Rééducation après une prothèse de genou

• Utilisez des soins culturellement adaptés qui tiennent compte des traumatismes et des violences. Expliquez pourquoi les questions sont importantes, demandez la permission avant d'aborder des sujets sensibles et adaptez la communication à la langue, à l'identité, à la culture, au handicap et aux expériences de soins de santé antérieures du patient (Agence de la santé publique du Canada, 2018).
• Informations sociodémographiques : age, sex, gender identity, language, living arrangement, occupation, caregiving responsibilities, health literacy, supports and communication or access needs.

Principales préoccupations

• Surgery and current plan: reason for surgery; operated side; total or partial replacement; primary or revision procedure; surgery date; surgeon and follow-up; operative and discharge information; weight-bearing status; movement or wound precautions; venous thromboembolism plan; and any complication, emergency visit or readmission.
• Current symptoms and course: knee, calf, thigh, hip or back pain; stiffness; swelling; bruising; wound change; fever or chills; shortness of breath or chest symptoms; fatigue; dizziness; numbness or weakness; sleep; and whether symptoms, mobility and daily activities are improving, unchanged or worsening.
• Baseline and current functioning: mobility and gait aid before surgery; current bed mobility, transfers, walking, stairs, self-care, household and community activities; falls; work or caregiving; driving; recreation; social participation; and assistance needed.
• Revue des systèmes corporels : cardiovascular and respiratory; neurological, cognitive and vestibular; musculoskeletal, including the other knee, hips, ankles and spine; skin and wound; vascular; genitourinary and gastrointestinal; nutritional; endocrine and metabolic; sleep; and mood symptoms that may affect safety, healing or rehabilitation.
• Santé, mode de vie et histoire : osteoarthritis and other pain conditions; previous joint replacement or surgery; venous thromboembolism or bleeding; diabetes; cardiovascular, respiratory, kidney, liver, neurological, inflammatory and bone-health conditions; infection history; recent hospitalization; physical activity; nutrition and hydration; sleep; tobacco; alcohol or substance use; and falls history.
• Medications and postoperative care: analgesics, anticoagulants, antibiotics and other current medicines or supplements; adherence and adverse effects; wound and dressing instructions; compression or other devices; and who to contact with questions.
• Home, equipment and supports: discharge destination, stairs, bathroom and sleeping setup, gait aid and other equipment, transportation, access to food and medicines, caregiver availability, home services and ability to summon help.
• Déterminants sociaux de la santé : housing, income, food security, discrimination, social support, caregiver strain, transportation, digital access and availability or affordability of rehabilitation, equipment and follow-up (Public Health Agency of Canada 2026).
• Soins et interventions antérieurs : preoperative preparation, inpatient or community rehabilitation, education, exercise, gait aids, pain and swelling care and other approaches tried; what helped, did not help, caused harm or was difficult to continue.
• Point de vue du patient : understanding of the operation and recovery plan, priorities, preferences, cultural context, acceptable risk, confidence, concerns, expectations and previous experiences of care.
• Signaler un avis : Vérifiez les signaux d'alerte et référez-vous aux modules distincts « Signaux d'alerte orange » et « Signaux d'alerte jaune » lorsque cela est pertinent.

Mesures des résultats

• Use measures that are meaningful to the patient, safe for the postoperative phase and practical to repeat. Record the test setup, gait aid, assistance and weight-bearing status so repeated results are comparable.
• Fonctionnement propre au patient : Échelle fonctionnelle propre au patient (PSFS).
• Handicap et participation : Échelle d'évaluation du handicap de l'OMS 2.0 (WHODAS 2.0).
• Qualité de vie : WHOQOL-BREF.
• Knee-specific symptoms and functioning: les Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR) can be used after total knee replacement when it fits the clinical question and setting.
• Mobility performance: a safe, repeatable task such as the Timed Up and Go ou 30-Second Sit-to-Stand Test, selected according to mobility and the clinical question.
• Symptoms and impairments: a consistent pain rating, swelling measure, knee flexion and extension, quadriceps activation or strength, and use of analgesia when these findings will guide care.
• Objectifs individuels : agree on patient-defined goals and how progress will be recognized. SMART wording may be used when helpful.

