Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Early Progressive Rehabilitation Following Total Knee Arthroplasty Improves Outcomes.
J. Bade2, Michael, Struessel2, Tami, E. Stevens-Lapsley2, Jennifer
Although total knee arthroplasty (TKA) reliably reduces pain, research indicates that current rehabilitation methods do not adequately rehabilitate patients to the level of their healthy peers. The purpose of this study was to assess the initial efficacy of a progressive rehabilitation program (PROG) compared to a standard rehabilitation program (historical controls).
Eight patients (PROG group) undergoing a unilateral, primary TKA for end-stage osteoarthritis participated(65.3 ± 11.5 years; 5 women, 3 men). Patients were compared to a historical cohort of 37 patients (64.9 ± 8.6 years; 19 women, 18 men). Patients from both groups were excluded if they had uncontrolled hypertension, uncontrolled diabetes, body mass index >35 kg/m2, contralateral knee pain, other significant lower extremity orthopaedic problems, or neurological impairments.
Active range of motion (AROM) was measured by goniometry. Maximum isometric quadriceps strength was assessed using an electromechanical dynamometer and normalized to body weight. Activation was assessed using a doublet twitch interpolation technique. Functional performance was assessed using the 6-minute walk test (6MW), timed up and go test (TUG), and timed stair climbing test (SCT). All measures were assessed preoperatively, 1 month, 3 months, and 6 months after surgery.
The historical cohort completed a previously published standard rehabilitation program. The PROG group completed a rehabilitation program that differed in several key ways: a longer duration of treatment (12 weeks vs. 10 weeks); a higher frequency of treatment (28 vs. 18 sessions); the use of single-leg, machine-based resistive exercise; and an emphasis on higher level functional exercises (e.g. lunges, step-downs).
There were no differences in baseline demographics between groups (age, BMI or sex). Compared to historical controls at one month after surgery, the PROG group walked 78.3 m farther on the 6MW, were 3.5s faster on the TUG, were 10.1s faster on the SCT, demonstrated 57.4% greater quadriceps strength, and 17.4% better quadriceps activation. At 3 months, the PROG group walked 47.2 m further on the 6MW, were 1.4s faster on the TUG, were 1.9s faster on the SCT, demonstrated 33.9% greater quadriceps strength, and 7.8% better quadriceps activation than controls. At 6 months after surgery, the PROG group walked 67.0 m further on the 6MW, were 1.1s faster on the TUG,1.2s faster on the SCT, demonstrated 35.5% greater quadriceps strength, and 9.3% better quadriceps activation than controls. Although there were baseline differences on AROM, at 6 months the PROG group demonstrated better knee extension (-1.9° vs. 1.2°) and better flexion (120° vs. 113°).
A progressive program of rehabilitation which includes higher frequency, longer duration, and higher level of exercise leads to improved outcomes compared to a standard rehabilitation program. This higher intensity rehabilitation did not impair ROM and did not result in any increased incidence of injury.
2009 ACR REF/Abbot Health Professional Graduate Student Research Preceptorship, NIH K23AG029978
To cite this abstract, please use the following information:
J. Bade, Michael, Struessel, Tami, E. Stevens-Lapsley, Jennifer; Early Progressive Rehabilitation Following Total Knee Arthroplasty Improves Outcomes. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :171