Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin 2016; 26(06): 284-287
DOI: 10.1055/s-0042-111326
Wissenschaft und Forschung
© Georg Thieme Verlag KG Stuttgart · New York

Effect of Physiotherapy on Pain and Recovery of Physical Function after Total Knee Arthroplasty: One Month Follow-up

Effekt der Physiotherapie auf Schmerzen und Wiederherstellung der körperlichen Funktion nach Knieendoprothetik: ein Monat Follow-up
A. Alghadir
1   Rehabilitation Research Chair, Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
,
Z. A. Iqbal
1   Rehabilitation Research Chair, Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
,
S. Anwer
1   Rehabilitation Research Chair, Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
2   Dr. D. Y. Patil College of Physiotherapy, Dr. D. Y. Patil Vidyapeeth, Pune, India
› Author Affiliations
Further Information

Publication History

received: 21 January 2016

accepted: 29 June 2016

Publication Date:
12 December 2016 (online)

Abstract

Objective: To investigate the effect of physiotherapy on pain and recovery of physical function after total knee arthroplasty (TKA).

Methods: 80 patients (male 29, female 51) in the age group of 48–80 years (mean 63.28, SD 9.44) undergone TKA (bilateral 50, unilateral 30) participated in the prospective interventional study. All the participants received daily inpatient physiotherapy and outpatient physiotherapy sessions 4 days a week for 3 weeks. Pain and physical function were assessed at preoperatively, 1 week, and 1 month post-operatively by visual analogue scale (VAS) and lower extremity functional scale (LEFS), respectively. The data was analysed using repeated measures analysis of variance.

Results: VAS score at 1-week after surgery was 4.38 (SD 0.99) vs. 2.13 (SD 1.35) at 1-month (p<0.001). At 1-month the VAS score was 2.13 (SD 1.35) vs. 8.85 (SD 0.99) preoperatively (p<0.001). LEFS at 1-week after surgery was 29.19 (SD 11.94) vs. 55.99 (SD 14.95) at 1-month (p<0.001). At 1-month the functional score was 55.99 (SD 14.95) vs. 17.26 (SD 9.70) preoperatively (p<0.001).

Conclusions: A regime of physical therapy program provides early pain reduction and improvement of function after TKA at 1-month post-operatively.

Zusammenfassung

Ziel: In dieser Studie soll ermittelt werden, welchen Effekt Physiotherapie auf Schmerzen und Wiederherstellung der körperlichen Funktion nach Knieendoprothetik hat.

Methoden: An der prospektiven interventionellen Studie nahmen 80 Patienten (29 männlich, 51 weiblich) in der Altersgruppe von 48–80 Jahren (Durchschnitt 63,28, SD 9,44) nach Knieendoprothetik (beidseitig 50, einseitig 30) teil. Alle teilnehmenden Patienten erhielten täglich Physiotherapie auf der Station und später ambulant 4 mal pro Woche über einen Zeitraum von 3 Wochen. Schmerzen und körperliche Funktion wurden präoperativ und dann postoperativ nach einer Woche und nach einem Monat mittels Visueller Analogskala (VAS) beziehungsweise Lower-Extremity-Functional-Scale (LEFS) bewertet. Die Daten wurden mittels Varianzanalyse mit Messwiederholungen analysiert.

Ergebnisse: Eine Woche nach der Operation betrug der Wert der Visuellen Analogskala 4,38 (SD 0,99) gegenüber 2,13 (SD 1,35) nach einem Monat (p<0,001). Nach einem Monat betrug der VAS-Wert 2,13 (SD 1,35) im Vergleich zu 8,85 (SD 0,99) präoperativ (p<0,001). Der LEFS-Wert betrug eine Woche nach der Operation 29,19 (SD 11,94) gegenüber 55,99 (SD 14,95) nach einem Monat (p<0,01). Nach einem Monat betrug der LEFS-Wert 55,99 (SD 14,95) im Vergleich zu 17,26 (SD 9,70) präoperativ (p<0,001).

Schlussfolgerung: Im Zeitraum von einem Monat nach Knieendoprothetik führt ein konsequentes Physiotherapieprogramm zu frühzeitiger Schmerzreduzierung und verbesserter körperlicher Funktion.

