), no crossing midline with the leg, no pivoting on the standing leg
        • posterior: no hip flexion beyond 90 degrees, no internal rotation (your foot rotating outward from your body while the knee moves inward), no crossing midline with the leg, no pivoting on the standing leg
        • lateral: no flexion beyond 90 degrees, no crossing midline, no extreme external or internal rotation
      • the PT will assess your gait and correct as needed for proper mechanics with a walker or cane
      • a home exercise program will be developed specific to your needs, and all exercises will be reviewed with the therapist or aide. These exercises will be performed daily, at home
      • depending on how you are feeling that day, a gym program may be started for you, which includes performing exercises using the clinic equipment
      • at the end of your session, a cold pack will be issued for 15 minutes
      • plan to spend about 60-75 minutes in the clinic your first day.
  • Follow-up visits
    • after a total hip replacement, the patient can expect to continue physical therapy sessions 2-3x/wk for an average of 3 months*
    • each follow up session averages 60-75 minutes
    • during each session, you will work 1 on 1 with the PT for about 25-30 minutes to work on stretching, strengthening and functional exercises, gait training (including progression from a rolling walker cane no assisted device) etc
    • the patient will also work with the PT aides for an average of 20-30 minutes to perform a gym program designed by your PT, specifically for your needs
    • after all exercises are complete, ice will be applied to the hip for 15 minutes
    • on a monthly basis, a progress note will be written to discuss the plan of care with the patient and the physician
  • General time-lines/goals*
    • after the start of PT, most patients will use a rolling walker for about 2-4 weeks. Then a cane will be used for the following 4-8 weeks
    • after starting PT, most patients will start going up stairs with a normal pattern in 4-6 weeks, and down stairs with a normal pattern in 8-10 weeks
    • sleeping for 6+ hours without significant disruptions occurs after about 6-8 weeks from surgery
    • driving can usually be resumed after 2-4 weeks (left leg surgery) or 4-6 weeks (right leg surgery), pending MD instructions and pain medication use
    • the hip precautions specific to your procedure will be adhered to for about 6 weeks


Total Shoulder Arthroplasty (TSA)

  • 1st day in PT (evaluation)
    • please arrive 15-20 minutes early to complete required paperwork
    • the physical therapist (PT) will perform an evaluation to determine your needs for therapy
      • the PT will obtain measurements of the shoulder motion and flexibility
      • the PT will assess your posture and adjust your sling if needed
      • the PT will review positions and movements to avoid
        • no active movement of the shoulder is allowed from the shoulder (ie: reaching activities) for the first 4-6 weeks.
        • no bearing weight through the affected arm or excessive movement behind the back for 4-6 weeks
      • a home exercise program will be developed specific to your needs, and all exercises will be reviewed with the therapist or aide. These exercises will be performed daily at home
      • depending on how you are feeling that day, a gym program may be started for you, which includes performing exercises using the clinic equipment
      • at the end of your session, a cold pack will be issued for 15 minutes
      • plan to spend about 45-60 minutes in the clinic your first day
  • Follow-up visits
    • after a total shoulder replacement, the patient can expect to continue physical therapy sessions 2-3x/wk for an average of 3 months*
    • each follow up session averages 60-75 minutes
    • during each session, you will work 1 on 1 with the PT for about 25-30 minutes to work on stretching, strengthening and functional exercises, etc
    • the patient will also work with the PT aides for an average of 15-30 minutes to perform a gym program designed by your PT, specifically for your needs
    • after all exercises are complete, ice will be applied to the shoulder for 15 minutes
    • on a monthly basis, a progress note will be written to discuss the plan of care with the patient and the physician
  • General time-lines/goals*
    • the sling will be worn for 3-4 weeks
    • driving can be resumed after 3-4 weeks
    • use of the arm independently can resume after 4 weeks, but the arm should not be used for lifting items heavier than a coffee cup
    • the arm should have enough range of motion to perform low overhead reaching activities (ie: pulling a shirt on overhead, reaching for a glass from a low cabinet shelf) at about 6-8 weeks
    • moderately challenging activities (carrying items such as a full pot/pan or laundry basket) can usually be resumed after 12 weeks
    • recreational activities (gardening, golf, etc) can be resumed after 16 weeks

*every individual responds differently to their surgery, and no two surgeries are the same. The numbers provided are a general guideline. Please consult with your physician about any specific questions regarding your surgery.