Physiotherapists should also be aware of the HTC recommendations for clotting factor replacement or bypassing agents which may be used postoperatively up to 4 weeks [21,22] or even longer, administered prior to each therapy session. Using total knee arthroplasty (TKA) as an example of physiotherapy in EOS, typical interventions, such as early mobilization and return to functional mobility, the use of ice, continuous passive motion (CPM) machines and post-operative exercise protocols, may need to be modified to promote healing and prevent bleeding in PWH and especially in PWHWI. Commonly, post-operative protocols following TKA in the general population

encourage aggressive, early mobilization, ambulation, and regaining early range of motion (ROM), often click here with the hallmark goal of reaching 90 degrees knee flexion before discharge from the acute care hospital [23]. In these cases, typical physiotherapy intervention can include manual techniques for ROM, the use of CPM devices, exercise regimens and instruction in resuming functional activity, and ambulation. Physiotherapists should be extremely cautious when attempting to employ these treatment strategies that are familiar in the general population because of the impairment to wound healing and potential bleeding complications in PWH and PWHWI. The typical goals of regaining early motion and mobility must be tempered with protecting the

surgical wound site postoperatively GDC-0449 manufacturer and prevention of joint bleeding should be paramount in all physiotherapy interventions for PWH and PWHWI. A risk versus benefit model is helpful when evaluating the use of standard physiotherapy interventions and their applications in PWH and PWHWI. Physiotherapy techniques for early ROM and mobility may need to be

curtailed or carried out in a very conservative manner to reduce tension on the healing wound and prevent risk of joint bleeding. In fact, regaining early ROM may be discouraged in order to meet these MCE goals [20]. Keeping this in mind, it is likely to limit the patient completing common post-EOS regimens, such as self-ROM exercises, dangling the operative knee over the edge of the bed, receiving passive ROM and early walking in the immediate postoperative period. Examining the use of CPM, recent literature reveals that there is questionable [24] or no difference in outcome for patients in the general population either in the short term [25,26] or long term following TKA [26]. Because the use of CPM could cause tension and interference in wound healing and has the potential for causing bleeding, this intervention likely carries more risk than benefit in PWH and PWHWI [27]. Similarly the use of ice in general post-surgical population is common and likely without significant risk. However this practice may need to be modified, especially in PWHWI where there is the potential for uncontrolled bleeding.