Patient Problems

#2
Rebecca Stevens

A 55 year old female had a TKR two weeks ago and her incision is well healed. She is very
anxious to get well and always does two times as many reps as you specify. When you discuss
this with her she says she is doing it because she will get better faster. Please specify a home
exercise program for her.

Patient Problems
#2
Rebecca Stevens
MEDICAL HISTORY:
Hypertension , controlled with Lasix
R TKR 5/2011
DIAGNOSIS:
L TKR status post 2 weeks, NWB for 4 weeks
SUBJECTIVE:
Pt. already doing prescribed Th. Ex. Through surgeons protocol. HS, AP 10x twice/day. She
does double the reps to get better faster. Uses ice for 30 minutes every 2 hours, as
prescribed.
Home situation: Lives along in ranch style home, 1 floor living space with basement. There are 4
steps to enter the home and 12 steps to basement. She owns an exercise bike and misses
riding it before school. She has a large dog and a neighbor helping to walk the dog for now.
Occupation: 8th grade English teacher, public school
Functional Activities: standing at blackboard, computer work and reading (seated), walking and
biking daily
Patient Goals: She is very anxious to get back to work and play with her dog. She knows the
Dr. told her she could go back to work if her 12 week re-eval is ok but wants to get better
faster.
OBJECTIVE:
Inflammation and swelling WNL of TKA status post 2 week
Sensations:
Sharp/Dull: 7/10
Light Touch: 6/10
Pain: current 6/10
GONIOMETRY
AROM
Left
Right
Left
Hip
85
90
91
Hip /
21
22
27
Hip ABD
36
37
42
Hip ADD
18
18
23
Hip IR
44
45
48
Hip ER
43
45
48
Knee
80
120
86
Knee /
-10
0
-8
Ankle df
20
20
23
Ankle pf
40
40
43
MMT
Hip
Hip /
Hip ABD
Hip ADD
Knee
Knee /
Ankle df
Ankle pf

Left
4+
4+
4
4
3
3
5
5

Right
5
5
4+
4+
5
5
5
5

PROM
Right
95
27
42
23
50
50
124
0
22
43

Patient Problems
#2
Rebecca Stevens
Treatment: 2-3x/wk, HEP, MH, CP, E-stim, strengthening, ROM, transfers and education.
Pt received instruction of HEP. Was indep in same program. Encouraged to only do the HEP
as written.
ASSESSMENT:
Condition: Subacute
Rehab Potential: Good
STG:
Indep transfers; 2-6 visits
Ambulate 50 with walker; 6-8 visits
Ambulate 50 unassisted; 8-14 visits
Ambulate 4 stairs reciprocally; 14-16 visits
LLE strength to 5/5; 14-20 visits
knee to 100; 14-20 visits
LTG: strength and ROM for return to ADLs and work
PLAN OF CARE:
Education: HEP, stairs, overuse of exercise prevention
Exercise Education: Pt insists on doing double the reps of each exercise. It is important to
explain the negative effects of overuse on the TKA. The HEP is devised to have a variety of
exercises to allow her to challenge herself in different ways. Points to consider in HEP
instruction include:
1. The knee and surrounding tissues are still inflamed, even though the incision looks better.
By overusing the joint, you can increase the inflammation. This will hinder progress.
2. You should use PRICE! Protect Rest Ice Compression Elevate, when you feel pain or the
joint becomes red and swollen. Working through the pain could cause damage to the new
joint.
3. Work smart, not hard! Rather than add more reps, try slowing down and focusing on
your form.
4. Ask the PT before you add more exercises or reps. The PT, PTA, and you (the patient)
are part of a team working together to ensure your progress. Lets work together to make
sure you are progressing at the right speed for your new knee. We will also work with
you to improve your mobility at an appropriate speed with the goal to get you back to
your routine as soon as possible!
Referral:
Discharge Plan: safe ambulation, indep stairs, indep HEP, and normal ADLs at facility.
Continued strengthening and ROM, use of home modalities (MH, CP)