Short and mid term outcome of total knee arthroplasty. The effect of rehabilitation

Abstract

Total knee arthroplasty (TKA) is the most common procedure performed for end stage osteoarthritis (OA) in older individuals. Current data from 21 European countries reveal that the annual incidence of TKA is 109 procedures per 100,000 persons, which is more than twice that reported in 1998 [1]. TKA reliably reduces pain and improves function in patients with knee OA and 90 % of patients report reduced pain, improved functional ability and greater health related quality of life after surgery [2]. Moreover, 85 % of patients who undergo TKA report being satisfied with the outcome [2]. Despite the well documented success of this procedure, patients continue to demonstrate physical impairment and functional limitations following TKA compared with individuals without knee disease [3]. One month after TKA quadriceps strength drops to 60 % of preoperative levels, even when traditional postoperative rehabilitation is initiated within 48 h after surgery [4, 5]. This quadriceps weakness persists years after surgery, based on comparisons with age-matched controls [6]. Similarly, functional performance is reported to worsen by 20-25 % 1 month after TKA [7] and reduced function persists with reports of 18 % slower walking speed and 51 % slower stair-climbing speed compared to age-matched controls at 12 months after TKA [3]. Despite these documented impairments and activity limitations, there is little evidence to support the introduction of structured rehabilitation to this population. In 2003, the National Institute of Health (NIH) concluded that “the use of rehabilitation services is perhaps the most understudied aspect of the perioperative management of TKA patients” and “there is no evidence supporting the generalized use of any specific preoperative or postoperative rehabilitation intervention” [2]. Currently, there is no universally accepted rehabilitation protocol for patients after TKA and rehabilitation paradigms are often institution or surgeon specific [8, 9]. © Springer-Verlag London 2015.