Early Outpatient Physical Therapy May Improve Range-of-Motion in Primary Total Knee Arthroplasty

Abstract

Knee stiffness is a relatively common complication following a primary total knee arthroplasty (TKA). Following this procedure, rehabilitation is essential to maintain, improve, and prevent the loss of knee range-of-motion (ROM). Currently, there is a paucity of studies describing whether the timing of physical therapy (PT) post-TKA plays a role in ROM outcomes. Therefore, the purpose of this study was to compare (1) flexion and (2) extension ROM at final follow-up of TKA patients who either began outpatient physical therapy (OPT) within 6 weeks or after 6 weeks of their TKA. Surgical records from all TKAs performed at one institution (three surgeons) between January 2013 and December 2014 (n = 485) were analyzed. Their mean age was 63 years (range, 32–90 years). Patients were stratified into two cohorts: patients who had OPT within 6 weeks (n = 411) and those who started after 6 weeks (n = 74). The t-tests were used to compare mean flexion and extension ROM at final follow-up. The patients who attended OPT within 6 weeks had a significantly higher mean flexion ROM at their final clinical visit ([mean, 114 degrees; range, 60–140 degrees] versus [mean, 111degrees; range, 80–130 degrees]). There was a lower mean extension in the patients who attended PT earlier as compared with those who attended it later (0.7 vs. 1.5 degrees). Patients who attended OPT within 6 weeks of TKA had a better mean flexion and extension ROM as compared with those who started after 6 weeks. Attending PT earlier may allow a patient to have better ROM and decreased stiffness. Because stiffness recalcitrant to PT is usually treated with manipulation under anesthesia (MUA), attending PT earlier and improving ROM may potentially allow post-TKA patients to avoid undergoing manipulation under anesthesia. Further work is needed to validate these findings. Future studies should be prospective with larger cohorts.

Efficacy of Post-Operative Logbook-Based Quadriceps Exercises on Functional Outcome after Total Knee Arthroplasty

“…The improvement in knee flexion was better in the logbook group than that in the non-logbook group at 24-week post-operatively, although the differrence was not statistically significant (p = 0.263). Similarly, McGinn et al studied early outpatient physical therapy within six weeks and found that early post-operative physical therapy resulted in greater knee flexion and extension than late physical therapy (13) .…”

Range of Motion at Discharge Predicts Need for Manipulation following Total Knee Arthroplasty

“…Encouraging early follow-up or additional interventions with in-home or early transition to outpatient physical therapy could be beneficial to this population. 11 Bong and Di Cesare reviewed previous studies that measured the effectiveness of manipulations post TKA. 10 They recognized the importance of early mobilization through physical therapy post TKA, and found that MUAs are most successful within the 3-month postoperative window if aggressive physical therapy results in little to no gains in flexion.…”

“…McGinn et al found that patients who attended outpatient physical therapy within the first 6 weeks post TKA had better mean flexion than those who waited more than six weeks to begin their physical therapy program. 11 In light of recent interest in cost-saving measures related to TKA, ROM at discharge may be an important indicator for patients that will incur greater cost without greater physician attentiveness and education. With knowledge of this association between discharge ROM and MUA, patients may be better risk stratified very early in the postoperative period.…”

Short-term outcomes for total knee arthroplasty patients with active extension lag

“…The timeline of a postoperative rehabilitation course after a total knee replacement is as follows: (I) acute inpatient PT lasts 1 to 3 days; (II) outpatient PT lasting 1 to 6 weeks focusing on passive range of motion (ROM), normal ambulation, and improving quadriceps strength; (III) returning to normal, everyday activity in 4 to 8 weeks (14). The modalities used for each patient were previously published as the multimodal approach (15). Discharge from PT occurs when the therapist determines the patient has reached maximum medical improvement, where there is no longer a benefit of continued PT, or has returned to an everyday functional level of activity.…”