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Aquatic therapy soon after TKA improves outcomes

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Starting aquatic therapy 6 days after total knee arthroplasty can lead to improved results, according to a study published in the Archives of Physical Medicine and Rehabilitation. The same study also found that delaying the onset of aquatic therapy for an additional week may be more appropriate following a total hip arthroplasty (THA).

“This multicenter study demonstrates that the timing of physiotherapy measures such as aquatic therapy has clinically relevant effects after [total knee arthroplasty (TKA)],” lead investigator Thoralf R. Liebs, MD, stated in a news release. “Ours is one of the few studies that demonstrates a clinically important effect on the health-related quality of life after TKA by a factor that can be influenced by the health care professional. The intervention is simple to administer, and requires limited extra input from the health care professional.”

In the study, THA and TKA patients were randomly assigned to receive aquatic therapy beginning either 6 days or 14 days postoperatively. For both groups, the therapy lasted 30 minutes and was performed three times a week up to the fifth postoperative week. The researchers evaluated physical function, pain and stiffness 3 months, 6 months, 12 months and 24 months postoperatively.

After THA, all measurements at every follow-up period were better in patients who began their aquatic therapy after the wound had healed. In contrast, all mean outcomes were better in the group that began therapy 6 days after TKA, according to the release.

“THA has a high rate of patient satisfaction, and patients report an improved quality of life after the procedure,” Liebs stated. “Additional interventions, such as early aquatic therapy, may not lead to much improvement. After TKA, patients are less satisfied, so the additional intervention has a greater effect.”

“The hydrostatic force of water reduces effusion in the knee joint,” he added. “Because the knee capsule is closed after TKA, reduced effusion leads to less pain. In THA, the joint capsule is not closed, so the effect of reduced effusion is less.”

Reference:

• Liebs TR, Herzberg W, Ruther W, et al. Multicenter randomized controlled trial comparing early versus late aquatic therapy following total hip or knee arthroplasty. Arch Phys Med Rehab. 2011. doi:10.1016/j.apmr.2011.09.011

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