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M. Kubota1, Y. Kokubo2, H. Matsuo3, H. Naruse3, K. Shoji3, T. Miyazaki4, A. Matsumine4, S. Shimada3
1Kanazawa University, Department of Physical Therapy, Graduate Course of Rehabilitation Science, School of Health Sciences, College of Medical, Pharmaceutical, and Health Sciences, Kanazawa City, Japan, 2University of Fukui Hospital, Surgical Center, Yoshida-gun, Eiheiji-cho, Japan, 3University of Fukui Hospital, Division of Physical Therapy and Rehabilitation Medicine, Yoshica-gun, Eiheiji-cho, Japan, 4University of Fukui, Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, Yoshica-gun, Eiheiji-cho, Japan
Background: Postoperative rehabilitation of total knee arthroplasty (TKA) is essential to minimize disability of the knee and to maximize the benefit from TKA. Especially, the acute phase postoperative rehabilitation was important to achieve the good articular excursion, muscle strength and recovery of ambulation and improvement of gait pattern, as well as the reduction of pain. Although several studies reported the effects of early starting rehabilitation after TKA, these have not been investigated one-year follow-up outcomes.
Purpose: The purpose of this study was to determine the effects of early initiating rehabilitation treatment after TKA until one-year follow-up.
Methods: Patients undergoing primary TKA for osteoarthritis were assigned to early rehabilitation (n=41) and control rehabilitation (n=39) groups. Rehabilitation was started within 4 hours postoperative in the early group and 2 days after surgery in the control group. Primary outcomes were joint range of motion (ROM) and pain which assessed before surgery and three days, three weeks, six months and one year after surgery. ROM was assessed flexion and extension of the knee. Knee pain was assessed using the pain intensity numeric rating scale (NRS) of 0–10 (0-no, 10-worst pain). Secondary outcomes were muscle strength and gait parameters were assessed before and three weeks after surgery. Isokinetic muscle strength testing procedure of quadriceps and hamstrings was completed using the isokinetic dynamometer (Biodex System 4). Gait analysis was performed using VICON MX system with ten strobe cameras (100Hz) and four force plates (2000Hz) placed in the middle of a 10-meter walkway. Written informed consent was obtained from all participants in the study, and which was approved by the ethical committee of our university.
Results: Extension ROM in the early group was significantly better than the control group at three days, three weeks and six months after surgery. Flexion ROM in the early group was better than the control group at one year after surgery. Pain NRS at six and one year after surgery in the early group were significantly decreased compared with the control group. Peak knee flexion and extension angle during stance phase in the early group were significantly decreased than the control group at three weeks after surgery. There were no significant differences between groups for muscle strength.
Conclusion(s): Starting rehabilitation within 4 hours after TKA might reduce the early loss of extension ROM and improve knee kinematics during gait. Furthermore, it might contribute to be better ROM and pain until one year after TKA.
Implications: Our study indicated that early initiating rehabilitation treatment after TKA might be important to sustained better ROM and pain until the one-year follow-up.
Funding, acknowledgements: Non funding for this study.
Keywords: total knee arthroplasty, early rehabilitation, range of motion
Topic: Musculoskeletal: lower limb
Did this work require ethics approval? Yes
Institution: Fukui University
Committee: The ethical committee of Fukui university
Ethics number: 20120120
All authors, affiliations and abstracts have been published as submitted.
