% Rehabilitation Treatment Plan — Post-Total Knee Arthroplasty
% De-Identified Sample for Pilot Review
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\lhead{\small\textcolor{primaryblue}{\textbf{Rehabilitation Treatment Plan}} --- \textcolor{darktext}{CONFIDENTIAL}}
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\begin{document}

% ============================================================
% PAGE 1: EXECUTIVE SUMMARY
% ============================================================
\thispagestyle{empty}

\begin{center}
{\LARGE\bfseries\textcolor{primaryblue}{Rehabilitation Treatment Plan}}\\[6pt]
{\large Post-Total Knee Arthroplasty (Right Knee) --- 62-Year-Old Patient}
\end{center}

\vspace{4pt}

\begin{patientinfo}
\begin{tabularx}{\textwidth}{@{}lXlX@{}}
\textbf{Report Type:} & Rehabilitation Treatment Plan & \textbf{Date:} & April 13, 2026 \\
\textbf{Age/Sex:} & 62 years / Male & \textbf{Primary Dx:} & M17.11 (Primary OA, R knee) \\
\textbf{Procedure:} & Right Total Knee Arthroplasty & \textbf{Procedure Date:} & April 10, 2026 \\
\textbf{BMI:} & 29.4 kg/m\textsuperscript{2} & \textbf{ASA Class:} & II \\
\textbf{Comorbidities:} & HTN (controlled), mild T2DM, BPH & \textbf{Surgeon:} & [De-Identified] \\
\end{tabularx}
\end{patientinfo}

\vspace{4pt}

\begin{goalbox}[Primary Rehabilitation Goals (SMART)]
\begin{itemize}[nosep, leftmargin=*]
  \item \textbf{Short-Term (2 weeks):} Achieve 0--90\textdegree{} active knee ROM, independent transfers, ambulate 150~ft with walker, VAS pain $\leq$4/10 at rest
  \item \textbf{Mid-Term (6 weeks):} Attain 0--110\textdegree{} ROM, independent ambulation with cane, negotiate stairs reciprocally, resume light household ADLs
  \item \textbf{Long-Term (12--16 weeks):} Full functional ROM ($\geq$120\textdegree{}), ambulate without assistive device, return to recreational walking/golf, KOOS score $\geq$75
\end{itemize}
\end{goalbox}

\vspace{4pt}

\begin{keybox}[Core Interventions]
\begin{itemize}[nosep, leftmargin=*]
  \item \textbf{Physical Therapy:} 3$\times$/week outpatient PT (Weeks 2--12); daily home exercise program; progressive weight-bearing per protocol
  \item \textbf{Pain Management:} Multimodal analgesia --- scheduled acetaminophen 1g TID + celecoxib 200~mg daily; short-course oxycodone PRN (taper by Week 2); cryotherapy 20~min QID
  \item \textbf{DVT Prophylaxis:} Rivaroxaban 10~mg daily $\times$ 14 days; ankle pumps hourly while awake; TED hose bilateral
\end{itemize}
\end{keybox}

\vspace{4pt}

\begin{warningbox}[Critical Considerations]
\begin{itemize}[nosep, leftmargin=*]
  \item \textbf{DVT/PE Risk:} BMI 29.4, age 62, major ortho surgery --- anticoagulation mandatory; monitor for calf swelling, dyspnea, chest pain
  \item \textbf{Weight-Bearing:} Weight-bearing as tolerated (WBAT) with walker immediately post-op; progress per pain and stability
  \item \textbf{Wound Monitoring:} Surgical incision must remain clean/dry; staple removal at 2-week follow-up; report erythema, drainage, fever $>$101\textdegree{}F
  \item \textbf{Glucose Control:} Monitor fasting glucose; target $<$180~mg/dL peri-operatively (per ADA perioperative guidelines)
\end{itemize}
\end{warningbox}

% ============================================================
% PAGE 2: DETAILED PHASE-BY-PHASE PROTOCOL
% ============================================================
\newpage
\tableofcontents
\newpage

