ARTICLES
Pre-Surgical Physical Therapy in Patients Undergoing Total Knee Replacement
Total Knee Arthroplasty (TKA) is the preferred treatment for patients with end-stage knee osteoarthritis (OA), inflammatory arthritis, or osteonecrosis when pain and functional disability persist despite conservative treatments. Preoperative pain levels, physical fitness, and impairments are strong predictors of knee function after TKA. Better preoperative knee function and fitness contribute to a smoother and faster postoperative recovery.
Patients are often referred to physical therapy before surgery to complete pre-surgical rehabilitation aimed at reducing limitations and improving range of motion (ROM) and strength, which can enhance outcomes after surgery.
A systematic review examining the effects of pre-surgical rehabilitation found the following benefits in the preoperative period across eight trials:
- Strength improvements in 75% of studies
- Enhanced performance in functional tasks such as the Timed Up and Go (TUG) and Sit-to-Stand (STS) tests in 66%
- Increased range of motion in 50%
- Reduced pain levels in 66%
- Improved health-related quality of life (HRQOL) in 33%
No significant changes were noted in stair climbing or walking tests preoperatively. Postoperatively, six trials reported favorable short-term effects on knee function:
- One trial showed significant strength gains
- Two trials showed improvements in TUG and ROM
- One trial noted HRQOL improvements
- Two trials demonstrated reduced pain levels
These benefits were observed up to three months after TKA, supporting improved recovery. While these short- and mid-term benefits are promising, evidence on long-term maintenance remains limited and of low to very low certainty.
Both clinicians and patients may consider prehabilitation as a valuable strategy to enhance short- and mid-term recovery following total knee replacement.
Reference:
Granicher, Pascale, et al. Prehabilitation Improves Knee Functioning Before and Within the First Year After Total Knee Arthroplasty: A Systematic Review with Meta-analysis. Journal of Orthopaedic and Sports Physical Therapy, Vol. 52, No. 11, 2022.
Physical therapist performing knee mobilizations.
Physical therapist providing manual therapy to improve knee flexion range of motion.
Physical therapist teaching a squat to improve knee mobility and strength.
Related Articles
A Patient with Lumbar Spinal Stenosis – A Case Report
The patient presents with a 20-year history of intermittent low back pain, which has gradually worsened over the past four months to include sharp, radiating pain down both legs to the toes. Radicular symptoms are slightly worse on the right side. Symptoms are aggravated by standing and walking, while sitting provides complete relief of leg pain.
Nutrition Needs for Concussions
Ouch! Ever get hit too hard during a sports practice or game and hurt your head? Many contact sports, such as lacrosse, football, or soccer, have higher incidences of concussions. These concussions are classified as mild traumatic brain injuries. A concussion occurs due to a hit or blow to the head, where the brain is rocked back and forth in the skull. Due to this movement, nerve cells in the brain need to work harder to recover, therefore using up more energy. Concussions can also lead to increased inflammation and stress in the body.
Vestibular Case Report
The patient reported experiencing increased dizziness following a recent sinus infection. Initially, she had a few days of congestion, after which the dizziness began.