High Tibial and Distal Femoral Osteotomy
Rehabilitation Protocol

Pre-operative

Prepare for surgery

Maximize lower limb strength (focus on VMO and gluteal complex)
Educate on post-operative rehabilitation
Fit and educate on use of crutches

Weeks 0-2

Soft Tissue

Swelling reduction & regular icing (20 min. every 2-3 hours when awake)
Compression with short leg TED and double tubigrip to knee, regular rest and elevation, encourage calf and quads contractions
Hamstring, calf and ITB stretches

Weight Bearing Status

Touch Weight Bearing with crutches

Strengthening

Static and inner range knee contractions (0-30°)
Calf pumps, hip coronal and sagittal resistance exercises

ROM

Active within the limit of ROM Brace

Bracing

ROM Brace 0-30 degrees flexion

Weeks 2-6

Soft Tissue

Daily scar massage
Foam roller for ITB (not for DFVO), gluteals, calf and HS releases

Weight Bearing Status

Touch Weight Bearing

Strengthening

Active strengthening within limits of Brace

ROM Brace

Increase by 10 degrees flexion per week

Weeks 6-12

Weight Bearing Status

Partial Weight Bearing
Begin at 50% of body weight and increase by 10% per week

Strengthening

Active Quads, Hamstring, Gluteal strengthening

ROM

Increase as can tolerate

Bracing

Wean out of ROM Brace

Weeks 12+

Soft Tissue

Progress to gym-focused program
Leg press and squat (0-60°), calf raises, hip abduction, hip adduction, hip flexor, HS curls, stationary bike
Commence eccentric WB quads sets once strength improving e.g. step ups
Address significant deficits e.g. poor gluteal control, tight soft tissue structures, balance exercises
Balance exercise to improve proprioception e.g. wobble board, mini tramp

Aerobic

Add elliptical trainer / stepper machine / rower machine
Swimming with flippers and road bike

6 months +

Sports-specific activities

No running or return to sport unless cleared by Dr Seeto
Return to sports highly dependent on severity of osteoarthritis

Do you need a

Knee replacement?

Dr Seeto in affiliation with Medibank Private and East Sydney Private hospital, offers a program for eligible Medibank Private Members, to eliminate medical out of pocket costs for your Knee Replacement.

The program includes a pre-surgery preparation program, spending the minimal time necessary in hospital, as well as home rehabilitation if necessary.