\section{Phase I --- Acute Recovery (Days 1--14)}

\subsection{Therapeutic Interventions}
\begin{itemize}[nosep]
  \item \textbf{Day 0--1 (Inpatient):} Bed mobility training, ankle pumps q1h, quad sets (10 reps $\times$ 3 sets), seated knee flexion, edge-of-bed transfers with walker
  \item \textbf{Day 1--2:} Ambulation 50--100~ft $\times$ 3/day with rolling walker (WBAT); commode/toilet transfers; continuous passive motion (CPM) machine 0--60\textdegree{}, advance 5--10\textdegree{}/day as tolerated
  \item \textbf{Days 3--14 (Home/HH PT):} Home health PT 3$\times$/week; progress ambulation distance to 150+~ft; supine SLR (straight leg raise), standing hip abduction, heel slides; seated knee extension with gravity
  \item \textbf{Cryotherapy:} Ice/cold therapy 20~min, 4--6$\times$/day to manage swelling
  \item \textbf{Edema Control:} Elevation above heart level when resting; compression stockings
\end{itemize}

\subsection{Phase I Milestones}
\begin{center}
\renewcommand{\arraystretch}{1.3}
\begin{tabularx}{\textwidth}{@{}>{\bfseries}l X l@{}}
\toprule
\rowcolor{lightblue} \textbf{Milestone} & \textbf{Criteria} & \textbf{Target} \\
\midrule
Pain Control & VAS $\leq$5/10 with oral analgesics & Day 3--5 \\
\rowcolor{lightskyblue} Quad Activation & Active SLR without extensor lag & Day 5--7 \\
Knee Flexion & Active ROM $\geq$70\textdegree{} & Day 7 \\
\rowcolor{lightskyblue} Knee Extension & Active extension to 0\textdegree{} (full) & Day 7--10 \\
Ambulation & 150~ft with walker, minimal assist & Day 10--14 \\
\rowcolor{lightskyblue} Wound Healing & Staples removed, incision clean/dry & Day 14 \\
\bottomrule
\end{tabularx}
\end{center}

\subsection{Pain Management Protocol --- Phase I}
\begin{center}
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\begin{tabularx}{\textwidth}{@{}>{\bfseries}l l X@{}}
\toprule
\rowcolor{lightblue} \textbf{Medication} & \textbf{Dosing} & \textbf{Notes} \\
\midrule
Acetaminophen & 1000~mg PO TID & Scheduled (not PRN); hepatic monitoring \\
\rowcolor{lightskyblue} Celecoxib & 200~mg PO daily & With food; hold if GFR $<$30; avoid with anticoagulants if bleeding \\
Oxycodone & 5~mg PO q4--6h PRN & Taper over 7--10 days; provide naloxone Rx \\
\rowcolor{lightskyblue} Gabapentin & 100~mg PO THS & For neuropathic/nighttime pain; titrate if needed \\
Cryotherapy & 20~min QID & Apply over dressing; avoid direct skin contact \\
\bottomrule
\end{tabularx}
\end{center}

\section{Phase II --- Early Rehabilitation (Weeks 2--6)}

\subsection{Therapeutic Interventions}
\begin{itemize}[nosep]
  \item \textbf{Outpatient PT 3$\times$/week} (45--60~min sessions):
  \begin{itemize}[nosep]
    \item Active-assisted $\rightarrow$ active ROM exercises (flexion/extension)
    \item Progressive resistance: mini-squats, step-ups (4-inch), leg press (low resistance)
    \item Stationary bike (no/low resistance, seat elevated initially)
    \item Balance training: tandem stance, single-leg stance (supported)
    \item Gait training: progress walker $\rightarrow$ single-point cane by Week 4
    \item Soft tissue mobilization / patellar mobilization as indicated
  \end{itemize}
  \item \textbf{Home Exercise Program (daily):} Heel slides, wall slides, prone hangs (extension), SLR all planes, seated knee extension, standing calf raises
  \item \textbf{Aquatic Therapy (from Week 4):} Pool walking, ROM exercises once incision fully healed
\end{itemize}

\subsection{Phase II Milestones}
\begin{center}
\renewcommand{\arraystretch}{1.3}
\begin{tabularx}{\textwidth}{@{}>{\bfseries}l X l@{}}
\toprule
\rowcolor{lightblue} \textbf{Milestone} & \textbf{Criteria} & \textbf{Target} \\
\midrule
ROM & Active flexion $\geq$110\textdegree{}, extension 0\textdegree{} & Week 6 \\
\rowcolor{lightskyblue} Ambulation & Independent with cane, 500+~ft & Week 4 \\
Stairs & Ascend/descend 12 steps with rail, step-over-step & Week 5--6 \\
\rowcolor{lightskyblue} Opioid Cessation & Discontinued all opioid analgesics & Week 2--3 \\
Driving & Resume driving (automatic transmission, left TKA or per surgeon) & Week 4--6 \\
\bottomrule
\end{tabularx}
\end{center}

