ISAKOS: 2019 Congress in Cancun, Mexico
ISAKOS

2019 ISAKOS Biennial Congress ePoster #946

 

The Efficacy of New Total Knee Arthroplasty Rehabilitation Protocol for Good Range of Motion After Follow-Up of Two Years

Masataka Nishikawa, MD, PhD, Osaka City, Osaka JAPAN
Atsushi Goshima, MD, Osaka City, Osaka JAPAN
Hajime Owaki, MD, PhD, Osaka City, Osaka JAPAN
Katsuya Nakata, MD, PhD, Osaka City, Osaka JAPAN
Takeshi Fuji, MD, PhD, Osaka City, Osaka JAPAN

Dept. of Orthopaedic Surgery, Japan Community Healthcare Organization (JCHO), Osaka Hospital, Osaka City, Osaka, JAPAN

FDA Status Not Applicable

Summary

We modified our total knee arthroplasty (TKA) rehabilitation protocol to obtain good post-operative range of motion (ROM). The self ROM exercise using triangular shaped knee rehabilitation cushion is active exercise and patients are able to exercise at maximum angle and time as much as possible. The new TKA rehabilitation protocol is considered to contribute good ROM after follow-up of 2 years.

Abstract

Background

Total knee arthroplasty (TKA) have good clinical result and longevity. However, many patients unsatisfied with their range of motion (ROM).

[Objectives]
We modified our TKA rehabilitation protocol to obtain good post-operative ROM. We evaluated the efficacy of new TKA rehabilitation protocol compared with old one for good ROM after follow-up of 2 years.

[Study Design & Methods]
Continuous passive motion (CPM) and a standing gait exercise program were started on post-operative (PO) day 2 as standard rehabilitation protocol previously (old rehabilitation). We modified TKA rehabilitation protocol for good ROM (new rehabilitation). First, we discontinued CPM and started self ROM exercise using triangular shaped knee rehabilitation cushion. Second, we did not encourage a standing gait exercise, and recommended the elevation of operated lower leg to avoid swelling. Third, all rehabilitation exercise were started on PO day 1. Forty-seven TKAs with old rehabilitation (old) and forty-six TKAs with new rehabilitation (new) by single surgeon were enrolled in this study. Next, we defined pre-operative ROM as 100% and also evaluated ROM% at post-operative period. We compared with the ROM and ROM% at pre-operation, PO week 1, 2, 3, month 2, 6, 12, 18 and 24 between old and new groups to evaluate the efficacy of new rehabilitation protocol for good ROM. Statistical analysis was performed using Mann-Whitney U test, and p<0.05 was considered to indicate statistical significance.

Results

There was no significant difference between 2 groups in pre-operative ROM (old/new; 14-128°/16-124°). However, there were significant differences between 2 groups in PO week 1 (6-99°/4-117°: p<0.001), 2 (4-109°/3-123°: p<0.001), 3 (2-116°/2-126°: p<0.001), month 2 (5-125°/5-132°: p=0.03), 6 (4-127°/3-134°: p=0.02), 12 (3-129°/2-136°: p=0.03), 18 (2-128°/1-137°: p=0.003), and 24 (2-129°/1-138°: p=0.005). Moreover, there were significant differences between 2 groups (ROM%) in PO week 1 (old/new; 84%/106%: p<0.001), 2 (94%/113%: p<0.001), 3 (102%/117%: p<0.001), month 2 (108%/119%: p<0.001), 6 (111%/122%: p<0.001), 12 (114%/126%: p<0.001), 18 (113%/128%: p<0.001), and 24 (114%/129%: p<0.001). All results showed significantly good post-operative ROM in new rehabilitation group compared with old one.

Conclusion

The usefulness of CPM after TKA was reported in 1980s. However, many recent studies reported that CPM provided no benefit to patients recovering from TKA. CPM is passive exercise and patients are able to exercise at only setting angle and time. The cost of CPM is also high. The self ROM exercise using triangular shaped knee rehabilitation cushion is active exercise and patients are able to exercise at maximum angle and time as much as possible. This exercise is easy to encourage patients’ motivation for ROM exercise. In addition, all rehabilitation exercise were started on POD 1; one day earlier that previous protocol. This ROM exercise in early post-operative period is able to start before post-operative joint contracture. These modifications of TKA rehabilitation protocol are considered to contribute good ROM after follow-up of 2 years. However, this protocol is not suitable for the unmotivated or upper extremity disability patients such as dementia, post-operative delirium, and rheumatoid arthritis.