 
  • References

  • 1 Kaukinen P, Podlipská J, Guermazi A et al. Associations between MRI-defined structural pathology and generalized and localized knee pain – the Oulu Knee Osteoarthritis study. Osteoarthritis Cartilage 2016; May 10. pii: S1063-4584(16)30062-0 DOI: 10.1016/j.joca.2016.05.001. [Epub ahead of print]
  • 2 Kennedy DM, Stratford PW, Riddle DL et al. Assessing recovery and establishing prognosis following total knee arthroplasty. Phys Ther 2008; 88: 22-32
  • 3 Wyndow N, Collins N, Vicenzino B et al. Is there a biomechanical link between patellofemoral pain and osteoarthritis? a narrative review. Sports Med 2016 May 3. [Epub ahead of print]
  • 4 Stratford PW, Kennedy DM, Riddle DL. New study design evaluated the validity of measures to assess change after hip or knee arthroplasty. J Clin Epidemiol 2009; 62: 347-352
  • 5 Hussain SM, Neilly DW, Baliga S et al. Knee osteoarthritis: a review of management options. Scott Med J 2016 Jun 21. pii: 0036933015619588. [Epub ahead of print]
  • 6 Barrington JW, Lovald ST, Ong KL et al. Postoperative pain after primary total knee arthroplasty: comparison of local injection analgesic cocktails and the role of demographic and surgical factors. J Arthroplasty 2016; May 12. pii: S0883-5403(16)30136-X DOI: 10.1016/j.arth.2016.05.002.. [Epub ahead of print]
  • 7 Calatayud J, Casaña J, Ezzatvar Y et al. High-intensity preoperative training improves physical and functional recovery in the early postoperative periods after total knee arthroplasty: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2016 Jan 14. [Epub ahead of print]
  • 8 Bruun-Olsen V, Heiberg KE, Mengshoel AM. Continuous passive motion as an adjunct to active exercises in early rehabilitation following total knee arthroplasty – a randomized controlled trial. Disabil Rehabil 2009; 31: 277-283
  • 9 Brander V, Gondek S, Martin E et al. Pain and depression influence outcome 5 years after knee replacement surgery. Clin Orthop Relat Res 2007; 464: 21-26
  • 10 Ethgen O, Bruyere O, Richy F et al. Health related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am 2004; 86-A: 963-974
  • 11 Kennedy DM, Stratford PW, Hanna SE et al. Modeling early recovery of physical function following hip and knee arthroplasty. BMC Musculoskelet Disord 2006; 7: 100
  • 12 Walsh M, Woodhouse LJ, Thomas SG et al. Physical impairments and functional limitations: a comparison of individuals 1year after total knee arthroplasty with control subjects. Phys Ther 1998; 78: 248-258
  • 13 Cavill S, McKenzie K, Munro A et al. The effect of prehabilitation on the range of motion and functional outcomes in patients following the total knee or hip arthroplasty: A pilot randomized trial. Physiother Theory Pract 2016; 32: 262-270
  • 14 Bade MJ, Stevens-Lapsley JE. Early high-intensity rehabilitation following total knee arthroplasty improves outcomes. J Orthop Sports Phys Ther 2011; 41: 932-941
  • 15 Lenssen AF, Crijns YH, Waltje EM et al. Efficiency of immediate postoperative inpatient physical therapy following total knee arthroplasty: an RCT. BMC Musculoskelet Disord 2006; 7: 71
  • 16 Artz N, Elvers KT, Lowe CM et al. Effectiveness of physiotherapy exercise following total knee replacement: systematic review and meta-analysis. BMC Musculoskelet Disord 2015; 16: 15
  • 17 Gill SD, McBurney H. Does exercise reduce pain and improve physical function before hip or knee replacement surgery? A systematic review and meta-analysis of randomized controlled trials. Arch Phys Med Rehabil 2013; 94: 164-176
  • 18 Gallasch CH, Alexandre NM. The measurement of musculoskeletal pain intensity: a comparison of four methods. Rev Gaucha Enferm 2007; 28: 260-265
  • 19 Jensen MP, Karoly P. Self-report scales and procedures for assessing pain in adults. in Turk DC, Melzack R. (eds.). Handbook of Pain Assessment. New York, NY: Guilford Press; 2011. 3rd edn.. 19-44
  • 20 Hjermstad MJ, Fayers PM, Haugen DF et al. Studies comparing numerical rating scales, verbal rating scales, and visual analogue scales for assessment of pain intensity in adults: A systematic literature review. J Pain Symptom Manage 2011; 41: 1073-1093
  • 21 Watson CJ, Propps M, Ratner J et al. Reliability and responsiveness of the lower extremity functional scale and the anterior knee pain scale in patients with anterior knee pain. J Orthop Sports Phys Ther 2005; 35: 136-146
  • 22 Pua YH, Cowan SM, Wrigley TV et al. The lower extremity functional scale could be an alternative to the Western Ontario and McMaster Universities Osteoarthritis Index physical function scale. J Clin Epidemiol 2009; 62: 1103-1111
  • 23 Buker N, Akkaya S, Akkaya N et al. Comparison of effects of supervised physiotherapy and a standardized home program on functional status in patients with total knee arthroplasty: a prospective study. J Phys Ther Sci 2014; 26: 1531-1536
  • 24 Boeckstyns ME, Backer M. Reliability and validity of the evaluation of pain in patients with total knee replacement. Pain 1989; 38: 29-33
  • 25 Petterson SC, Mizner RL, Stevens JE et al. Improved function from progressive strengthening interventions after total knee arthroplasty: a randomized clinical trial with an imbedded prospective cohort. Arthritis Rheum 2009; 61: 174-183
  • 26 Bade MJ, Stevens-Lapsley JE. Restoration of physical function in patients following total knee arthroplasty: an update on rehabilitation practices. Curr Opin Rheumatol 2012; 24: 208-214
  • 27 Unver B, Ertekin O, Karatosun V. Pain fear of falling and stair climbing ability in patients with knee osteoarthritis before and after knee replacement: 6 month follow-up study. J Back Musculoskelet Rehabil 2014; 27: 77-84
  • 28 Heiberg KE, Bruun-Olsen V, Mengshoel AM. Pain and recovery of physical functioning nine months after total knee arthroplasty. J Rehabil Med 2010; 42: 614-619
  • 29 Vuorenmaa M, Ylinen J, Kiviranta I et al. Changes in pain and physical function during waiting time and 3 months after knee joint arthroplasty. J Rehabil Med 2008; 40: 570-575
  • 30 Topp R, Swank AM, Quesada PM et al. The effect of prehabilitation exercise on strength and functioning after total knee arthroplasty. PMR 2009; 1: 729-735
  • 31 Lenssen AF, de Bie RA. Role of physiotherapy in peri-operative management in total knee and hip surgery. Injury, Int J Care Injured 2006; 37S: S41-S43