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  • APTA's TKA Guidelines: Your Comments Needed by January 3

    APTA is developing a new clinical practice guideline (CPG) on total knee arthroplasty (TKA) and your help is needed.

    The CPG is now in the public review phase of its development, and APTA is asking for public comment. But hurry—deadline for comments is January 3, 2020.

    Funded entirely by APTA, the draft CPG covers topics ranging from preoperative exercise to physical therapy discharge planning and assessment of outcomes. The resource was developed by a volunteer development group that included member expert PTs from many of the Academies, an orthopedic surgeon, a nurse, and a consumer, and was based on systematic reviews of current scientific and clinical information related to the PT management of TKA.

    APTA has created a webpage that links to the CPG and allows visitors to provide comments.

    Comments

    • I work in homeware so my comments are related to physical therapy in the home. I have found great success when a patient returns home getting P.T. initially for 3 times per week for 2-3 weeks then wean down to 2 times per week for 3-4 weeks then discharge to output P.T. Many times I find that pt may not even need output P.T. if ROM is WFL;s and strength is at lest 3/5 and are walking with a straight cane indoors and outdoors. Much success at home if no complications and good surgeon.

      Posted by Carol Schellinger on 12/18/2019 2:40 PM

    • I left all of my comments on one page. If I need to fill out a new form for each comment, please make the "button below" available or more noticeable

      Posted by Olivia Howard on 12/18/2019 7:18 PM

    • There needs to be communication and trust established between the surgeons and therapists. Home health is extremely expensive and the cost-to-benefit ratio is not ideal when it comes to establishing function. They should receive home health only if they cannot arrange for transportation or if their functional goals are very low and home health is most appropriate. Outpatient therapy should start post-op day 2 or 3. A large emphasis should be on education to the patient regarding reasonable goals and expectations. Terminal knee extension should be the first goal emphasized and this should be expected by day 7-10. By the first follow-up with the surgeon, motion should be 0-90 and quad strength/activity should be 3/5. By two weeks patient should be walking with a straight cane and proper heel-strike with terminal knee extension and a smooth gait cycle through push-off. Motion should be pushing 110 by this point and PRE’s should be implemented for quad, hamstring, gastroc, hip complex and core. Functional squatting and stepping should also be implemented at this stage along with single leg static and dynamic balance. By week 4 motion should be near 0-115/120 and nothing really beyond this to avoid creating an unstable joint. Strength should be progressing each week toward 4+/5 and should be walking without any assistive device. At this point the majority of patients should be discharged to a detailed Home Exercise Program unless their functional goals are more advanced, in which case the next 2-3 weeks should be spent with activity specific training for proper transition to their activity of choice (often golfing or hunting/fishing).

      Posted by Scott Jablonka on 12/18/2019 10:04 PM

    • Please make a comment on dry needling recommendations: how long to wait post-op for infection risk, benefits of pre-operative needling (myoral, 2013), whether or not needling should be included in treatment plan Mayoral, O., Salvat, I., Martín, M. T., Martín, S., Santiago, J., Cotarelo, J., & Rodríguez, C. (2013). Efficacy of myofascial trigger point dry needling in the prevention of pain after total knee arthroplasty: a randomized, double-blinded, placebo-controlled trial. Evidence-Based Complementary and Alternative Medicine, 2013.

      Posted by Trent Stensrud on 12/19/2019 7:54 AM

    • Whenever I see a TKA that has had therapy elsewhere but failed to succeed they almost always forgot/ignored the importance of restoring patella mobility and tibiofemoral ER/IR mobility. Other than that I see a lack of attention to the ankle below and the the hip above the newly replaced knee. We have to rehabilitate the whole limb to reach the highest functional outcome.

      Posted by Dan Swinscoe on 12/19/2019 8:07 AM

    • This is fine but fro those of us in rural heal settings the number one term you left out is flexibility for the therapist.

      Posted by Max Morton on 12/19/2019 9:49 AM

    • Inpatient PT should be done POD#0 with emphasis on out of bed activities after bed exercises when pain is controlled and patient has sensation in both feet. Ice packs on the knee should be applied to decrease swelling. Patient should be seen by PT prior to discharge the following day. Home health PT should follow as recommended by Home Health PTs.

      Posted by LEONORA FERNANDEZ on 12/19/2019 11:08 AM

    • I am an orthopedic physical therapist. I have noticed a trend of low back pain patients that have less than 120 degrees of flexión from previous TKA. Functional outcomes I strive for to minimize LBP include lunges with a chair and squats without support and good eccentric control going down stairs.

      Posted by Mariza Negrete on 12/20/2019 10:33 PM

    • Knowing what to expect significantly impacts perceived pain management, how to appropriately manage pain and the importance of early and often mobility. That being said, there should be strict guidelines with few exceptions to: 1.Patients MUST complete a formal total joint education class prior to surgery. (No exceptions). 2. Patients MUST participate in OOB/weight bearing activity POD 0. (Exceptions are unstable vitals/change in condition ect...) 3. Patients MUST (physician driven)wean from IV pain meds to PO pain meds within 2 hours post operation. In regard to total joint class, clear expectations shall be laid out on discharge plan to HOME is the plan, pain management plan/expectations/elevation program, physiology (in layman’s terms) of why early and often mobility is important for pain management and reduction in post operative complications. Patients do better when they make a connection of what is going on inside their body. Especially, when they have the power to control how they feel. Nate Augustine, MPT/Clinical Liaison (Acute Rehab)

      Posted by Nate Augustine on 12/22/2019 7:38 PM

    • Working in inpatient i have seen drastically change in the last few years. We no longer use CPMS in the house ( some use at home) and a large percentage of our joints go home day 1 post surgery. Because they are doing well enough to home home they are also most likely to only need Outpatient and/or a very short home health rehab. I also think that they do highly benefit from patellar, fibular head and ankle joint mobilization as well as the normal strengthening and ROM activities.

      Posted by kimberly dennies on 1/2/2020 3:59 PM

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