Distal Femoral Osteotomy Rehab Protocol

Phase 1 (0-6 weeks)

Goals: Control swelling, restore neuromuscular communication loops, prevent kinesiophobia; gait training
Modalities: Compressive cyrotherapy, e-stimulation
Weightbearing: Non-weightbearing
Brace:
- Locked in full extension at all times initial 48 hours (2 days).
- ROM opened 0-90° from day-2 through 4 weeks
- ROM opened to full, 0-120° weeks 4-6.
ROM:
- First priority is to focus on regaining terminal extension.
- Advance knee flexion ROM 5-10° daily as tolerated with goal of 90° within 2-3 weeks.
Exercises:
- 0-2wks: Quad sets, SLR, calf pumps, passive leg hangs to 90° at home
- 2-6wks: PROM/AAROM to tolerance, patella and tibiofibular joint mobs, quad, hamstring, and glute sets, SLR, side-lying hip and core

Weightbearing: *Guided by 6-week in-office radiographs. Call for clarity if not designated by physician.
- Advance 25% weekly until full weightbearing. Instruct patient to recognize maladaptive gait.
Brace: Begin to wean from brace after 6 weeks. Advocate to continue in uncontrolled settings or adverse weather.
ROM: Full 0-120°.
Exercises: Advance phase 1 exercises. Progress weightbearing flexibility, begin toe raises and closed chain quad work. Begin floor-based core and gluteal work, balance exercises, hamstring curls and stationary bike.

Weightbearing: Advance 25% weekly and progress to full with normalized gait pattern
Brace: None
ROM: Full
Exercises: Advance closed chain quads, progress balance, core/pelvic and stability work. Begin stationary bike at 6 weeks. Advance SLR, floor based exercise; hip/core

Weightbearing: Full
Brace: None
ROM: Full
Exercises: Progress flexibility/strengthening, progression of functional balance, core, glutes program. Advance bike, add elliptical at 12 weeks as tolerated. Swimming ok at 12 weeks.

Weightbearing: Full
Brace: None
ROM: Full
Exercises: Advance Phase IV activity. Progress to functional training, including impact activity after 20 weeks when cleared by MD.