Standardized rehabilitation may improve post-TKA function

Total knee arthroplasty (TKA) success may be related to the duration of postoperative physical therapy, according to a study conducted by researchers at the University of Massachusetts Medical School in Worcester, Mass.

They asked 179 patients with knee osteoarthritis with a mean age of 65.1 years or more to wear ankle accelerometer devices before undergoing TKA. After they measured walking at baseline and at 8 weeks and 6 months postoperatively, the researchers found some patients experienced different types of physical therapy while others actually ended therapy before their steps reached preoperative levels.

“Our findings demonstrated wide variability in the utilization of physical therapy in these subjects, in the amount of physical therapy, the number of days in physical therapy and also wide variability in the kind of physical therapy after surgery,” Carol A. Oatis, PhD, PT, lead investigator and professor of physical therapy at Arcadia University in Glendale, Pa., stated in a press release.

Oatis was scheduled to present the findings at the American College of Rheumatology Annual Meeting 2012.

She and colleagues found that average and median step counts at 8 weeks were about 1,000 steps fewer than preoperative levels, with mean and median step increases at 6 postoperative months of 738 steps and 354 steps, respectively. Additionally, 30% of subjects left rehabilitation at 8 weeks and continued their therapy at home and 40% of subjects completed rehabilitation after 9 weeks, according to the abstract.

“What struck me was that a large percentage of people had been discharged from physical therapy while their physical activity level was still greatly below their preoperative level,” Oatis stated in the release. “That was a pretty stunning picture of the relationship between the timing of rehabilitation services and functional activity.”

Oatis noted in the release that standardizing the timing of rehabilitation and setting functional goals that are in line with patient expectations may help offset the discrepancies in physical activity levels after TKA that her study revealed.

Reference:

Oatis CA. Paper #1585. Presented at: American College of Rheumatology Annual Meeting; Nov. 10-14, 2012; Washington D.C.

Disclosure: Oatis has no relevant financial disclosures. One of the authors (Franklin) is supported from Zimmer. NIAMS provided some funding for the study.