Total Knee Replacement - Which Therapy?

How much and what type of therapy should patients have after total knee replacement? Recent research has shed some light on this difficult question.

Researchers in the UK at the University of Birmingham searched the medical literature for evidence of which kind of exercise was most helpful post-operatively. The results are provisional at best but give some pointers.

The management of knee replacement has changed greatly over the last 10 years. The length of stay in hospital has rapidly and greatly decreased, with a common stay of 4 to 5 days. This has transferred much of the rehabilitation effort to outside hospital units.

The researchers found there was some evidence to support the performance of functional exercises (e.g. balance, coordination, stair climbing, cycling) over just performing static strengthening and range of motion exercises.

At 3 to 4 months after surgery there was a small but useful advantage in doing the functional exercises, but at a year this advantage had disappeared.

I think this means that performing functional exercises may get you back towards normal function a little quicker than not doing them, but that in the long term it does not matter much.

The bigger question remains. Should there be much extensive and intensive therapy after knee replacement to address the obvious limitations in strength, range and abilities after this major orthopaedic surgery?

Reference: Lowe CJ et al. Effectiveness of physiotherapy exercise after knee arthroplasty for osteoarthritis: systematic review and meta-analysis of randomised controlled trials. BMJ (British Medical Journal) 2007, September 20.