The patient is a 79-year-old woman referred to the clinic 3…
The patient is a 79-year-old woman referred to the clinic 3 weeks after a left total knee arthroplasty. She had received home physical therapy for 4 visits to initiate range of motion and strengthening after surgery. At the time of the initial evaluation, she complained of intermittent central knee pain with walking; she denied pain at rest. Her goal was to be able to walk through a large mall without pain in order to shop with her daughter. She had a right total knee arthroplasty 2 years ago. Comorbidities include hypertension and gastroesophageal reflux. disease. Upon evaluation, the patient’s involved leg active range of motion was lacking 2° extension and she was able to flex her knee to 128°. Active range of motion on the uninvolved was 0° to 132°. Her incision was well healed with puckering at rest; hypomobility of the scar was noted with palpation. Her patellar mobility was slightly decreased superiorly and inferiorly. Measurements at mid-patella revealed a girth 5 cm greater on the left. A quadriceps lag was observed with straight leg raise. Quadriceps maximum voluntary isometric contraction testing at 60° was 425 N on the right and 202 N on the left, indicating the left quadriceps force was 48% of the right. Strength testing of the hip flexors, abductors, and ankle dorsiflexors was 4/5. She was utilizing a rolling walker for ambulation. The authors noted her stance time was equal, but decreased weight bearing on the left was observed. In addition, she ambulated with a flexed knee gait. Her Knee Outcome Scale was 66%. Functional testing included the Timed Get Up and Go Test, measured at 9.8 seconds, and the Stair-climbing test, which she performed in 25.6 seconds. Your initial tactics to address the range of motion impairments would include: