Dose-Associated Changes in Gait Parameters in Response to Exercise Programs after Total Knee Arthroplasty: Secondary Analysis of Two Randomized Studies

Physical Therapist Management of Total Knee Arthroplasty

A clinical practice guideline on total knee arthroplasty was developed by an American Physical Therapy (APTA) volunteer guideline development group that consisted of physical therapists, an orthopedic surgeon, a nurse, and a consumer. The guideline was based on systematic reviews of current scientific and clinical information and accepted approaches to management of total knee arthroplasty.

Effect of Dynamic Balance Exercises Based on Visual Feedback on Physical Function, Balance Ability, and Depression in Women after Bilateral Total Knee Arthroplasty: A Randomized Controlled Trial

The aim of this study was to compare the effects of dynamic balance exercises with and without visual feedback on recovery from total knee arthroplasty. The participants were 30 women who underwent total knee arthroplasty more than one week before the study, and were randomly allocated into two groups. The average ages of the experimental and control groups were 70.13 and 69.00 years, respectively. The dynamic balance exercise with visual feedback (VF) group practiced dynamic balance exercises using a laser pointer for five 30-min sessions over a 4-week period. The dynamic balance exercise without visual feedback (control) group practiced dynamic balance exercises for five 30 min sessions over a 4 week period. The following clinical measures were used for assessing physical function, balance ability, and depression. Compared with the control group, the VF group showed significant improvements in the physical performance test, Western Ontario and McMaster Universities Arthritis Index (WOMAC), confidence ellipse area (CEA), path length (PL), average velocity (AV), and Timed Up and Go test (TUG test) (p < 0.05). Furthermore, the VF group showed significant improvements in all post-surgery outcome measures compared with the pre-surgery values (p < 0.05). The above results indicated that the dynamic balance exercises based on visual feedback improved physical function and balance ability in patients following total knee arthroplasty, suggesting the need for effective rehabilitation programs for patients with total knee arthroplasty.

Total knee arthroplasty in a patient with ipsilateral hip ankylosis: A case report

RATIONALE

There is a large number of people that have knee degeneration in China. Total knee arthroplasty is one of the most effective methods of treatment in the later stages of the disease. However, there are challenges when performing total knee arthroplasty on patients with ipsilateral hip akylosis. So far, there are few reports on postoperative curative effect of total knee arthroplasty for these patients. This case report records how to perform total knee arthroplasty in a patient with ipsilateral hip ankylosis.

PATIENT CONCERNS

Due to ankylosing spondylitis, the flexion of the patient's hips are restricted in 10°, which leads to a limited ipsilateral knee flexion to 30° when she is in the supine position.

DIAGNOSES

Right knee osteoarthritis; right hip ankylosis.

INTERVENTIONS

We modified the traditional surgical position to allow easy exposure of the knee during surgery. After total knee arthroplasty, the patient was included in a planned training program, and was followed for 6 months.

OUTCOMES

The patient walked well without ambulation aid and achieved satisfactory knee joint function.

LESSONS

Conversion of a fused hip to a total hip arthroplasty does improve the quality of life of patients, but, given the high incidence of complications and more financial burden to the patient, we modified traditional surgical position of the patient to provide ideal surgical exposure of the knee. We hope that this case can be used as a reference for clinicians to deal with similar situations.

COmmunity-based Rehabilitation after Knee Arthroplasty (CORKA): study protocol for a randomised controlled trial

Background

The number of knee arthroplasties performed each year is steadily increasing. Although the outcome is generally favourable, up to 15 % fail to achieve a satisfactory clinical outcome which may indicate that the existing model of rehabilitation after surgery may not be the most efficacious. Given the increasing number of knee arthroplasties, the relative limited physiotherapy resources available and the increasing age and frailty of patients receiving arthroplasty surgery, it is important that we concentrate our rehabilitation resources on those patients who most need help to achieve a good outcome. This pragmatic randomised controlled trial will investigate the clinical and cost-effectiveness of a community-based multidisciplinary rehabilitation intervention in comparison to usual care.

Methods/design

The trial is designed as a prospective, single-blind, two-arm randomised controlled trial (RCT). A bespoke algorithm to predict which patients are at risk of poor outcome will be developed to screen patients for inclusion into a RCT using existing datasets. Six hundred and twenty patients undergoing knee arthroplasty, and assessed as being at risk of poor outcome using this algorithm, will be recruited and randomly allocated to one of two rehabilitation strategies: usual care or an individually tailored community-based rehabilitation package. The primary outcome is the Late Life Function and Disability Instrument measured at 1 year after surgery. Secondary outcomes include the Oxford Knee Score, the Knee injury and Osteoarthritis Outcome Score quality of life subscale, the Physical Activity Scale for the Elderly, the EQ-5D-5L and physical function measured by three performance-based tests: figure of eight, sit to stand and single-leg stand. A nested qualitative study will explore patient experience and perceptions and a health economic analysis will assess whether a home-based multidisciplinary individually tailored rehabilitation package represents good value for money when compared to usual care.

Discussion

There is lack of consensus about what constitutes the optimum package of rehabilitation after knee arthroplasty surgery. There is also a need to tailor rehabilitation to the needs of those predicted to do least well by focussing on interventions that target the elderly and frailer population receiving arthroplasty surgery.

Trial registration

ISRCTN 13517704, registered on 12 February 2015.