REHABILITASI MEDIK PADA OSTEOARTRITIS

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 REHABILITASI MEDIK - WHO
 Tindakan ditujukan untuk mengurangi dampak
disabilitas/handicap  penderita dapat berintegrasi
dengan masyarakat

 Macamnya:
– Rehabilitasi medik: pelayanan kesehatan 
mengembangkan kemampuan fungsi fisik dan psikologis
kalau perlu mekanisme kompensasinya  dapat mandiri
– Rehabilitasi Sosial:  penderita dapat berintegrasi atau
reintegrasi ke masy. dengan membantunya menyesuai-
kan diri pada keluarga, masy & pekerjaannya
– Rehabilitasi Karya (Vocational Rehabilitation): Latihan
kerja, penempatan selektif untuk penyandang cacat

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 FUNGSI → HOLISTIK
• Impairment:
– Gangguan sementara atau menetap yang mengenai
struktur anatomi, faal maupun psikologik
• Disability:
– Pembatasan kemampuan akibat impairment  tidak
dapat melakukan aktivitas yang dianggap normal
• Handicap:
– Disability atau Impairment menghalangi penderita
melakukan tugas-tugas sosial  handicap

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 KASUS REHABILITASI
• NEUROMUSKULAR
• MUSKULOSKELETAL
• GERIATRI
• PEDIATRI
• KARDIORESPIRASI
• SPORT INJURY

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 TIM REHABILITASI MEDIK
 Dokter
RSUD KAB KEP MERANTI
 Fisioterapis
 Terapis okupasi
 Ortotis Prostetis
 Pekerja sosial medik
 Psikolog
 Terapis Wicara

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TUJUAN TERAPI KFR
Pencegahan

Menghilangkan masalah  agar tidak

terjadi kecacatan

Mengurangi masalah  agar kecacatan

yg terjadi dapat diminimalkan

Memaksimalkan fungsi yang ada

Memberi kualitas hidup yang lebih baik

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 PENDAHULUAN
• Artritis merupakan salah satu dari penyakit rematik, yang
melibatkan satu atau beberapa sendi dalam proses
peradangan (inflammatory) dan destruktif ataupun
proses degeneratif mekanik tanpa peradangan (non
inflammatory)

• Penyakit Rematik kumpulan beberapa penyakit dengan

manifestasi pada jaringan ikat, otot, tulang atau sendi.

• Gejala – gejala (nyeri, keterbatasan LGS, deformitas

sendi)  DISABILITAS

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 Klasifikasi Penyakit Rematik
• Penyakit Rematik dibagi dalam 100 macam penyakit diantaranya
adalah:
I. Penyakit Jaringan Ikat Diffuse  RA, SLE
II. Artritis yang berasosiasi dengan Spondilitis  AS, Psoriatic Artritis
III. Penyakit Degenerasi Sendi  OA
IV. Artritis, tenosinovitis, dan bursitis yang berasosiasi dengan agen
infeksi
a. Direct
- bakteri (gram positif, gram negatif, mycobacterium, dll)
- viral, fungal, parasit, unknown
b. Indirect
- bakteri
- virus ( hepatitis B)
V. Metabolik  gout
Primer on the Rheumatic Disease 8
 MASALAH YG DIHADAPI

Keterbatasan
Nyeri Atrofi Otot
LGS

Ggg
Instabilitas
Deformitas Pembebanan
Sendi
Sendi

Penggunaan
Ggg Densitas Penurunan
energi tdk
Tulang Fungsi
efisien
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MODUL IKFR
 DIAGNOSIS ARTRITIS

ANAMNESIS

PEMERIKSAAN FISIK
- Pemeriksaan fungsi
- Pemeriksaan penunjang

1. ISTIRAHAT
2. TERAPI LATIHAN
TATALAKSANA KFR 3. MODALITAS
4. ORTOSIS
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MODUL IKFR
I. Common Rheumatic Diseases :
A. Osteoarthritis
B. Rheumatoid Arthritis
C. Ankylosing Spondylitis
D. Gout

II. Less Common Rheumatic Diseases :

A. Lupus Arthritis
B. Psoriatic Arthritis

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BRADDOM
I. Common Rheumatic Diseases :
A.Osteoarthritis
B. Rheumatoid Arthritis
C. Ankylosing Spondylitis
D. Gout

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 Osteoartritis
Definisi
• Penyakit sendi non inflamasi yang ditandai
dengan menipisnya rawan sendi secara
progresif, disertai pembentukan tulang baru
pada trabekula subkondral, dan terbentuknya
rawan sendi serta tulang baru pada tepi sendi
(osteofit)

Primer on the reumatic diseases 13

 Osteoartritis
Epidemiologi
• Paling sering terjadi
• Insiden  1:1 (45-55 thn), ♀>♂ (>55 thn)
• Usia  50-60 th (primer)
20-30 th (sekunder-trauma)

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 Osteoartritis
• Etiologi tidak diketahui secara pasti
• Faktor Risiko
1. Faktor predisposisi umum
umur, jenis kelamin, kegemukan, genetik,
hormonal
2. Faktor mekanik
trauma berulang, aktifitas fisik,
pekerjaan/olahraga
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OSTEOARTHRITIS

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 Osteoartritis
Gejala Klinik
1. Nyeri sendi
2.“Articular Gelling” kekakuan stlh istirahat lama/inaktifitas, kekakuan hilang
dlm bbrp menit stlh aktifitas
3. Kekakuan sendi pagi hari < 30 menit

Tanda-tanda Klinik
1. nyeri tekan
2. nyeri gerak
3. keterbatasan gerak
4. instabilitas sendi
5. atrofi disekitar sendi yang terkena

Temu Ilmiah Reumtatologi 20

 Osteoartritis
Pemeriksaan Penunjang
1. Laboratorium : tidak ada kelainan

Temu Ilmiah Reumtatologi 21

Radiologi

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 Osteoartritis
OA paling sering terjadi pada:
1. OA tangan
2. OA lutut
3. OA hip
4. OA spine (cervikal, lumbal)
5. OA kaki

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 Osteoartritis
1. OA tangan -- ACR
 Nyeri tangan atau kaku Dan
 Min 3 dr 4 :
o Pembesaran jaringan keras pada ≥2 dr 10 sendi tangan
tertentu
o Pembesaran jaringan keras pada ≥2 sendi DIP
o>3 pembengkakan sendi MCP
oDeformitas min 1 dr 10 sendi tangan tertentu
• 10 sendi tangan tertentu : DIP II, III, PIP II,III, &
CMC I, kedua tangan

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BRADDOM
 Osteoartritis
Deformitas Sendi Tangan
Hand & wrist
oHeberden’s node : spur formation at the DIP joint
oBouchard’s nodes : PIP

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X-Ray Findings in Osteoarthritis

26 BRADDOM
 Osteoartritis

ACR : oKlinik & radiologi

Nyeri lutut + min 1 dr 3 :
2. OA lutut  Umur > 50 thn
oKlinik & lab  Kaku pagi <30 menit
Nyeri lutut + min 5 dr 9 :  Krepitus pada gerakan aktif
 Umur > 50 thn +
 Kaku pagi <30 menit  Osteofit
 Krepitus pada gerakan aktif
 Nyeri tekan oKlinik
 Pembesaran tulang Nyeri lutut + min 3 dr 6 :
 Tidak panas pada perabaan  Umur > 50 thn
 LED < 40 mm/jam  Kaku pagi <30 menit
 RF < 1:40  Krepitus pada gerakan aktif
 Analisis cairan sendi normal  Nyeri tekan
 Pembesaran tulang
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 Tidak panas pada perabaan
KNEE ANATOMY

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HOPPENFELD
29
 Osteoartritis
• Nyeri pada lutut yang bisa berasal dari:
1. Elevasi periosteal oleh karena pembentukan
osteofit
2. Mikrofraktur subkondral
3. Iritasi ujung saraf dan sinovial oleh karena
osteofit
4. Spasme periartikuler
5. Peregangan kapsul sendi oleh karena sinovitis
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 Pemeriksaan Status Lokalis Lutut
Indikasi : OA Lutut
1. Deformitas pada lutut
2. Anatomi lutut
3. Pengukuran Trofi m. Quadriceps
4. Pengukuran ROM
5. Pengukuran Q-angle
6. Pemeriksaan MMT
7. Pemeriksaan provokasi tes
a. Pemeriksaan Ligamen
 Valgus test ( medial collateral ligamen)
 Varus stress tes ( lateral collateral ligamen)
 Anterior Drawer tes ( anterior cruciatum ligamen)
 Posterior drwaer tes ( posterior cruciatum ligamen)
 Apley distraction
b. Pemeriksaan meniskus  McMurray tes, Appley compression

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KNEE DEFORMITIES

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HOPPENFELD
 Wheeless' Textbook of Orthopaedics

Q angle (Quadricep angle)

• Sudut yang dibentuk oleh
perpotongan garis dari SIAS ke
patellar midpoint & garis dari tibial
tubercle ke patellar midpoint
• Normal ♂ : 14, ♀ : 18
• Q angle ↑  valgus

Genu valgum (knock knee) : pusat knee joint

jatuh pada medial dari axis yg menghubungkan
pusat hip & ankle joint
• > 3 cm jarak antara malleolus medial posisi
berdiri
Genu varum (bow leg) : pusat knee joint jatuh
pada lateral dari axis yg menghubungkan pusat
hip & ankle joint
• > 3 cm jarak antara condillus femoralis medial
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posisi berdiri
 HOPPENFELD

VALGUS &
VARUS STRESS TEST

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ROM KNEE

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HOPPENFELD
TROPHY M.QUADRICEPS ( WEAKNESS )

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HOPPENFELD
MMT M.QUADRICEPS & M.
HAMSTRING

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HOPPENFELD
ANTERIOR & POSTERIOR DRAWER TEST

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Wheeless' Textbook of Orthopaedics
MC MURRAY TEST

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HOPPENFELD
 40
HOPPENFELD
APLEY’S COMPRESSION & DISTRACTION

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HOPPENFELD
 Kellgren-Lawrence
Radiographic Grading Scale

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BRADDOM
X-Ray Findings in Osteoarthritis

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BRADDOM
 Joint Space Narrowing
• OA typically asymmetrical

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Paget’s disease
 Subchondral Sclerosis
• Increased bone density or thickening in the
subchondral layer

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 Osteophytes
• Bone spurs

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 Subchondral Cysts
• Fluid-filled sacs in subchondral bone

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Osteoartritis
3. Hip OA

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BRADDOM
 Pemeriksaan Status Lokalis Hip
Indikasi: sacroilitis, OA Hip

Provokasi tes:
1. Pelvic Rock test
2. Gaenslen’s sign
3. Patrick/ Fabere test

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PELVIC ROCK TEST
• Patient lie supine
• Thumb  SIAS
• Palm  Illiac tuberositas
• Compress the pelvis toward
the midline of the body
• Pain  Sacro Iliac Joint 
(+)
- Infection
- Secondary to trauma

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HOPPENFELD
 GAENSLEN’S SIGN
Drop unsupported leg  Pain in the
SI Joint  (+)
- SI Joint pathology
Draws both legs to his chest

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HOPPENFELD
PATRICK / FABERE TEST
• Patient lie supine
• Hip Joint  Flexi, Abduction,
Exorotation
• Inguinal Pain  (+)
- Pathology in the hip joint
- Or surrounding muscle

• One hand in the SIAS opposite

site
• Another hand in the affected
knee joint
• Press down these 2 points  Pain
 (+)
- Sacro Iliac pathology
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HOPPENFELD
X-Ray Findings in Osteoarthritis

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BRADDOM
SACROILIITIS

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 Osteoartritis
I.A.4. OA Spine
a. OA Cervikal
Dapat menyebabkan cervical sindrom
Gejala Klinis:
- nyeri di tengkuk
- nyeri menjalar sampai lengan
- kesemutan
- keterbatasan gerak
Pemeriksaan Fisik
• Tes spurling
• Distraksi
• Valsava nafziger

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 Osteoartritis
OA Spine
a. OA Lumbal
Dapat menyebabkan Low Back Pain
Gejala Klinis:
- nyeri punggung bawah, nyeri radikular
- keterbatasan gerak
- spasme otot
Pemeriksaan Fisik
- Scober test
- SLR test
- FABER test
Refleks fisiologis dan patologis
Kuliah Prof. dr. Angela, SpKFR-K 56
TES PROVOKASI

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 Hip Tests
Fabere (Patrick) (Figure 4–77)
• This test is used to assess Flexion,
Abduction, External
Rotation
• Perform this test with the patient supine,
passively flex
and externally rotate and abduct the hip
• The hip joint is now flexed, abducted, and
externally
rotated. In this position, inguinal pain is a
general indication
that there is pathology in the hip joint or
the surrounding
muscles
Schober Test
– Used for detecting limitation of
forward flexion & hyperextension of the
lumbar spine (Figure 3–4)
– While standing erect, place a landmark
midline at a point 5 cm below the iliac crest
line & 10 cm above on the spinous
processes.
– On forward flexion, the line should increase
by greater than 5 cm to a total of 20 cm or
more (from15 cm)
– Any increase less than 5 cm is considered a
restriction
60
Gambaran Radiologi OA spine

