The Role of Physical Activity and Rehabilitation Following Hip and Knee Arthroplasty in the Elderly

Abstract

Hip and knee replacement is an effective treatment for symptomatic, end-stage hip and knee osteoarthritis, aiming to relieve pain and restore joint function. Several postoperative rehabilitation protocols and physical activities are proposed in routine clinical practice. However, their effect on clinical outcome and implant revision in patients undergoing joint replacement is still unclear. A systematic review of the literature was performed through a comprehensive search on online databases including Pubmed-Medline, Cochrane central, and Google scholar. We included all the available studies on postoperative physical activity and rehabilitation protocols after total knee and total hip arthroplasty in patients older than 65 years. The primary endpoint was to evaluate the effect of physical activity and rehabilitation on clinical outcome; the secondary outcome was to determine the effect on patients’ quality of life (QoL) and implant survival. Although the heterogeneity of the rehabilitation protocols and outcome measures did not allow to draw definitive conclusions, most studies suggested that aquatic therapy, ergometer cycling, and fast-track protocols have a beneficial effect on muscle strength, gait speed, and main clinical scores after total hip arthroplasty. Similarly, enhanced rehabilitation protocols produced an improvement in primary and secondary outcomes after total knee arthroplasty.

Multimodal approach to intraarticular drug delivery in knee osteoarthritis

“…TKA is usually complemented with multimodal interventions on modifiable factors. The loss of motor function and muscle strength is compensated by various rehabilitation regimens and proper physical activity [60]. In fact, the best outcomes are achievable with complex perioperative interventions on muscle strength and management of nutrition, obesity, and other comorbidities [60][61][62][63].…”

Total Knee Arthroplasty for the Oldest Old

“…It is accepted that rehabilitation programs, also based on physiotherapy, improve the outcome of TKA patients. Diverse protocols and techniques have been associated with improvements in function and patient perception after total knee arthroplasty [11][12][13][14]. There is no agreement in the scientific literature on which type of physiotherapy is most effective in patients undergoing total knee arthroplasty.…”

“…Protocols for preoperative initiation of physical therapy have been proposed that may improve outcomes. Papalia et al [14] suggest that patients over 65 years of age would benefit from intensive physiotherapy and aqua therapy protocols in conjunction with physical activity.…”

“…There is a consensus on the benefit of rehabilitation in the process of TKA [12]. Several protocols and techniques are used without evidence of the superiority of one over the other [12][13][14]. Rehabilitation after TKA includes physical exercises and other modalities (like hydrotherapy or electrotherapy, among others) in order to reduce the pain and improve joint function [11,13,14].…”

“…Several protocols and techniques are used without evidence of the superiority of one over the other [12][13][14]. Rehabilitation after TKA includes physical exercises and other modalities (like hydrotherapy or electrotherapy, among others) in order to reduce the pain and improve joint function [11,13,14]. Another topic to consider in rehabilitation, in older patients, is the need for collaboration in this type of treatment.…”