What is the recommended physical therapy for patients after osteotomy surgery?

Physical Therapy After Osteotomy Surgery

Start supervised physical therapy on the day of surgery with immediate mobilization, progressive range of motion exercises, and quadriceps strengthening, while carefully managing weight-bearing restrictions based on the specific osteotomy type to optimize functional recovery and minimize complications. 1

Immediate Post-Operative Phase (Day 0-2 Weeks)

Early Mobilization

• Begin rehabilitation on the day of surgery to reduce hospital length of stay and improve early functional outcomes 1
• Start active hip range of motion exercises and gentle isometric hamstring and quadriceps muscle sets on the day of surgery 2
• Perform supervised exercise sessions for 30 minutes twice daily (morning and afternoon) with a physical therapist every weekday for the first 6 weeks 2

Weight-Bearing Protocols

• For tibial and femoral osteotomies: Restrict full weight-bearing for 2-3 months post-operatively to prevent complications 2, 3
• Non-weight-bearing or partial weight-bearing with two crutches should be maintained during the initial healing phase 2
• Critical warning: Accelerated weight-bearing protocols (allowing full weight-bearing immediately post-operatively) result in unacceptably high rates of postoperative pelvic fractures (8/76 patients vs 1/80 with standard protocols) 2

Range of Motion

• Most protocols restrict ROM to ≤90° of knee flexion within the first three weeks post-operatively 4
• Joint immobilization is typically set within one week post-operatively, particularly when tibial tuberosity osteotomy is performed (93.8% of protocols) 4
• Progress ROM gradually as tolerated, avoiding forced manipulation 5

Early Recovery Phase (2 Weeks-3 Months)

Exercise Therapy Components

• Quadriceps strengthening is the cornerstone of rehabilitation, initiated within two weeks post-operatively in most protocols 4
• Include hamstring strengthening, core stabilization exercises, and hip musculature strengthening 2
• Progress from isometric exercises to active-assisted and then active resistance exercises 5

Aquatic Therapy Consideration

• Aquatic environment rehabilitation can be highly beneficial for earlier joint mobilization, pain reduction, and earlier weight loading 5
• A case study demonstrated improvement from 66° to 125° knee flexion and complete pain resolution (6/10 to 0/10) using 30 sessions of aquatic therapy (3 sessions/week, 60 minutes each) 5
• Water-based exercises reduce joint stress while allowing progressive strengthening 5

Intermediate Recovery Phase (3-6 Months)

Progressive Weight-Bearing

• Transition to full weight-bearing typically occurs between 2-4 months post-operatively for standard protocols 2
• Average time to full weight-bearing without support is approximately 4-7 months, depending on the protocol and osteotomy type 2
• For proximal femoral osteotomy in cerebral palsy patients: Community or household ambulators return to preoperative function at a mean of 7 months, while wheelchair and therapeutic ambulators require 10 months 6

Functional Training

• Progress to closed-chain exercises, balance training, and proprioceptive activities 1
• Incorporate gait training with progressive reduction in assistive device dependence 3
• Patients with unicompartmental arthroplasty show better muscle torque recovery at 6 months compared to high tibial osteotomy patients at 12 months, indicating osteotomy requires longer rehabilitation 3

Late Recovery and Return to Sport (6+ Months)

Return to Sport Timeline

• Return to sport is typically permitted at 6 months post-operatively in most protocols 4
• This timeline applies to medial patellofemoral ligament reconstruction with or without tibial tuberosity osteotomy 4

Long-Term Rehabilitation Considerations

• Regular visits with a licensed physical therapist result in faster return to function compared to home exercise programs supervised by parents or caregivers 6
• Full functional recovery may take up to 30 months in some cases, particularly in patients with complex presentations 6
• Families should be counseled that rehabilitation typically requires 7-10 months on average 6

Critical Clinical Pearls

Avoid Accelerated Protocols

• Do not implement accelerated weight-bearing protocols despite their theoretical appeal for early recovery, as they result in an 8-fold increase in postoperative pelvic fractures (10.5% vs 1.25%) 2

Supervised Therapy is Essential

• Supervised physical therapy during the first 2 months after osteotomy significantly improves physical function 1
• Regular professional supervision accelerates recovery compared to unsupervised home programs 6

Expected Outcomes

• With appropriate rehabilitation protocols, weighted mean Kujala scores reach 87.4 points post-operatively 4
• Most patients achieve satisfactory functional outcomes when weight-bearing and ROM restrictions are maintained in the early post-operative period 4