Les signaux d'alerte orange indiquent qu'un problème de santé mentale ou de toxicomanie peut nécessiter une évaluation d'urgence ou rapide, voire une prise en charge partagée, et peut influencer la prise en charge musculo-squelettique. Ce n'est pas un diagnostic. En cas d'inquiétude, posez des questions directes et respectueuses en tenant compte de la sécurité immédiate, de la gravité du problème, de tout changement par rapport au fonctionnement quotidien habituel et du contexte. Les facteurs psychosociaux susceptibles d’affecter le rétablissement, mais ne nécessitant pas d’évaluation médicale ou psychiatrique distincte, sont abordés sous la rubrique « Signaux d’alerte jaune ».

ACTION : Organisez immédiatement une évaluation d'urgence en cas de danger immédiat ou de besoin médical urgent :

• Suicide, automutilation ou violence envers autrui : intention ou plan actuel, tentative récente, incapacité à rester en sécurité ou comportement suggérant un risque immédiat de préjudice grave.
• Changement grave de l'état mental : agitation extrême, confusion, désorganisation, psychose ou manie possible avec altération du jugement ou comportement dangereux, ou incapacité à satisfaire les besoins fondamentaux lorsque cela crée un danger immédiat.
• Urgence médicale ou liée à la consommation de substances : Suspicion de surdosage, intoxication grave, sevrage dangereux, délire ou autre changement soudain nécessitant des soins médicaux urgents.

En cas de danger immédiat, ne laissez pas la personne seule pendant que les secours sont organisés. Suivez les procédures d'urgence locales et composez le 911 en cas de danger immédiat ou d'urgence médicale. Si la personne a des pensées suicidaires, téléphonez ou envoyez un SMS. 9-8-8 : Ligne d’assistance en cas de crise suicidaire avec eux ou les aider à le faire.

En cas de violence, d'abus ou d'exploitation avérés ou soupçonnés, assurez immédiatement la sécurité des personnes concernées et respectez les procédures de sécurité et de signalement applicables.

ACTION : Organisez rapidement une évaluation médicale ou psychiatrique si :

• Pensées suicidaires ou d'automutilation : Des pensées sans danger immédiat.
• Symptômes ou effets importants : symptômes graves, persistants ou s'aggravant de dépression, d'anxiété, de traumatisme, de psychose ou de manie possible, de troubles alimentaires ou de consommation de substances qui affectent considérablement la vie quotidienne, la prise de décision ou la participation en toute sécurité aux soins.
• Autres motifs d’évaluation : un changement marqué par rapport au comportement ou au fonctionnement habituel ; une inquiétude concernant les effets des médicaments ou des substances ; une présentation qui dépasse les compétences du clinicien ; ou une demande d'aide.

Informer le patient des personnes à contacter, du délai de contact et de la marche à suivre en cas d'aggravation de son état. S'assurer que le patient a bien pris contact avec le service lorsque cela est cliniquement nécessaire.

ACTION : Adapter et coordonner les soins musculosquelettiques :

• Soins en toute sécurité : Les soins peuvent se poursuivre lorsqu'ils sont sécuritaires et acceptables et ne retardent pas l'évaluation nécessaire. Adaptez la communication, l'examen et les soins ; obtenir un consentement continu ; et coordonnez-vous avec les autres professionnels de la santé avec la permission du patient.
• Poursuivre l'évaluation musculosquelettique : Ne présumez pas qu'un problème de santé mentale ou de toxicomanie explique les symptômes musculo-squelettiques. Continuez à considérer les causes physiques et à tenir compte du récit du patient.
• Questionnaires: Ils peuvent soutenir la discussion et le suivi, mais ne permettent pas d’établir un diagnostic et ne remplacent ni les questions directes, ni le jugement clinique, ni les mesures à prendre.
• Soutien acceptable : Demandez à la personne quel type d’aide lui convient et si le soutien linguistique, culturel, familial, communautaire ou autre est important pour elle.

