Total Knee Arthroplasty #3

One Patients Story to Treatment and Recovery

““Orthopedic injuries can only bear a certain amount of weight. With this machine, we can gauge how much weight and be compliant with the doctor’s orders. The patient can exercise without as much pain.””

Trent Leonard, Rehabilitation Service Manager, Life Care Center

One Patients Recovery from a Total Knee Arthroplasty #3

Paulo Bautista, RPT; Christopher Vasquez, OTR/L; Alyssa Barrett, Clinical Specialist Allure Rehabilitation Services

Introduction

The patient is a 66 year old male with history of right knee pain from osteoarthritis that was becoming progressively worse and limiting his activity level. The patient underwent a right Total Knee Replacement on 10/21/2014 at Mt. Sinai Beth Israel Hospital. The patient lives with his family in a two-family home, and prior to surgery he was able to ambulate with no assistive devices. The patient lives an active lifestyle, and he enjoys traveling to his community Synagogue for prayers daily and visiting with his family. The patient was admitted to Bedford Center for Nursing and Rehabilitation on 10/24/14 to participate in physical therapy and occupational therapy.

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Goals

  • Develop a normal gait pattern
  • Improve strength of R lower extremity
  • Improve knee ROM for extension and flexion
  • Tolerate standing to safely participate in self-care and mobility
  • Participate in community ambulation using a straight cane
  • Restore normal stair ascend/descend mechanics

History / Progression

  • The patient had a long history of right knee osteoarthritis and pain which was progressively getting worse and limiting his daily activity.
  • Prior to surgery the patient was attending traditional outpatient physical therapy for two years which provided short term relief. Therapy focused on pain management through the use of Ultrasound, TENS, ice/heat, soft tissue mobilization, and traditional dynamic knee exercises focusing on knee extension and flexion. The patient also participated in Aqua therapy. • When symptoms increased and traditional physical therapy was not providing patient with any further pain relief, the patient elected to undergo a Right Total Knee Arthroplasty on 10/21/2014.
  • During inpatient stay, the patient participated in 3 days of inpatient rehabilitation.
  • At initial evaluation the patient’s right knee PROM was: flexion = 0-80, extension = 80-0. The patient was ambulating 10 feet with a rolling walker and moderate assistance and weight bearing as tolerated. The patient’s strength was 3-/5 and pain was rated at 5/10 with moderate effect on function. C A S E S T U D Y Total Knee Arthroplasty
  • One week post-op the patient began outpatient physical therapy and occupational therapy at Bedford Center for Nursing and Rehabilitation. The patient initiated a walking program on the AlterG Anti-Gravity Treadmill at 35% of his body weight at 1.5 mph and no incline for a 15 minute interval. The protocol included gait training on the AlterG Anti-Gravity Treadmill, soft tissue mobilization, proprioception training, and strengthening/stretching of the right lower extremity.
  • Two weeks post-op, the patient progressed to 50% his body weight at 2.0 mph and no incline for a 30 minute interval.
  • Three weeks post-op, the patient progressed to 60% of his body weight at 2.0 mph and no incline for a 40 minute interval.
  • Four weeks post-op, the patient progressed to 85% of his body weight at 1.0 mph and no incline for a 40 minute interval.
  • Program duration was 5 weeks.

Results

Download Case Study to see progression table. 

He demonstrated strength of 4+/5 in his R LE after completion of physical therapy. The effect of pain no longer impacted the patient’s function and the patient demonstrated independence with preventative pain management strategies including utilizing a cold compress following exercise sessions.

The AlterG Anti-Gravity Treadmill assisted in improving the patient’s gait pattern and provided the patient visual feedback to self-monitor his gait pattern during ambulation. Following treatment, the patient demonstrated the ability to ambulate on both even and uneven surfaces for community distances with use of a standard cane.

The patient demonstrated the ability to negotiate 3 flights of stairs with proper gait mechanics. He uses a standard cane and unilateral handrail, which will enable him to return to visiting with his family on the second floor living space and attending daily prayers at his Synagogue.

The patient also improved his ability to don/doff lower body clothing from the maximal assistance level to independent level which enabled him to achieve independence during activities of daily living.

The patient walked on the AlterG Anti-Gravity Treadmill 6 times per week and progressed his time, speed, and body weight to focus on returning to the community. The Anti-Gravity Treadmill also contributed to the patient’s confidence when progressing ambulation with use of a rolling walker to a straight cane. The patient was discharged at 5 weeks post-op. The rehabilitation program incorporating AlterG Anti-Gravity Treadmill enabled this patient to reach his goals and return to his prior living environment. The patient was discharged from Bedford Center for Nursing to the community on 11/28/2014.

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