A. Causes (4 Points)

• Indication: Severe, debilitating knee pain and loss of function.
• Primary Cause: End-stage Osteoarthritis (OA) that is refractory to conservative management.
• Secondary Cause: Rheumatoid Arthritis or post-traumatic arthritis.
• Objective: Replacing the damaged joint surfaces with metal and plastic implants.

B. Symptoms

• Pre-Op Pain: Severe, chronic pain, often worse at night or after activity.
• Post-Op Pain: Surgical pain managed by medication; must be controlled to allow therapy.
• Stiffness: Post-operative stiffness limiting range of motion.
• Weakness: Significant quadriceps inhibition (muscle shutdown) and atrophy.

C. Diagnosis

• Pre-Op: Confirmed by X-ray showing severe joint space narrowing and bone spurring.
• Post-Op Monitoring: Regular assessment of pain, swelling, and surgical incision status.
• Key Metric: Consistent measurement of active and passive Range of Motion (ROM).
• Gait Assessment: Monitoring the use of assistive devices and the quality of walking.

D. Physiotherapy Treatment Plan

• Immediate Goal: Achieve full knee extension (0°); crucial for long-term function.
• Pain/Swelling: Rigorous use of ice, elevation, and quad muscle activation (quad sets).
• Early ROM: Gentle Heel Slides and passive stretching (or CPM) to achieve >90 ∘ flexion.
• Strengthening: Prioritize Quadriceps control; initially with straight leg raises (SLR) and closed-chain exercises.
• Gait Training: Progression from walker to cane to independent walking; training on stair climbing.
• Scar Management: Gentle mobilization of the incision once fully healed to prevent adhesion.
• Activity Limitation: Permanent avoidance of high-impact activities (running, jumping).
• Discharge Goal: Independent walking, ability to navigate stairs, and >100∘ knee flexion.