Intensive, personalized multimodal rehabilitation in patients with primary or revision total knee arthroplasty: a retrospective cohort study

Abstract

Background: Recent evidence has shown that many patients suffer from persistent pain and impaired function after primary or revision total knee arthroplasty (TKA). Post-surgical complications may in addition decrease physical performances and lead to more pain and impacted quality of life. The purpose of the study was to assess the changes in pain intensity and functional capacity among patients with post-surgical complications after TKA three weeks of intensive, personalized multimodal rehabilitation. Methods: A retrospective cohort study consisting of 217 patient of which 166 had primary TKA and 51 had revision TKA was conducted. On average, primary TKA patients and revision TKA patients were 3.7 and 2.7 months post-surgical, respectively. All patients have had post-surgical complications and were referred to an inpatient rehabilitation department, where they received a personalized three-week intensive, multimodal rehabilitation protocol. The rehabilitation consisted of sessions targeting neuromuscular function, postural control, and flexibility, sessions focusing on improving muscle strength and cardiovascular function and sessions with focus on gait retraining. The frequency of training was 2-4 sessions/day. The primary outcome was the Knee injury and Osteoarthritis Outcome Score (KOOS) and secondary outcomes were pain intensities measured using numerical rating scale, 6 min. walking test, stair-climbing test and range of motion for knee flexion and extension. Outcome measures were assessed at baseline upon referral and at follow-up before discharge. Results: All outcomes, except pain at rest in the revision group, improved significantly. KOOS subscales, improved 8.5 to 14.2 in the primary TKA group (p < 0.001) and 6.9 to 10.8 in the revision group (p < 0.001). For the TKA group, effect sizes were medium-to-large for all KOOS subscales, 6 min. walking test, stairclimbing test, and pain intensity during activity. For the revision group, effect sizes were medium-to-large for KOOS subscales symptoms and activity of daily living, 6 min. walking test, stair-climbing test, and knee flexion. Conclusion: Patients with post-surgical complications after primary or revision TKA experienced clinical relevant improvement in self-reported outcomes, pain relief, and improved physical performances after three weeks of personalized multimodal rehabilitation. The results suggest that an intensive, multimodal approach might be useful to obtain clinically relevant improvements.

The indication for aseptic revision TKA does not influence 1-year outcomes: an analysis of 178 full TKA revisions from a prospective institutional registry

“…Physical function and health-related quality of life scores as measured by the KSS, KOOS-PS, and EQ-5D in our study are similar to those reported by prior analysis of revision TKAs (4,13,14,22,30). Although all groups showed improvements at their 1-year follow-up that were above the MCII threshold for the outcome scores, neither group reached the PASS level in any outcome other than pain at rest and pain during mobilization (17,21,31) (Figures 2, 5-6, see Supplementary data).…”

What is the effect of supervised rehabilitation regime vs. self-management instruction following unicompartmental knee arthroplasty? – a pilot study in two cohorts

“…Furthermore, they showed patients appreciate the convenience of staying at home due to lack of traveling, as some patients have to rely on others for travel, due to typical temporary driving restrictions imposed on TKA patients [ 24 ]. Outpatient physiotherapy may have larger efficacy on knee patients experiencing perioperative complications [ 25 ], but as no complications was found for either cohort (Table 1 ) this remains speculative for UKA patients. When examining the literature for discharge criteria for knee patients, there is no univocal evidence in support of particular ROM targets before discharge [ 26 , 27 ], and as few patients in general satisfy discharge criteria which incorporate any ROM threshold [ 28 ] functional discharge criteria are recommended for UKA patients [ 27 ], which resonate with our results.…”

Better precision of a new robotically assisted system for total knee arthroplasty compared to conventional techniques: A sawbone model study

“…Although TKA surgery has been regarded as a successful treatment option for restoring function and for alleviating pain in the treatment of knee joint disease, approximately 20% of these cases have little or no improvement in physical function, pain and quality of life. 20,21 Many risk factors, such as the female sex, age, alcohol use, smoking, pre-existing psychiatric illness and the African-American race, are associated with increased persistent pain and increased patient dissatisfaction after TKA. 22,23 Among these risk factors, precise bone resection and accurate component positioning are important for preventing the malalignment of TKA.…”