ACTION : Documentation et suivi :

Consignez la préoccupation, les questions pertinentes et les réponses de la personne, la décision relative à la sécurité et les raisons qui la justifient, les mesures prises, les conseils donnés et les références effectuées, les communications et le consentement, le suivi prévu ainsi que toute préoccupation non résolue. Respectez les exigences applicables en matière de confidentialité, de sécurité et de signalement.

Pour obtenir des renseignements sur les services provinciaux, territoriaux et nationaux, consultez : Soutien en santé mentale : obtenir de l’aide (Agence de la santé publique du Canada, 2026).

Les signaux d’alerte psychosociaux (drapeaux jaunes) sont des facteurs personnels, sociaux, professionnels, scolaires, liés aux soins de santé, environnementaux ou structurels qui peuvent influencer les symptômes, le fonctionnement, la participation aux activités ou la réponse aux soins. Ils sont liés au contexte et ne constituent ni des diagnostics ni des prédictions certaines. Ils ne signifient pas que les symptômes sont d’origine psychologique. Ils permettent d’adapter la prise en charge et ne nécessitent pas, à eux seuls, une orientation urgente vers un autre professionnel de la santé. Explorez ces facteurs par la discussion et le suivi continu des résultats, en tenant compte des priorités, des forces et de la situation de la personne. Il n’est pas nécessaire d’utiliser un score distinct pour les signaux d’alerte psychosociaux (drapeaux jaunes). Les nouveaux signes ou l’aggravation de signes d’une maladie physique grave doivent être traités selon la procédure relative aux signes d’alerte (drapeaux rouges). Les préoccupations liées à la santé mentale ou à la consommation de substances qui nécessitent une évaluation distincte, ainsi que toute préoccupation immédiate concernant la sécurité, doivent être traitées selon la procédure relative aux signaux d’alerte psychosociaux urgents (drapeaux orange) et aux protocoles d’urgence ou de protection applicables.

Explorez les facteurs pertinents :

• Compréhension, attentes et expériences en matière de soins de santé : Préoccupations liées aux blessures ou aux dommages, incertitude, attentes quant au rétablissement, confiance en ses capacités, conseils contradictoires, expériences antérieures de banalisation des symptômes ou de préjudices subis, et confiance envers les soins reçus.
• Réactions aux symptômes et à l’activité : Inquiétude, peur, évitement, alternance entre périodes d’activité excessive et périodes de repos prolongées, difficulté à gérer le rythme des activités, stratégies d’adaptation, sommeil, confiance en sa capacité à gérer ses symptômes et reprise des activités significatives.
• Emotional and life context: distress, low mood, anxiety, grief, trauma, caregiving, relationship change, job loss or other major events. Ask permission before sensitive questions and limit discussion to what is relevant and acceptable to the patient.
• Relationships, culture and strengths: supportive relationships, isolation, family and community roles, cultural or spiritual practices, identity, preferences, language and other sources of resilience.
• Work, school and administrative context: physical and psychosocial demands, control, satisfaction, job security, accommodations, return concerns, and compensation, insurance or legal processes. Explore these neutrally and in context.
• Social and structural conditions: consider social and structural determinants of health (Public Health Agency of Canada 2026), including income, housing, food security, transportation, childcare, access and cost of care, discrimination, racism, colonialism, neighbourhood and workplace conditions, and physical or digital accessibility.

