DROITWICH PROTOCOL

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DESCRIPTION

This may be a total knee replacement or partial (unicompartmental) replacement. Unicompartmental replacements will probably progress more quickly and achieve a greater degree of knee flexion.

ACUTE STAGE (Whilst on ward)

C.P.M. 0 - 60 ° overnight and subsequently as necessary.
Rest the knee in full extension (no pillow under the knee)
P.W.B. with frame
T.E.D. stocking for both legs (To continue for six weeks)
Muscle pump exercises
Isometric quadriceps
Active knee flexion aiming for 90 ° when C.P.M. can be stopped
Active knee extension g S.L.R. when able

Progress to: ......P.W.B. with crutches
...........................Stairs

SEVEN DAYS

Increase weight bearing as able
Active hamstrings
Increase flexion gently

PROGRESS

Progress to full weight bearing (stick for balance)
Progressive mobilising and strengthening to include : Static bike, Step work, flexion in prone lying, proprioceptive re-education etc.

CONDITIONS FOR DISCHARGE

1. Reduced swelling and pain
   
2. Knee flexion at least 90 ° hopefully 110.
   
3. Able to demonstrate control on ascending and descending steps
   
4. Full weight bearing, may need walking aid as appropriate for general condition