Early Progressive Strength Training to Enhance Recovery After Fast‐Track Total Knee Arthroplasty: A Randomized Controlled Trial

Abstract

Objective. To compare 7 weeks of supervised physical rehabilitation with or without progressive strength training (PST) commenced early after fast-track total knee arthroplasty (TKA) on functional performance. Methods. In total, 82 patients with a unilateral primary TKA were randomized to 2 different interventions: 7 weeks of supervised physical rehabilitation with PST (PST group) and without PST (CON group) commenced early after fast-track TKA. The primary outcome was the maximal distance walked in 6 minutes (6-minute walk test). Secondary outcomes were lower extremity strength and power, knee joint effusion and range of motion, knee pain, and self-reported disability and quality of life. All outcome measures were assessed before TKA (baseline) and 4, 8, and 26 weeks after TKA.Results. There was no statistically significant difference between the PST and CON groups in the change score from baseline to the 8-week postoperative assessment (primary end point) for the 6-minute walk test with unadjusted baseline scores (mean difference between groups: ؊11.3 meters [95% confidence interval ؊45.4, 22.7]; analysis of variance P ‫؍‬ 0.51). There were no statistically significant or clinically meaningful differences between groups in change scores from baseline to any other time point for all secondary outcomes. The secondary outcome knee extension strength did not reach the level recorded before surgery in both groups. Conclusion. Seven weeks of supervised physical rehabilitation with PST was not superior to 7 weeks of supervised physical rehabilitation without PST in improving functional performance, measured as the maximal walking distance in 6 minutes, at the primary end point 8 weeks after fast-track TKA.

Patient experience with early discharge after total knee arthroplasty: a focus group study

“…During hospitalisation they are encouraged to be as active as possible, wearing their own clothes, participating in group physiotherapy and having their meals in a dining room together with other patients . We found that many participants were concerned about exercising and regaining muscular strength, as recent research recommend strength training and physical exercise soon after surgery . Physiotherapy sessions are supposed to start 2–3 weeks after surgery, but the majority of the participants in our study had already been in contact with a physiotherapist in their municipality before the interviews.…”

Minimally invasive total knee replacement: techniques and results

“…This new approach to TKR was driven by several factors. First of all other specialties were ahead of orthopaedic surgery with regard to minimally invasive surgery principles [8]; second of all, the resurgence of UKR using mini-invasive approach gave surgeons the skills to transpose similar technique to TKR [98, 99]; third the development of computer-assisted technology with the navigation and robotic surgery which interestingly followed the progression of UKR growth on the market [12, 97]; and finally the rapid adoption of enhanced recovery thinking in arthroplasty surgery [61, 62]. …”

Patients' expectations about total knee arthroplasty outcomes

“…Modest changes to length of stay have impacted initial physical therapy approaches; however, there have not been significant shifts in specific treatment. Rehabilitation after TKA has not changed substantially in the past 7 years . Other unmeasured confounder or mediator variables might have influenced Patients' expectations.…”

“…Rehabilitation after TKA has not changed substantially in the past 7 years. 32,33 Other unmeasured confounder or mediator variables might have influenced patients' expectations. Lastly, large variability in patient perceptions of time to functional recovery existed among particular activities, such as kneeling and being able to walk 5 blocks.…”