Rehabilitative Guidelines after Total Knee Arthroplasty: A Review

Abstract

Rehabilitation following total knee arthroplasty (TKA) continues to pose a challenge for both patients and providers. In addition, guidelines vary considerably between institutions, which often leave therapy regimens to the discretion of the provider. The lack of clear guidelines for rehabilitation may contribute to inadequate recovery of strength and range-of-motion, resulting in less optimal functional outcomes. Therefore, the aim of this review was to highlight and discuss a variety of post-TKA rehabilitative modalities currently available and to provide evidence regarding efficacy and practicality. Specifically, we assessed the role of and evidence for exercise therapy, aquatic therapy, balance training, continuous passive motion, cold therapy and compression, neuromuscular electrical stimulation, transcutaneous electrical nerve stimulation, and instrument-assisted soft-tissue therapy. Additionally, we proposed general recommendations for rehabilitation after TKA, and as we specifically described active and obese patients, we have included guidelines for these subsets as well. Our review examines the various rehabilitative modalities to offer suggestions for recovery of strength and range-of-motion after TKA, with a focus on the early incorporation of exercise therapy, balance training, aquatic therapy, cryopneumatic therapy, neuromuscular electrical stimulation, and transcutaneous electrical nerve stimulation. Dedication and commitment to rehabilitation may help patients attain and exceed their preoperative activity levels.

Effects of Phased Rehabilitation Programs after Total Knee Arthroplasty: A Randomized Controlled Trial

“…By 2009, the number of patients undergoing TKA annually had increased to 1.2 per 1000 patients [10], and the number of patients undergoing TKA continues to increase. As many patients who undergo TKA experience decreased muscle strength, especially in the quadriceps and hamstring muscles, postoperative rehabilitation is becoming increasingly popular among patients with knee osteoarthritis [11]. Several studies have shown lower extremity muscle weakness and functional deficits in patients who have undergone TKA compared with age-matched control subjects who have not undergone TKA [12,13].…”

“…In this rehabilitation project, we focused on decreasing knee pain and swelling, remodeling and improving knee mobility under painless conditions, improving muscle strength during different types of contractions, restoring normal gait patterns, and neuromuscular coordination. Previous clinical trials have only studied the effectiveness of muscle strength training for patients after TKA [11,15]; these studies may have an increased number of patients lost to follow-up. Furthermore, because simple exercise styles could cause the patients to become exhausted more quickly, the training was not as effective as expected.…”

Rehabilitation and Physical Therapy before and after Total Knee Arthroplasty: A Literature Review and Unanswered Questions

“…Many studies suggest or support specific rehabilitative treatments [63]. Most of these studies have important clinical relevance because they are based on large patients series, on case-control groups, on well-functioning practical experiences and on world-wide accepted treatments.…”

“…Most of these studies have important clinical relevance because they are based on large patients series, on case-control groups, on well-functioning practical experiences and on world-wide accepted treatments. Nevertheless, close analysis of the literature reveals a certain deficiency in terms of evidence-based protocols, well defined studies and the use of scientific approaches in general, as well as suggested by a recently published revision about TKA and rehabilitation [63].…”

“…Unfortunately, it is difficult to find evidence of the effectiveness of rehabilitation programmes before and after TKA because of the lack of randomisation and the low number of subjects included in the studies [63]. Moreover, in many cases, the types of exercises and interventions are not clear, or are too heterogeneous for effective comparison.…”