Demographic data:

Name: Krishna Singh

Age: 63 years
Gender: Female
Occupation: Housewife
IP No.- P233630

Chief complaint: Knee pain (R>L) since 3 years

History:
Present History: No history of trauma, fall and injury. Pain increased since last 3
months

Past History: Debridement done over left foot for venous ulcer on Oct’ 20
Medical History: On medications for HTN
Surgical History: Right TKR done on Dec’20
Pain history
Site: Over the incision site
Aggravating factor: Weight bearing
Relieving factor: rest

NPRS:8
Observation- In Hospital
Body build: Mesomorphic
Oedema: Present
Deformities: slight flexion of right knee
Posture: Mild flexion of knee
On palpation:
Tenderness: Present
Temperature of skin: Increased

On examination
Range of motion:

Knee Flexion/Extension Active Passive

0-15 0-20

Manual muscle testing: Not tested due to pain

Investigations – XRAY

Provisional diagnosis- Right TKR

Treatment-
Short term goal: To reduce pain
To reduce swelling

Long term goal: To strengthen muscles

To improve ROM
To be able to do ADLs

Exercise programme:
Ankle toe pump x 10 exercises
Isometric Quadriceps exercise x 10 repetitions
Vastus Medialis Oblique x 10 repetitions
SLR x 10 repetitions
Assisted Knee bending x 5 repettitions
Dynamic Quads x 10 repetitions
Hip Add-Abd exercise x 10 repetitions

Next day
Same exercises as above
Assisted knee bending x 7 repetitions
Ambulation with walker (PWB)
3rd Day
Same exercises as 1st day
Assisted knee Bending x 10 repetitions
Unilateral pelvic bridging x 5 repetitions
Pelvic rolling x 7 repetitions
Ambulation with walker (PWB)

4th day
Continue the same

Discharge

After 4-6 weeks

Observation:
Gait: Using walker
Posture: Normal
Palpation
Tenderness: present over incision site
Oedema : Absent
Temperature: Normal
Examination:
ROM Knee Flexion/Extension
95-100
MMT Not done due to restriction

PT advice: Hot pack x right knee x 15 minutes

Patellar mobilisation( grade 3)
Knee bending x 10 repetitions
Isometric Quads x 1kg wt x 10 repetitions
Isometric Hams x 1kg wt x 10 repetitions
Straight leg raise x 1kg wt x 10 repetitions
Vastus medialis oblique exercise x 1kg wt x 10 repetitions
 Calf and hamstring stretching exercise x 7-8 repetitions
Gait training using cane
Static cycling
Stair climbing
Next week
Observation:
Gait: Using walker
Posture: Normal
Palpation
Oedema : Absent
Temperature: Normal
Examination:
ROM Knee Flexion/Extension
100-105

PT Advice: Hot pack x 15 minutes x right knee

Isometric Quads x 2kg wt x 10 repetitions
Isometric Hams x 2kg wt x 10 repetitions
Vastus medialis oblique exercise x 2kg wt x 10 repetitions
SLR x 2kg wt x 10 repetitions
Dynamic Quads x 2kg wt x 10 repetitions
Hamstring curls x 1kg wt x 10 repetitions
Mini squats x 8-10 repetitions
Partial lunges x 7- 10 repetitions
Swiss ball exercises x 10-15 repetitions (Ant-Post & Lateral direction)