Benefits of starting rehabilitation within 24 hours of primary total knee arthroplasty: randomised clinical trial
Osteoarthritis is estimated to affect around three quarters of over 65s in developed countries, and when it affects the knees it can be intensely painful, affecting the gait and leading to deformity. As a result, replacing the knee joint with a surgical implant has now become a routine, but major, surgical procedure. This study finds that commencing physical therapy within 24 hours of surgery can improve pain, range of joint motion and muscle strength. On average, those beginning treatment earlier stayed in hospital two days less than the control group and had five fewer rehabilitation sessions before they were discharged. Considering the economic pressures hospitals are under, cutting the length of hospital stays has become a priority. The policy to starting rehabilitation sooner following knee surgery could pay dividends – for both patients and hospitals.
Objective: To compare the benefits of initiating rehabilitation treatment within 24 hours versus 48–72 hours after total knee arthroplasty for osteoarthritis.
Design: Experimental study with clinical trial design.
Subjects: Patients undergoing primary total knee arthroplasty for osteoarthritis were randomly assigned to experimental (n¼153) and control (n¼153) groups.
Interventions: Rehabilitation was started within 24 hours post surgery in the experimental group and between 48 hours and 72 hours post surgery in the controls.
Main measures: Measurement variables included joint range of motion, muscle strength, pain, autonomy, gait and balance.
Results: In comparison with the controls, the experimental group showed significantly shorter hospital stay (by (mean_standard deviation) 2.09_1.45 days; P<0.001), fewer rehabilitation sessions until medical discharge (by 4.95_2.34; P<0.001), lesser pain (by 2.36_2.47 points; P<0.027), greater joint range of motion in flexion (by 16.29_11.39 degrees; P<0.012) and extension (by 2.12_3.19; P<0.035), improved strength in quadriceps (by 0.98_0.54; P<0.042) and hamstring muscles (by 1.05_0.72; P<0.041), and higher scores for gait (P<0.047) and balance (P<0.045).
Conclusion: Initiation of rehabilitation within 24 hours after total knee arthroplasty reduces the mean hospital stay and number of sessions required to achieve autonomy and normal gait and balance.
Labraca, N., Castro-Sanchez, A., Mataran-Penarrocha, G., Arroyo-Morales, M., Sanchez-Joya, M., & Moreno-Lorenzo, C. (2011). Benefits of starting rehabilitation within 24 hours of primary total knee arthroplasty: randomized clinical trial Clinical Rehabilitation DOI: 10.1177/0269215510393759