\section{Phase III --- Advanced Rehabilitation (Weeks 6--12)}

\subsection{Therapeutic Interventions}
\begin{itemize}[nosep]
  \item \textbf{Outpatient PT 2$\times$/week} (progressive intensity):
  \begin{itemize}[nosep]
    \item Progressive strengthening: wall squats, lateral band walks, single-leg press, hamstring curls
    \item Proprioception: wobble board, single-leg stance (unsupported), perturbation training
    \item Endurance: stationary bike 20--30~min (progressive resistance), elliptical trainer
    \item Functional training: sit-to-stand from low surfaces, floor transfers, gardening simulation
    \item Soft tissue/scar mobilization as needed
  \end{itemize}
  \item \textbf{Home Program (daily):} Continued strengthening, 30-min walking program, flexibility
\end{itemize}

\subsection{Phase III Milestones}
\begin{center}
\renewcommand{\arraystretch}{1.3}
\begin{tabularx}{\textwidth}{@{}>{\bfseries}l X l@{}}
\toprule
\rowcolor{lightblue} \textbf{Milestone} & \textbf{Criteria} & \textbf{Target} \\
\midrule
ROM & Flexion $\geq$120\textdegree{}, full extension maintained & Week 10--12 \\
\rowcolor{lightskyblue} Strength & Quad strength $\geq$80\% of contralateral limb & Week 12 \\
Balance & Single-leg stance $\geq$15~sec; TUG $<$12~sec & Week 10 \\
\rowcolor{lightskyblue} Endurance & Walk 30~min continuously, no assistive device & Week 10--12 \\
Function & KOOS score $\geq$70; independent all ADLs/IADLs & Week 12 \\
\bottomrule
\end{tabularx}
\end{center}

\section{Phase IV --- Return to Activity (Weeks 12--16+)}

\subsection{Therapeutic Interventions}
\begin{itemize}[nosep]
  \item \textbf{PT 1$\times$/week or independent gym program}
  \item Sport-specific conditioning: golf swing mechanics, doubles tennis footwork (if applicable)
  \item Advanced strengthening: lunges, lateral step-downs, resistance machines
  \item Community reintegration: walking on uneven terrain, prolonged standing tolerance
  \item Lifelong maintenance: 30--45~min exercise 5$\times$/week (walking, cycling, swimming); avoid high-impact activities (running, jumping, heavy squats)
\end{itemize}

\subsection{Phase IV Discharge Criteria}
\begin{itemize}[nosep]
  \item Active ROM 0--125\textdegree{}+ (or patient-specific functional ROM)
  \item Ambulation without assistive device on all surfaces
  \item Independent stair negotiation and floor transfers
  \item KOOS score $\geq$75; VAS pain $\leq$2/10 with activity
  \item Patient-identified functional goals achieved (e.g., return to golf, gardening)
\end{itemize}

\section{Rehabilitation Timeline}

\begin{figure}[h!]
  \centering
  \includegraphics[width=\textwidth]{figures/rehab_timeline.png}
  \caption{Post-Total Knee Arthroplasty Rehabilitation Milestone Progression. Four phases span acute recovery through return to full activity over 12--16 weeks, with key milestones and monitoring parameters at each stage.}
\end{figure}

\section{Monitoring and Outcome Measures}

\begin{center}
\renewcommand{\arraystretch}{1.3}
\begin{tabularx}{\textwidth}{@{}>{\bfseries}l l X@{}}
\toprule
\rowcolor{lightblue} \textbf{Measure} & \textbf{Frequency} & \textbf{Target / Purpose} \\
\midrule
VAS Pain Score & Each PT visit & $\leq$4/10 (Phase I); $\leq$2/10 (Phase III--IV) \\
\rowcolor{lightskyblue} ROM Goniometry & Weekly (PT) & Flexion $\geq$90\textdegree{} (Wk 2), $\geq$110\textdegree{} (Wk 6), $\geq$120\textdegree{} (Wk 12) \\
Timed Up and Go (TUG) & Wks 2, 6, 12 & $<$12~sec by Week 10 \\
\rowcolor{lightskyblue} KOOS Questionnaire & Wks 6, 12, 26 & $\geq$75/100 by Week 12 \\
6-Minute Walk Test & Wks 6, 12 & $\geq$400~m by Week 12 \\
\rowcolor{lightskyblue} Wound Assessment & Each visit (Phase I) & No signs of infection; staple removal Day 14 \\
Quad Circumference & Wks 2, 6, 12 & $<$2~cm deficit vs.\ contralateral by Week 12 \\
\rowcolor{lightskyblue} Knee Effusion & Each PT visit & Trace or less by Week 6 \\
\bottomrule
\end{tabularx}
\end{center}