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62
 Osteoartritis
I.A.5 OA kaki
Diantaranya:
a. Hallux Valgus  PIP berdeviasi ke arah lateral
caput MTP I
b. Hallux RigidusPenyakit sendi degeneratif atau
kehilangan kartilago articular dari sendi (MTP) I
c. Hammer Toe Hiperekstensi sendi MTP, fleksi
sendi PIP, ekstensi sendi DIP
d. Claw Toe  hiperekstensi sendi MTP dengan
atau tanpa fleksi sendi PIP

Frontera 63
Hallux Valgus

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Hallux Rigidus

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• Hammer Toe • Claw Toe

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 OA
Treatment A. Konservatif B. Non Konservatif
1.Education (pembedahan)
o Penurunan berat badan
o Joint protection o Arthroscopic debridement
2. Medikamentosa o Osteotomi tibial tinggi
o Acetaminophen : Pct 4 x 1gr o Arthroplasti
o NSAIDs
o DMOAD ( Diaserin )
o COX-2 inhibitor
o Analgesic narcotics : tramadol
o Intra-articular steroid or hialuronan or NSAID : max 3x/thn
o Topical : krem NSAID, salisilat atau capsaicin
o Suplemen : glucosamine, condroitin sulfat
3. Rehabilitasi Medik
Exercise:ROM, strengthening, aerobic exerc
Modalitas :
o Fase Akut: RICE
o Fase kronik: Superficial heating, profunda, terapi manipulasi,
laser, magneto therapy, traksi dll
•Orthotic  Assistive device, dynamic splint, knee brace, aid gait,
TLSO, LSO , soft colar neck dll
Terapi terbaru : Stem cell mesenkim (asalnya tlg rawan)
Memperbaiki jaringan tlg rawan yg rusak dgn berdifferensiasi. 67
TATALAKSANA KFR PADA ARTRITIS
GOAL  Maintenance and restoration of function as well
as prevention of dysfunction.
INTERVENTION Individualized treatment plans  to
maximize patient function by :
• Education
• Physical modalities
• Exercise
• Assistive and adaptive devices
• Energy conservation
• Joint protection
• Vocational planning

68
DE LISA
EDUCATION

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 TATALAKSANA KFR PADA ARTRITIS
FASE AKUT
1. Istirahat (Rest)
2. Modalitas  terapi dingin
( dibahas pada modul modalitas)
3. Ortotik  resting splint

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 1. Istirahat (Rest)
• Istirahat lokal (Local Rest)  FASE AKUT / SUB AKUT
• TUJUAN :
- Mengurangi nyeri
- Mengurangi peradangan pd sendi
• INTERVENSI :
 At night  nonfunctional resting splints
 During the day  functional splints
 Short rest periode  during the day of 20 to 30
minutes  splints
• ADDITIONAL:
One ROM exercise daily for joints during rest of 2
weeks’ duration
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MODUL IKFR DE LISA
2. Modalitas  COLD
• Some clinical studies have shown greater and
more prolonged relief of pain with ice than
deep or superficial heat in patients with RA.

• COLD EFFECT :
- decrease the pain threshold
- can relax surrounding spastic muscles  by
direct action on the muscle spindle activity
- decrease joint temperature
- inhibit collagenase activity in the synovium
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DE LISA
73
3. Ortotik

Resting splints
• Immobilize the hand
and wrist
• Are used at night for
patients with :
- active RA
- CTS
- extensor tendinitis

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BRADDOM
 TATALAKSANA KFR PADA ARTRITIS
FASE KRONIK
1. Terapi Latihan Penguatan Pasif-Aktif
2. Latihan Peregangan
3. Latihan Ketahanan
4. Modalitas  terapi panas
(dibahas pada modul modalitas)
5. Ortotik
6. Assistive & Adaptive Device
7. Joint Protection
8. Energy Conservation

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 1. TERAPI LATIHAN
• TUJUAN :
- Pemeliharaan dan peningkatan LGS
- Penguatan otot
- Peningkatan ketahanan
- Peningkatan fungsi secara menyeluruh

