Page 3 - Total Knee Packet
P. 3
Dr. Christian Eccles
Hip and Knee Replacement Surgery
2940 E. Banner Gateway Dr. #200, Gilbert, AZ 85234
1675 E Melrose St, #101, Gilbert, AZ 85297
Phone: 480.964.2908 | Fax: 480.388.3519
Medical Assistant (Reese) extension: 3186
Surgery Scheduler (Debbie) extension: 4141
Physician Orders ________________
Outpatient Physical Therapy Patient Name
Total Knee Protocol
Diagnosis: s/p Total Knee Replacement (Z96.651 for a right knee, Z96.652 for a left knee)
Outpatient Physical Therapy 3 times per week for 4-6 weeks
● AROM/PROM focusing on terminal knee extension and flexion
o Ideally at from -5 – 95 degrees by 2 weeks
o Ideally from 0 – 120 degrees by 6 weeks
● Gait training as needed, progressing from rolling walker to cane to no device per
patient tolerance
● Balance Training
● Strengthening with focus on closed chain activities
● Modalities as needed for pain and swelling control
● Incision care:
o If dressing contains bleeding, wetness, or drainage larger than the size of a
quarter, please notify our office.
o If dressing loses water-tight seal, ok to reinforce.
o Patients are typically instructed to leave dressing on until 2-week follow-up.
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Date
