Case Study: Jane

PE 445: IROC Physical Therapy Internship

March 2024
Abby Martin

Jane is a 67-year-old female with a longstanding battle against osteoarthritis in both of

her knees, predominantly affecting her left side. Her condition, which was revealed in X-rays
showed a significant amount of joint space narrowing which led her to undergo a total knee
arthroplasty on January 23, 2024. This case study will drive into Jane’s recovery journey as well
as her goals and challenges she faced throughout her time in physical therapy.

Total knee Arthroplasty or TKA is a type of knee replacement surgery involving

replacing the damaged or worn-out knee joint with an artificial joint. Normally, this surgery is
performed to relieve pain and improve the function of the knees but in some cases much like
janes, it’s to relieve and replace the severe knee arthritis she had. During a TKA, the surgeon will
remove portions of the knee that are deteriorating restoring it back to a normal function knee
which will improve quality of life for individuals. The length of this recovery process can vary
depending on the individual, but most people can expect to see gradual improvement in their
knee function over the course of several months. This procedure has allowed Jane to return to not
all, but some of her goals. She will be undergoing another TKA for the right side followed with
intense physical therapy to ensure all goals of hers are met.

Janes goals include restoring her left knee’s range of motion, walking long distances for
exercise, and playing with her grandkids. For this outpatient surgery, she started by using a
rolling walker for mobility which allowed her to feel less fear that she will fall while walking
and gave her the confidence to stand and move around. This is a great first step for individuals
who underwent a TKA procedure. The next step in this process is to remove her fear of walking
without the walker and get her to gather enough quad and knee strength to move to walking with
a cane. She’s faced some challenges throughout her time in physical therapy as well as prior
complications with the surgery such as incision opening which set her back by two weeks. This,
as well as other factors such as the inability to conquer some weight bearing and weight shifting
led to her making the decision to push back her right TKA procedure by 4-weeks. Until then, she
continues to be seen for physical therapy working on her ability to regain strength and mobility.

Starting out with her journey, my part in this was to help the physical therapist come up
with a 6-week plan of what her exercises would be as well as continuously taking measurements
of her knee extension and flexion. This allowed me to work on my competencies, “the applicant
demonstrates the ability to support development in a broad range of circumstances in different
developmental domains and context.” Basically, I was able to show my capabilities and
knowledge of the human body through a progression lens and build a program with the help of
my mentor to ensure the patient is receiving the proper care she needs to regain and maintain
strength. Starting off the first two weeks, she was strictly no weightbearing meaning table or
seated exercises working to recover some strength. After the two-week mark, she was able to
attempt standing exercises and gait training allowing her to become more mobile. When asked,
Jane said week 3-4 were the hardest due to shifting weight and lack of range of motion in her
knee. Week 5-6 became tremendously easier, and she was back to forward and lateral
movements. As for the physical therapist goals for Jane, she has met them quite well only having
a few minor setbacks. The first set of measurements are shown below:

Physical Therapists goal for the patients is to restore Flexion to 110º and extension to 0º
by herself or passively. During her last visit before being discharged, the measurements were
taking again. Jane’s flexion was at 107º, and her extension was 0º which is considered a good
outcome and prepares her enough to undergo her second surgery. She was able to walk without
her walker only using the cane meaning her ability to weight bear and shift her weight both
lateral and forward improved as well as her gait mechanics and ability to use her steps.

Her ability to regain strength and meet her goals even through hardships showed great
determination which allowed me to see and learn more about progress and regression.
Throughout my time following Janes journey, I was able to practice and share ideas along side
professionals to ensure the patient returned to healthier quality of life. This whole progression
was rewarding to watch and allowed me to drive deeper in my understanding of the human body
as well as connect it back to my competencies. By the end, I was able to discharge the patient
and focus on the competencies “applicant provides clear, coherent, and consistent expectations
and sets approriate boundaries” which allowed me to provide her the information and skillsets
needed to continue physical therapy at home while maintaining her strength. By dicussing with
the patient and making sure she was fully comfortable doing the exercises at home, I was pleased
enough to send her on her way and believe she was capable of home exercising. This is one of
the most important goals I see in physical therapy and I’m glad I was able to see her journey start
to end.