 INTERVENSI :
- Passive Exercise
- Active Exercise
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MODUL IKFR DE LISA
 a. Passive Exercise
– Bukan oleh pasien sendiri tetapi oleh orang lain atau suatu
alat
– Mis :
• CPM (continuous passive motion) : untuk kelemahan
otot berat
• Stimulasi listrik
– Dihindari pada :
• Peradangan sendi yang hebat & akut
– Merrit & Hunder, Agudelo, Schumacher, Phelps : 
keradangan
–  tekanan intraartikular pada keadaan efusi sendi
(Jayson & Dixon → robekan kapsul sendi)

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 b. ACTIVE EXERCISE
Strengthening Exercise
– Isometrik/ statik
• mengembalikan & memelihara kekuatan pada pasien atrofi otot
• Gerber & Hicks :
– OA lutut sering dalam kesegarisan valgus atau varus dengan kontraktur
fleksi, memudahkan tegangnya otot hamstring & peregangan kronik otot
quadricep.
– Latihan : stretching hamstring 2x1 & isometric exercise NWB pada fleksi
lutut 20-30º
– Isotonik
• Peningkatan tahanan bertahap
• Atau beban ringan konstan, repetisi rendah
– Isokinetik
• Misal cybex
• Untuk OA ringan atau RA nonaktif yang dini dengan kec torque
medium & rentang gerak terbatas
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Terapi latihan

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82
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85
BACK EXERCISE

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 2. Stretching Exercise
• INDICATION
 to prevent contractures
 maintain / restore ROM by breaking
capsular adhesions.

• CONTRA INDICATION
 acute inflammation

87
DE LISA
 3. Endurance Exercise
• Patients with systemic Reumatic disease
 Limited endurance
 ability to perform static or dynamic tasks is
impaired
• PRESCRIPTION :
 Intensity : at least 60% maximal heart rate
 20 minutes  at least 2 x / week  for 6
weeks
88
DE LISA
– Manfaat :
• Mencegah kontraktur
• Memelihara atau memperbaiki lingkup gerak sendi
– Bertahap menurut derajat keradangan sendi, nyeri,
toleransi terhadap nyeri
– Sebelum stretching :
• Terapi panas :  daya regang atau ekstensibilitas kolagen
• Terapi dingin :  nyeri
– Stretching pasif : (-) peradangan akut
– Stretching aktif-asistif : subakut & nyeri sudah 
– Stretching aktif : nyeri & keradangan (-)

89
 Recreational Exercise
• Swimming
 an excellent form of isotonic exercise for
arthritis patients because gravity is eliminated
and ROM of the joints is less painful.
• Dancing
 have shown increased strength, flexibility,
and aerobic capacity
 decreased joint pain and depression
90
DE LISA
POOL THERAPY WHIRLPOOLS

HYDROTHERAPY

HUBBARD TANKS CONTRAST BATH

91
 MODALITAS
HEAT
• Mainardi et al.  no increase and no decrease in joint
destruction and inflammatory activity in the hand in RA
with the use of superficial heat.

• When joint temperature is increased from 30.5°C to

36°C  collagenase found in rheumatoid synovium is
four times as active, resulting in lysis of cartilage

• HEAT EFFECT :
- Heat can raise the threshold for pain
- Heat affects the viscoelastic properties of collagen
92
DE LISA
93
94
 INJEKSI INTRAARTIKULAR VISCOSUPLEMEN

advantages and disadvantages

 Advantages:  Disadvantages:
- Work well across the - Patients with long-term
spectrum of patient- and / or severe-grade
assessed OA OA may respond less
- Better in earlier-grade - Some local adverse
OA events
- Improves pain • Injection site
- Generally well tolerated evrytheme
- Low rate of • Joint effussion /
complications swelling / warmth
- Long-term effectiveness • arthalgia
- No significent systemic
adverse events
Wang CT et al. J Bone Joint Surg Am. 2004;86-A:538-545
Kemper F et al. Curr Med Res Opin. 2005;21-1261-1269
Lussler A et al. rheumatol. 1996;23:1959-1585
PIR PERDOSRI JATENG 24
Vad VBDIY 2016
et al. Arch Phys Med Rehabil. 2003;84:634-637
Petrelle RJ et al. Arch Intern Med. 2002;162:292-298
 INJEKSI INTRAARTIKULAR
• Lohmander and associates
similarly found no significant
differences between overall
treatment and placebo groups;
however, a subgroup analysis of
patients more than 60
• Intra-articular
viscosupplementation was
moderately effective in relieving
knee pain in patients with
osteoarthritis at 5 to 7 and 8 to
10 weeks after the last injection
but not at 15 to 22 weeks