\section{Follow-Up Schedule}

\begin{center}
\renewcommand{\arraystretch}{1.3}
\begin{tabularx}{\textwidth}{@{}>{\bfseries}l l X@{}}
\toprule
\rowcolor{lightblue} \textbf{Visit} & \textbf{Timing} & \textbf{Focus} \\
\midrule
Surgeon F/U \#1 & 2 weeks post-op & Wound check, staple removal, X-ray, clear for outpatient PT \\
\rowcolor{lightskyblue} Surgeon F/U \#2 & 6 weeks post-op & ROM assessment, X-ray, medication review, driving clearance \\
Surgeon F/U \#3 & 12 weeks post-op & Functional outcome assessment, discharge from acute rehab \\
\rowcolor{lightskyblue} Surgeon F/U \#4 & 6 months post-op & Long-term outcome, KOOS, activity level, patient satisfaction \\
Annual Follow-Up & Yearly & Implant surveillance, X-ray, function, activity counseling \\
\rowcolor{lightskyblue} PCP Coordination & Ongoing & HTN management, diabetes monitoring, medication reconciliation \\
\bottomrule
\end{tabularx}
\end{center}

\section{Patient Education --- Key Points}

\begin{infobox}[Patient Instructions]
\begin{itemize}[nosep, leftmargin=*]
  \item \textbf{Activity:} Walk frequently (short bouts, increase gradually). Avoid kneeling, deep squatting, and high-impact sports. Use ice after exercise sessions
  \item \textbf{Wound Care:} Keep incision clean and dry. Steri-strips fall off naturally. No soaking (bath, pool) until surgeon clearance ($\sim$4 weeks)
  \item \textbf{Medications:} Take pain medications on schedule (not just when pain is severe). Continue blood thinner for full 14-day course
  \item \textbf{Home Safety:} Remove throw rugs, install grab bars in bathroom, use raised toilet seat, shower chair as needed
  \item \textbf{Diet:} High-protein diet to support healing. Adequate hydration. Fiber/stool softener to prevent constipation from opioids
\end{itemize}
\end{infobox}

\vspace{6pt}

\begin{emergencybox}
\begin{itemize}[nosep, leftmargin=*]
  \item \textbf{Call 911 or go to ER immediately for:} sudden chest pain, shortness of breath, severe calf swelling/pain (possible DVT/PE)
  \item \textbf{Contact surgeon's office for:} fever $>$101\textdegree{}F, increasing redness/warmth/drainage at incision, sudden loss of knee motion, fall with inability to bear weight
  \item \textbf{Surgeon's Office:} [Phone Number] (business hours)
  \item \textbf{After-Hours Nurse Line:} [Phone Number]
  \item \textbf{Physical Therapy Clinic:} [Phone Number]
\end{itemize}
\end{emergencybox}

\vspace{12pt}

\noindent\textit{This treatment plan was developed in accordance with AAOS Clinical Practice Guidelines for Surgical Management of Osteoarthritis of the Knee (2022) and APTA post-TKA rehabilitation evidence-based protocols. Plan is individualized based on patient comorbidities, functional baseline, and surgical approach. To be reviewed and updated at each follow-up visit.}

\vspace{20pt}

\noindent\begin{tabularx}{\textwidth}{@{}XX@{}}
\textbf{Prepared by:} & \textbf{Attending Surgeon:} \\[4pt]
\rule{6cm}{0.4pt} & \rule{6cm}{0.4pt} \\[2pt]
Rehabilitation Team Lead, PT, DPT, OCS & Orthopedic Surgery, MD \\[2pt]
Date: \rule{3cm}{0.4pt} & Date: \rule{3cm}{0.4pt} \\
\end{tabularx}

\end{document}