ACTION: Respond with the patient:

• Ask, do not assume: use open questions to understand what helps, what gets in the way, what matters and what feels feasible. Ask about strengths and protective factors, not only difficulties. Do not treat a person’s circumstances, culture or choices as a deficit.
• Plan together: integrate relevant findings into shared goals, education, self-management, physical activity or exercise, and participation in meaningful activities. Adapt communication, setting, pace, cost and access where possible.
• Connect and coordinate: with the patient’s consent, consider appropriate clinical, social, workplace, school, community, Indigenous or culturally specific supports. Clarify who will do what and follow up when the connection is important to the plan.
• Review response to care: reassess the patient’s account and the pathway’s selected outcomes at clinically relevant points. If progress differs from expected, review the clinical impression, care plan, access and other barriers; do not automatically attribute the outcome to Yellow Flags.
• Document: record relevant factors and strengths, the patient’s priorities and preferences, agreed actions, consent, referrals or coordination, follow-up, and any change requiring the Orange Flag process.

Select examination elements that answer a clinical question or may change care. Adapt the examination to the surgical plan, postoperative phase, presentation, comfort, consent and abilities.

• Consent and comfort: explain what you propose, provide choices about positioning, draping, pace, assistance and caregiver involvement, and confirm ongoing consent before examining the knee, wound or other sensitive areas.
• Surgical plan and stability: confirm the procedure, date, weight-bearing status, precautions, wound instructions and medical clearance before loading or moving the knee. Defer or modify testing when these are unknown or the person is medically unstable.
• General observation and wound: alertness, distress, breathing, pallor, hydration, posture, spontaneous movement, swelling, bruising, dressing or incision condition, drainage, skin integrity and signs of pressure injury.
• Vital signs and medical screening when indicated: heart rate and rhythm, blood pressure, oxygen saturation, temperature, orthostatic response, pain behaviour and signs of acute illness, bleeding or medication adverse effects.
• Neurovascular examination: distal pulses, colour, temperature, capillary refill, swelling, sensation and motor findings when new pain, weakness, numbness, vascular symptoms or a surgical complication is plausible.
• Pain and swelling: location, intensity and response to movement or loading; effusion and limb swelling using a repeatable method; warmth, tenderness and tissue sensitivity; and change after activity.
• Knee movement: active and passive flexion and extension as needed, noting movement quality, pain, restriction, end feel and extension lag. Interpret change against the person’s baseline, surgical plan and trend rather than a universal milestone.
• Force et contrôle du moteur : quadriceps activation and strength, straight-leg raise or extension lag when appropriate, and safe testing of hip, hamstring, calf and other lower-limb muscles that may affect mobility.
• Gait and mobility: bed mobility, sit-to-stand, transfers, gait initiation, step pattern, knee control in stance, turning, walking distance, stairs, weight-bearing tolerance, assistance and safe use of the prescribed gait aid.
• Évaluation fonctionnelle : patient-prioritized self-care, household, vehicle, work, caregiving, community and recreational tasks, and the interaction among the person, equipment, environment and available support.
• Balance and falls assessment: standing balance, turning, reaching and other tasks matched to safety and goals, especially when falls, fear, dizziness or unsteadiness are present.
• Régions adjacentes : examine the other knee, hips, ankles, feet or spine when symptoms or impairments there may affect walking, loading or recovery.
• Imagerie : review available postoperative imaging and the surgical report when relevant. New imaging is not routine for expected recovery; arrange medical or surgical assessment when new trauma, deformity, inability to bear weight, worsening focal pain or another suspected complication is likely to change care.
• Repeat and adapt: repeat focused findings to review progress, check the fit of the working presentation and decide whether rehabilitation, medical assessment or surgical follow-up needs to change.

Working clinical presentations

These presentations can overlap or change. Use them to organize assessment and care, not as fixed stages or substitutes for the surgical diagnosis and plan.

