Summary

A pedaling-based three exercise protocol in the immediate post-operative period after TKR was superior to a standard ten exercise non-pedaling protocol in both functional and patient reported outcomes.

Abstract

Background

Despite Total Knee Replacement (TKR) patients routinely receiving physical therapy in the immediate and early post-operative phase, there is a paucity of research into the optimal exercise protocols in both the acute inpatient setting and early post-operative period after discharge. The early postoperative inpatient days after TKR have become increasingly important for post-operative rehabilitation as average length of stay (LOS) rates decline worldwide. Pedaling has often recommended by clinicians after TKR for rehabilitation, but to our knowledge, there has been no investigation into its utility in the acute postoperative setting.

Methods

Study Design: Randomized Control Trial. 60 TKR patients were randomized to either a 3 exercise pedaling or 10 exercise non-pedaling physical therapy postoperative protocol both commencing with 24 hours of surgery and continuing after discharge till 14 days post-op. Outcomes were assessed at 2 days, 2 weeks and 4 months, and included physical tests of function, patient reported outcomes, and other perioperative outcomes. The primary outcome of performance-based physical function was the TKR validated 6-minute walk test (6MWT) which measures the distance walked along a 30-meter corridor in 6 minutes. All patients received low dose spinal analgesia and peri-articular local anathestic infiltration to allow mobilization on the day of surgery.

Results

The primary outcome, the Six Minute Walk Test (6MWT), was significantly greater in the three exercise pedaling group than the ten exercise non-pedaling group at 2 days postoperatively (mean difference 66 meters, p = .001). Other functional tests, the 10-meter walk speed (10MWT) and the Timed Up and Go (TUG) test, were both significantly superior in the three exercise pedaling group at 2 days (10MWT p = .016; TUG p = .020) as was the patient reported Oxford Knee Score (p = .034). The VAS component of the EQ5D was significantly better for the pedaling group at all assessment time-points (U= 305.0, p = .031 (Day 2); U= 318.5, p = .050 (Day 14); U= 271.0, p = .044 (4 months)). Length of stay was significantly shorter for the pedaling group compared with the non-pedaling group by a half day (Av. 1.5 days vs 2 days, p = 0.024). The ten exercise protocol was not superior for any outcome measure at any time point.

Conclusions

A post-operative pedaling-based three exercise protocol after TKR was superior to a standard ten exercise non-pedaling protocol in both functional and patient reported outcomes.

Level of evidence: Therapeutic Level I