Sources: Current Orthopedic PT Precautions (2018) + CUMC Ortho Discharge Recommendation Protocol (2023); Allen OT Orientation Packet (2021); PT Patient Prioritization policy. Surgeon-specific rules change — verify with the team.
🚨 Weight-bearing status comes from ORDERS, not documentation. Compare the WB precautions in the ortho note against the OT/PT orders and clarify discrepancies. If therapy orders carry inaccurate WB precautions (e.g., PWB or NWB that shouldn't be there — this sometimes happens for medicine patients), the orders must be changed before you see the patient and let them weight-bear. First contact: text the ortho team on Epic/Rover, or page 81313 if no provider is listed.
| Procedure / surgeon | Precautions |
|---|---|
| Total shoulder (Levine, Jobin) | NWB. AAROM forward elevation to 130° and ER to 30° as tolerated; no IR/extension; no active or resistive IR. Elbow/wrist/hand AROM; wand or other-arm AAROM OK. Sling in public and while sleeping. |
| Reverse TSA — Levine | NWB. No shoulder ROM for 4 weeks; no ER, no extension; elbow/wrist/hand ROM only. Sling in public and sleeping — but patients can be out of the sling more than in it at home (writing, typing, page-turning OK). |
| Reverse TSA — Jobin | NWB. No shoulder ROM for 4 weeks; no ER/extension; elbow/wrist/hand only. Stay in the sling day and night except 3×/day to stretch the elbow straight, then back in the sling. |
| Surgeon | Precautions |
|---|---|
| Geller, Shah, Cooper | No specific precautions for standard primary anterior or posterior THR. Per ortho: regular-height chair and toilet OK, crossing legs OK, rolling in bed OK with education, reaching to don socks/shoes OK, no abductor pillow. MD will specify for revisions and complex primaries case-by-case. |
| Greisberg (trauma — hip fx → THR) | Anterior-lateral approach: WBAT, no flexion >90°, no extension, no active abduction. |
| Kadiyala | Rarely operates here (trauma/on-call). |
Geller, Shah, Cooper: WBAT unless otherwise specified. Hip-fracture and revision patients are typically treated BID in the first post-op days.
| Population | Exercises |
|---|---|
| TKA / partial knee / TKA revision | Quad and glut sets, LAQs, heel slides, knee flexion A/PROM up to 100°. |
| THA | Quad/glut sets, heel slides, knee-flexion A/PROM. No active, passive, or antigravity hip flexion (no SLRs, marching, step-ups). No hip abduction. No long-arc quads. |
| THA revision | Case by case. |