Main rules until surgeon review

• Use a hinged knee brace or knee immobilizer locked fully straight for standing and walking.
• Use a walker, especially given age and fall risk.
• Weight-bearing should be only what the surgeon has permitted. Commonly, with stable fixation, weight bearing is allowed with the knee locked straight, but do not assume full weight-bearing if it was not explicitly prescribed.
• Do not kneel, squat, sit on low chairs, climb stairs repeatedly, or twist on the operated leg.
• No resisted knee-extension machine, leg press, cycling with resistance, or deep knee bending yet.
• Do not force bending or push through sharp pain.

Physiotherapy program: current stage, weeks 5-6

1. Swelling and circulation

• Elevate the whole leg above heart level for 15-20 minutes, 3-4 times/day.
• Ice wrapped in cloth for 10-15 minutes after exercise, avoiding direct ice on the incision.
• Ankle pumps: 20 repetitions hourly while awake.
• Gentle toe curls and ankle circles.

2. Knee protection and mobility

• Heel slides: gently bend then straighten the knee while lying down.
  • At about week 5, a conservative target is 0-90 degrees, unless the surgeon has already allowed more.
  • 10 repetitions, 2-3 sets.
  • Do not force the bend or pull aggressively with a towel.
• Passive assisted knee bend: slide heel on bed using the other foot or a towel, only to the permitted angle.
• Knee extension: place a small towel under the heel and allow the knee to straighten gently for 2-5 minutes, 2-3 times/day. Do not place a pillow under the knee for prolonged periods.

3. Quadriceps activation

• Quadriceps sets: straighten the knee as much as possible, tighten the front-thigh muscle, press knee gently into bed, hold 5-10 seconds.
  • 10 repetitions, 3 sets.
• Straight-leg raise: only if he can raise the entire leg without the knee bending or “lagging.”
  • Begin with brace locked in extension.
  • 5-10 repetitions, 2-3 sets.
  • Stop if there is pain at the fracture site or loss of knee control.
• Glute squeezes: hold 5 seconds, 10-15 repetitions.
• Hip abduction and hip extension while lying down, with the knee held straight: 10 repetitions each.

4. Walking training

• Walker, short frequent walks on level surfaces.
• Brace locked in extension.
• Step through with walker first, then operated leg, then the other leg.
• Avoid uneven ground and stairs unless supervised.
• Do not discontinue walker or brace until the surgeon confirms adequate healing and good quadriceps control.

Progression after the 6-week X-ray, only if surgeon confirms healing

• Increase knee bending gradually beyond 90 degrees, often about 10-15 degrees/week depending on symptoms and X-ray.
• Begin active knee extension through a comfortable range.
• Gradually reduce brace use only when able to perform a straight-leg raise without lag and walk safely.
• Advance from walker to cane only with safe gait and surgeon/physiotherapist approval.
• Closed-chain strengthening such as mini-squats or supported sit-to-stand is usually delayed until healing is confirmed, often around 8-12 weeks.
• Stationary bicycle is generally introduced after adequate flexion and healing clearance, starting with no resistance.

Seek urgent orthopaedic review if any of these occur

• Increasing redness, warmth, wound discharge, fever, or worsening swelling
• New severe pain, a pop, deformity, or sudden inability to actively straighten the knee
• A wire or pin becoming prominent through the skin
• New calf pain/swelling, breathlessness, or chest pain
• Repeated falls or inability to walk safely with the walker