96
 ORTHOTICS
• FUNCTION :
- unweight joints
- stabilize joints
- decrease joint motion
- support joints in a position of maximal function

• UPPER EXTREMITIES  Hand and Wrist

- Resting splints
- Functional wrist splints
- Thumb post splints
- Ring splints

97
DE LISA
Resting splints
• Immobilize the hand and
wrist
• Are used at night for
patients with :
- active RA
- CTS
- extensor tendinitis
Functional wrist splints
• Extend to the mid-palmar
crease  permit finger
function, block wrist flexion
• Are used for activities
during periods of
inflammation.
98
BRADDOM
A functional thumb Thumb spica
postsplint  De Quervain
 Hand OA  to
relieve CMC and IP pain

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Tripoint finger splint Swan neck ring splint

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 BRADDOM
Ulnar deviation splint

101
• OA, RA  Hallux Valgus deformity  Silicone
Soft Insert (Toe Spacer)

102
• OA  Laxity Ligament • OA  Varus / Valgus
 Dynamic Splint deformity  Knee
Brace with lateral /
medial pad

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LUMBOSACRAL ORTHOSIS SEMIRIGID

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 6. Assistive Devices & Adaptive Aids
• FUNCTION :
- compensate for limited ROM and pain
- help promote independence and lesser
impairment, and disability
- improve patient function

105
DE LISA
Walker Platform Crutches

Distribute weight on the

forearm

ADVANTAGE :
• Reducing the need for
wrist extension
• Eliminating weight-
bearing forces through
the wrist and hand

106
DE LISA
ASSISTIVE DEVICES, ADAPTIVE AIDS &ENVIRONMENTAL DESIGN

107
Adaptive Devices for Transfer

108
 Adaptive Aids

Zipper hooks Shoehorns Clip & Pull Pants Assist

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Button hooks Large-handled Dressing Stick
Clothing made with Velcro

Long-handled sponges

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shower with a seat elevated toilet seats

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 7. Joint Protection
PRINCIPLES TECHNIQUES  to reduce force
across joints :
• using the largest possible joints to support
activity
• avoid overuse by interrupting sustained
activity with rest periods
• using adaptive equipment and strategies for
efficient use of joints
• using splints when limbs need to be
supported in functional positions
112
DE LISA
 8. Energy Conservation
PRINCIPLES TECHNIQUES  to maximize
function with energy-efficient :
• orthotics
• assistive devices  ambulation
• adaptive aids and clothing
• proper environmental design
• rest periods throughout the day
• maintenance of ROM and strength
• maintenance of proper posture
113
DE LISA
Konservatif

Tidak
berhasil

Surgery

114
 SURGERY
• Indications :
- the restoration or preservation of joint
mechanics and function
- relief pain
- improve function
• HIP Hip Replacement surgery  patients with
RA, SLE (avascular necrosis), and AS
• KNEETotal Knee Replacement surgery 
patients with bi- and unicompartmental joint
space destruction, persistent pain, and functional
loss
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TOTAL KNEE REPLACEMENT

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TOTAL HIP REPLACEMENT

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LUMBAR LAMINECTOMY

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 1. Preoperative Rehabilitation Management

• Teaching the patient crutch walking with the

appropriate type of crutch
• weight reduction for the obese patient
• Strengthening of the quadriceps before knee
replacement and the hip abductors before hip
surgery

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 2. Postoperative Rehabilitation Management

• The rehabilitation management goals of a

total joint replacement program are :
- to relieve pain
- to redevelop musculoskeletal function
- to use joint protection techniques  avoid
overstressing the prosthetic joint

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2a. Postoperative of a Hip Replacement
• ROM started immediately with ankle pumps
• Isometric exercise to the quadriceps
• Stand (bedside) with :
- Full Weight Bearing  cemented
- Partial Weight Bearing  uncemented
• Patients are placed in an abduction sling
• Told to restrict hip flexion to less than 90 degrees
 use an elevated toilet seat and an elevated
chair seat
• AVOID adduction and internal rotation (IR)
• Discharge from the hospital  fifth day
• Strengthening quadriceps, hip abductor, and hip
flexor
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2b. Postoperative of a Knee Replacement
• Knee ROM started immediately
(w/continuous passive motion machine)
• Total weight bearing (to tolerance) with
crutches and ambulation is started on the first
postoperative day using crutches or a walker
• Active assistive flexion is the basic of
management and usually needs to be done
under supervision of the physical therapist

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TERIMA KASIH
SEMOGA
BERMANFAAT

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