• Uncomplicated early recovery after primary total knee arthroplasty: expected postoperative pain, swelling, reduced knee movement, quadriceps inhibition and need for a gait aid, with a stable wound and gradual progress in mobility and daily activities (Bove et al. 2026; Rehabilitative Care Alliance 2026).
• Ongoing strength and mobility recovery: pain and swelling are settling, while knee movement, quadriceps and lower-limb strength, walking, stairs, endurance or confidence remain below the person’s goals.
• Self-directed recovery with planned review: the person is medically stable, understands the plan, can mobilize safely, has suitable support and is progressing with a home or community program (NICE 2020).
• Supervised or interdisciplinary rehabilitation needs: daily activities, cognition, mobility, falls risk, wound or symptom monitoring, exercise progression, equipment, home setup or access needs call for individual, group, virtual, home or outpatient support (NICE 2020; Bove et al. 2026; Rehabilitative Care Alliance 2026).
• Knee stiffness or arthrofibrosis risk: flexion or extension remains markedly restricted or is losing ground, with pain, swelling, guarding or tissue restriction limiting daily activities and progression. Confirm the surgical follow-up plan and use Red Flags when the course is unexpected.
• Persistent pain, swelling or loss of progress: symptoms remain high, worsen or no longer match the expected course, or mobility and participation decline after earlier improvement. Revisit complications, implant-related concerns, adjacent regions, pain contributors and medical or surgical review.
• Presentation outside routine primary knee replacement rehabilitation: revision or complex surgery, fracture, infection, neurological or vascular disorder, or another medical condition requires the relevant procedure-specific, medical or shared-care pathway.

Base care on the surgical plan, presentation, safety, goals, context and response. Develop the plan with the patient and repeat meaningful outcomes to guide change.

Éducation, autogestion et participation aux activités

• Recovery plan and safety: clear information can cover the procedure, expected variability in pain, swelling, stiffness and fatigue, wound and medicine instructions, exercises, gait aid use, daily activities, who to contact and the warning signs in Red Flags (NICE 2020; Rehabilitative Care Alliance 2026).
• Daily routines and participation: pacing, sleep, nutrition, hydration, medication routines, transport, home setup, work or caregiving changes and a practical home plan can support participation. Address barriers without assuming that difficulty following a plan reflects poor motivation.

Protection et mise en charge optimale

• Early mobility and loading: when medically stable, mobility and rehabilitation can begin on the day of surgery or within 24 hours. Loading follows the surgeon’s weight-bearing plan, wound status, symptoms, motor control and safe use of the prescribed gait aid (NICE 2020; Bove et al. 2026; Rehabilitative Care Alliance 2026).
• Activity response: progress walking, standing and daily tasks in manageable amounts. A temporary rise in soreness or swelling may call for a smaller dose or more recovery time; new marked pain, swelling, wound change or loss of mobility follows Red Flags.
• Falls and equipment: select and fit gait aids, rails, seating, bathroom or dressing equipment when they improve safety or independence, and review them as mobility changes.

Activité physique et exercices

• Knee movement: active, active-assisted and passive range-of-motion exercises can target flexion and extension. Dose reflects irritability, swelling, wound healing, movement quality and response rather than a universal target date (Bove et al. 2026; Rehabilitative Care Alliance 2026).
• Progressive strengthening: quadriceps and lower-limb strengthening can progress from activation and supported tasks to resistance and weight-bearing exercise. Progression reflects technique, symptoms, swelling, recovery after exercise and goals (Bove et al. 2026).
• Neuromuscular electrical stimulation: this can be an adjunct to active exercise when quadriceps activation or strength is markedly limited, with screening for contraindications and a tolerable setup (Bove et al. 2026).
• Gait, balance and functional training: practice can include transfers, walking, turning, stairs, uneven surfaces and other meaningful tasks, with feedback or balance challenges matched to safety and goals (Bove et al. 2026; Rehabilitative Care Alliance 2026).
• Physical activity and endurance: a gradual plan can build walking and low-impact aerobic activity around current capacity, interests and longer-term health goals (Bove et al. 2026).

Thérapies manuelles et interventions visant à soulager les symptômes

• Cold and positioning: cold and comfortable elevation can be used for short-term pain or swelling relief. Protect the skin, account for altered sensation or circulation, and follow wound and surgical guidance (Bove et al. 2026).
• Hands-on care: gentle soft-tissue or movement-based care can be used as an adjunct when it is consistent with wound healing and the surgical plan and helps a specific symptom or movement goal. Avoid deep pressure over the healing incision and do not use passive care in place of active rehabilitation (Bove et al. 2026).

Soutien psychologique, social et interdisciplinaire

• Confidence and distress: clear information, graded practice and problem-solving can address fear of falling or movement. Persistent distress, low mood, anxiety, cognitive change or pain-related concerns can be managed with the appropriate primary care, rehabilitation or mental-health provider.
• Care setting and supervision: self-directed, individual, group, virtual, home and outpatient options can be used. The level of supervision reflects safety, mobility, cognition, daily activity needs, goals, home support, transport, technology and access (NICE 2020; Bove et al. 2026; Rehabilitative Care Alliance 2026).
• Prise en charge interdisciplinaire : surgical and primary care, nursing, physiotherapy, occupational therapy, pharmacy, dietetics, home care and social services can be coordinated around medical stability, wound and medicine needs, mobility, self-care, nutrition, equipment and transitions (Rehabilitative Care Alliance 2026).

Medication coordination

• Analgesia and postoperative medicines: coordinate with an authorized prescriber or pharmacist when pain limits rehabilitation, adverse effects such as sedation, dizziness, nausea or constipation occur, or questions arise about anticoagulants, infection treatment or other postoperative medicines. Medication changes remain within the appropriate provider’s scope.

Return to activities

• Work, driving, recreation and sport: timing reflects the operated side, mobility, strength, reaction time, medicine effects, job or activity demands, transport and the surgeon’s advice. Low-impact activities are commonly used after recovery; higher-impact or contact activities require individual discussion with the surgical team (NICE 2020; Arthritis Society Canada n.d.).

Approaches not used routinely

• Continuous passive motion and early ROM bracing or splinting: these are not part of routine care solely to increase knee movement after uncomplicated primary total knee arthroplasty. A surgeon-directed plan for a specific complication takes precedence (Bove et al. 2026).
• Stand-alone passive care or prolonged restriction: passive modalities or hands-on care do not replace mobility, exercise and self-management, and prolonged bed rest or avoidable activity restriction can delay recovery.

Suivi et réévaluation

• Agree on a reassessment point based on the postoperative phase, safety, goals, care being tried, patient needs and access rather than a fixed visit schedule.
• Repeat the small outcome set recorded at baseline and review pain, wound and swelling, relevant neurological and vascular findings, knee movement, strength, mobility, functioning, participation, benefits, harms, treatment burden and progress toward patient-defined goals.
• Continue what is useful and acceptable; adapt or stop what is not; and revisit the clinical presentation, surgical plan, differential diagnosis, referral or shared care when progress differs from expectations or new safety concerns emerge.

• Évolution attendue : after uncomplicated primary total knee arthroplasty, pain, mobility and daily activities often improve over the first weeks and months. Knee movement, strength, endurance, confidence and participation can continue to change for many months, and some people have ongoing pain, stiffness or activity limits (Bove et al. 2026; Arthritis Society Canada n.d.).
• Facteurs associés à une évolution moins favorable : poorer mobility or strength before surgery, multimorbidity, surgical or medical complications, persistent pain or swelling, marked movement loss, quadriceps inhibition, fear of movement or falling, distress, limited support and barriers to rehabilitation may be associated with slower or incomplete recovery. These are group-level patterns, not certain individual predictions (Bove et al. 2026; Rehabilitative Care Alliance 2026).
• Facteurs pouvant favoriser le rétablissement : a clear surgical and rehabilitation plan, early safe mobility, appropriately progressed knee movement, strengthening and functional practice, suitable pain and swelling care, confidence, practical equipment, home support and access to review may support recovery (Bove et al. 2026; NICE 2020; Rehabilitative Care Alliance 2026).
• Discussion du pronostic : explain what is known about the person’s procedure and current progress without promising a date, range-of-motion value or outcome. Compare change with baseline and goals, discuss uncertainty plainly, and update the outlook when symptoms, repeated outcomes, support or the surgical plan changes.