Hi Sergio
I was interested to read your request and eagerly looked forward to peoples' replies since I haven't done hospital orthopaedic physio for five years. I was amazed to read Aileen's response that her TKR patients are not allowed to flex their knees for a week!
I worked at Kingston Hospital in the UK and one of the most irritating parts of our job was that we used to get called down to the operating theatre recovery rooms (had to change but not scrub up) so as to load the still unconscious patient's knee onto a CPM - continuous passive movement machine. So the patient would wake up with the knee being continuously moved post - op. It was very annoying and rather time-consuming but it has to be said that on the occasions that the theatre staff did the job themselves it wasn't very well done and the poor patient would almost have their tibia unscrewed !!
It seemed to work fine as a system, though, and it was never really a problem achieving 90 degrees of flexion.
We would get the patients up the day after surgery. If they were under about 70 and fit they would be given a non-cemented knee which required them to be minimally partially weighbearing for six weeks. If they were older and were likely to be making less long term demands on their new knee, they were given a cemented joint and could fully weightbear from day one.
I always remember how well the RA patients did....they used to get up and practically dance on the following day because their joint pain had gone: the surgical pain was nothing to them......whereas the OA patients used to find the post-op pain difficult to handle!
But that was all five years ago. I don't know whether the protocols have changed.
Sophie Dhenin
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