Functional Outcomes After Critical Pathway for Inpatient Rehabilitation of Total Knee Arthroplasty

Exercise with blood flow restriction among adults undergoing total knee arthroplasty: A scoping review

BACKGROUND

Quadriceps strength is relevant for recovering functional capacity in total knee arthroplasty (TKA). This requires strength exercises with high loads, which is difficult to perform after TKA. Rehabilitation with blood flow restriction (BFR) produces gains in strength and muscle mass, avoiding the use of heavy loads.

OBJECTIVE

To identify exercise prescription parameters and the effect of BFR training on muscle mass, muscle strength, and functional capacity of patients with TKA.

METHODS

Following the PRISMA-ScR methodology, a systematic search was carried out in the following databases: Pubmed, Virtual Health Library, Scopus, and Web of Science. The execution of exercises with BFR during TKA prehabilitation and rehabilitation stages were considered. Two authors independently assessed articles for eligibility, and a third author resolved conflicts.

RESULTS

5 articles were selected. During the prehabilitation stage, increases in strength, muscle mass, and functionality occurred. Muscle strength increased in the rehabilitation stage. Studies with a control group did not detect significant differences. Various protocols were applied regarding the prescription, dosage, and implementation of the exercise programs.

CONCLUSION

Strength, muscle size, and physical function increase in people with TKA during the prehabilitation and rehabilitation stages. The analysis carried out indicates a wide methodological variety, lack of standardization, and gaps in BFR protocol application.

The effect of preoperative education on fear of first mobilization experienced after total knee arthroplasty in individuals

OBJECTIVE

Total knee arthroplasty is a surgical intervention performed to reduce pain and movement restriction resulting from advanced joint deformity in individuals diagnosed with osteoarthritis, and to improve their quality of life and functionality. Meeting the preoperative educational needs of individuals undergoing total knee arthroplasty positively impacts postoperative recovery, mobilization, and rehabilitation. In this context, this study was conducted to determine the effect of preoperative education on fear of mobilization experienced after surgery in individuals who have undergone total knee arthroplasty.

MATERIALS AND METHODS

This study, was conducted using a single-group pre-test-post-test model, included 36 individuals who underwent total knee arthroplasty. Data were collected preoperatively and postoperatively using a questionnaire, a fear of falling and fall history assessment form, a Visual Analog Scale-10 (VAS-10), and a fall information exchange form.

RESULTS

The average age of the 36 participants (27 women [75 %]; 9 men [25 %]) was 65.56 ± 4.39 years. The pre-education level of fear was 5.09 ± 1.57, the post-education level of fear was 3.73 ± 0.68, and the level of fear of pre-mobilization was 4.08 ± 0.81. A statistically significant difference was found between the pre-education and post-education level of fear of mobilization (t = 8.324, p = 0.000), between the post-education level and the level of fear before the first mobilization (t = -22.293, p = 0.000). However, it should be noted that fear of mobilization slightly increased during the postoperative first mobilization compared to after education; this may be related to patients' fear of mobilization, pain or anxiety.

CONCLUSION

The results of this study show that preoperative education provided to individuals undergoing total knee arthroplasty has positive effects on reducing fear of first mobilization experienced after surgery.

Establishment of a qualified integrated care system after total knee arthroplasty as a role of regional rheumatoid and degenerative arthritis centers

BACKGROUND

The geriatric population and advanced knee osteoarthritis are rapidly increasing in Korea, and the socioeconomic burden of total knee arthroplasty (TKA) is increasing. This study aimed to analyze the demographic, clinical and socioeconomic characteristics of patients who underwent TKA and to differentiate the factors affecting participation in inpatient-intensive rehabilitation programs after TKA in the Jeju regional rheumatoid and degenerative arthritis center established by the government.

METHODS

This retrospective cohort study included 845 patients (735 females; 72.0 ± 5.8 years) diagnosed with primary osteoarthritis (OA) of the knee who underwent elective unilateral primary TKA between January 2013 and June 2016. Demographic, clinical, and socioeconomic characteristics, including age, body mass index, obesity, length of stay, OA severity, underlying disease, education level, occupation, and location of residence were reviewed. Patients were allocated to the TKA-only group (home discharge) and to the TKA + rehab group (participation in post-TKA rehabilitation). The variables were analyzed and compared before and after the establishment of the center and according to participation in intensive rehabilitation.

RESULTS

Patients who underwent TKA were mostly female, in the 60 s, and had a high prevalence of comorbidities and obesity. After the rehabilitation center's establishment, the intensive post-TKA participation increased profoundly from 3% to 59.2%. Participants after the center establishment had lower mean BMI and a higher proportion of K-L grade 4 compared to those before the center establishment. The location of residence was the only factor differentiating the participation in the intensive rehabilitation.

CONCLUSION

The regional rheumatoid and degenerative arthritis center was appropriate to satisfy the high unmet need for participating in the intensive rehabilitation after TKA and to execute the qualified integrated post-TKA care system. Policy support should ensure the early rehabilitation and a qualified integrated care system and prepare for the increased burden of revision. Future longitudinal studies should be conducted to assess the long-term effect of the integrated post-TKA rehabilitation program on functional outcomes and patient survivorship free from revision.

Physical Performance Correlates with Self-Reported Physical Function and Quality of Life in Patients at 3 Months after Total Knee Arthroplasty

Background

Although total knee arthroplasty (TKA) is an effective treatment for knee osteoarthritis, assessment of postoperative outcomes remains unclear. This study aimed to identify postoperative physical performance factors that are correlated with self-reported physical function and quality of life (QoL) at 3 months after unilateral TKA.

Methods

In total, 158 patients who underwent unilateral primary TKA completed performance-based physical function tests at 3 months after surgery, including Stair Climbing Tests (SCT), 6-Minute Walk Tests (6MWT), Timed Up and Go tests (TUG), and instrumental gait analysis. We also measured the isometric knee flexor and extensor strengths of the operated and non-operated knees. Self-reported physical function and QoL were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Euro-QoL Five Dimensions (EQ-5D) questionnaire, respectively.

Results

Bivariate analyses showed that WOMAC function and EQ-5D were correlated with age, other self-reported measures, and performance-based measures. The WOMAC pain (r=0.71, p<0.001) showed a high positive correlation. While the EQ-5D (r=-0.7, p<0.001) showed a highly negative correlation with WOMAC function, WOMAC pain (r=-0.67, p<0.001) showed a moderately negative correlation with EQ-5D. In multivariate linear regression analyses, WOMAC pain, peak torque of the flexor of the non-operated knee, and reductions in extensor and stride length were associated with self-reported physical function, whereas WOMAC pain, SCT ascent, and cadence were associated with postoperative QoL.

Conclusions

Physical performance factors were significantly associated with self-reported physical function and QoL in patients at 3 months after unilateral TKA. These findings suggest that performance-based physical function could be used to assess outcomes after TKA.

Comparison of simultaneous bilateral versus unilateral total knee replacement on pain levels and functional recovery

BACKGROUND

Total knee replacement is a common operative procedure to improve pain, function, and quality of life in patients with end stage knee osteoarthritis. The current study aimed to compare simultaneous bilateral versus unilateral total knee replacement on pain intensity and recovery of function.

METHODS

A total of 80 patients (bilateral 50, unilateral 30) aged 63.28 (9.4) years undergone total knee replacement participated in the current study. The participants were admitted for 5-7 days in the hospital. Participants in both the group received similar inpatient and outpatient physiotherapy sessions. Pain intensity and function capacity were assessed at baseline, day 7, and day 30 postoperatively using visual analogue scale and lower extremity functional scale, respectively. Repeated measures analysis of variance was used to analyze the data.

RESULTS

Both groups showed a significant reduction of pain intensity (Day 0, mean 8.9, SD 1.0; Day 30, mean 2.2, SD 1.3 in bilateral total knee replacement; Day 0, mean 8.8, SD 1.1; Day 30, mean 2.0, SD 1.5 in unilateral total knee replacement; p < 0.001) and improvement in the functional capacity (Day 0, mean 16.2, SD 10.1; Day 30, mean 55.6, SD 14.6 in bilateral total knee replacement; Day 0, mean 19.1, SD 9.1; Day 30, mean 56.7, SD 15.8 in unilateral total knee replacement; p < 0.001) following total knee replacement at 30 days post-operatively. However, there was a non-significant difference noted between bilateral versus unilateral total knee replacement on the reduction of pain intensity (mean changes, 6.9 versus 6.8) and improvement in the functional capacity (mean changes, 39.4 versus 37.6) at 30 days post-operatively (p > 0.05).

CONCLUSION

Simultaneous bilateral total knee replacement was associated with a similar reduction of pain intensity and recovery of function compared to unilateral total knee replacement, suggesting the use of simultaneous bilateral total knee replacement in patients with bilateral knee osteoarthritis since its costs and rehabilitation process could be reduced compared to staged bilateral total knee replacement.