Total Hip and Knee Replacement Treatment Programs: A Report Using Consensus

Enloe, Lori J.; Shields, Richard K.; Smith, Kent; Leo, Ken C; Miller, Bruce S.

doi:10.2519/jospt.1996.23.1.3

Cited by 85 publications

(37 citation statements)

References 12 publications

(22 reference statements)

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“…Some patients find these restrictions interfere with their recovery. Most surgeons agree on hip precautions of restricting flexion of the hip beyond 90°, no adduction past neutral, and no internal rotation past neutral for 6 weeks after surgery [14]. These have not been guided by surgical approach [65].…”

Section: Discussionmentioning

confidence: 99%

Factors Influencing Early Rehabilitation After THA: A Systematic Review

Sharma

Morgan

Cheng

2009

Clin Orthop Relat Res

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A wide variation exists in rehabilitation after total hip arthroplasty (THA) in part due to a paucity of evidence-based literature. We asked whether a minimally invasive surgical approach, a multimodal approach to pain control with revised anesthesia protocols, hip restrictions, or preoperative physiotherapy achieved a faster rehabilitation and improved immediate short-term outcome. We conducted a systematic review of 16 level I and II studies after a strategy-based search of English literature on OVID Medline, PubMed, CINAHL, Cochrane, and EMBASE databases. We defined the endpoint of assessment as independent ambulation and ability to perform activities of daily living. Literature supports the use of a multimodal pain control to improve patient compliance in accelerated rehabilitation. Multimodal pain control with revised anesthesia protocols and accelerated rehabilitation speeds recovery after minimally invasive THA compared to the standard approach THA, but a smaller incision length or minimally invasive approach does not demonstrably improve the short-term outcome. Available studies justify no hip restrictions following an anterolateral approach but none have examined the question for a posterior approach. Preoperative physiotherapy may facilitate faster postoperative functional recovery but multicenter and welldesigned prospective randomized studies with outcome measures are necessary to confirm its efficacy.

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Section: Discussionmentioning

confidence: 99%

Factors Influencing Early Rehabilitation After THA: A Systematic Review

Sharma

Morgan

Cheng

2009

Clin Orthop Relat Res

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“…The following literature databases were searched: EBSCO (10), Hooked on Evidence (4), Google Scholar (3), and CINAHL (2). All articles were written in English, peerreviewed, and had a 1990 to present date restriction.…”

Section: Methodsmentioning

confidence: 99%

“…5,7--9 Physical therapy protocols vary in exercise programs, functional activities, frequency, and treatment progression, as well as, duration with less than consistent practice patterns reported among physical therapists. 10 As of today, some controversy exists in the literature regarding the most effective physical therapy protocol for patients who have had a TKA. The purpose of this review article was to combine relevant research regarding the most appropriate physical therapy intervention and to provide recommendations for treatment of patients after TKA.…”

Section: Introductionmentioning

confidence: 99%

A critical review of the literature regarding physical therapy management of patients with total knee arthroplasty

Kohia

Reyes

Koehler

et al. 2015

Current Orthopaedic Practice

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This review analyzes the research literature on physical therapy management of patients anticipating or recovering from total knee arthroplasty (TKA). Using databases and keywords, several relevant studies were found. Twenty-four studies met the criteria and were classified according to Sackett's levels of evidence. Fifteen studies were graded as level I, five studies as level II, one as level IV, and three as level V. From the levels of evidence, seven grade A, four grade B, and one grade C recommendations were developed, with grade A being the most significant. The results of this review found that there is a potential benefit to using accelerated procedures (initiation of rehabilitation within 24 hr after TKA). Encouraging patients to perform active range of motion exercise would be a better option than passive range of motion and that physiotherapy can focus on more functional rehabilitation, such as preparing to return to daily activities. Eccentric exercise of the hamstring is one of the effective methods to recover knee extension after TKA. A multidisciplinary rehabilitation program, including a physician specializing in physical medicine and rehabilitation, a physical therapist, a psychologist, a social worker, a nutritionist, and an orthopaedic surgeon in the outpatient setting, does not reduce the use of rehabilitation services or yield faster achievement of functional recovery or quality of life. Functional training and balance training are safe treatment methods and have the potential to decrease functional limitations. Clinical recommendations and future research directions also are provided.

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“…Le taux d'émergence d'une proposition correspondait au nombre de fois où une modalité thérapeutique était recommandée dans les listes de recommandations existantes. Vingt-trois recommandations ont été prises en considération pour déterminer le taux d'émergence d'une proposition [6][7][8][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. Le niveau de consensus a été obtenu par la méthode Delphi réalisée sur 110 modalités de traitement.…”

Section: Méthode D'élaboration Des Recommandations Par L'oarsiunclassified