Benefits of direct patient discharge to outpatient physical therapy after total knee arthroplasty

Christensen, Jesse C.; Paxton, Roger; Baym, Carol; Forster, Jeri E.; Dayton, Michael R.; Hogan, Craig; Stevens‐Lapsley, Jennifer E.

doi:10.1080/09638288.2018.1505968

Cited by 7 publications

(4 citation statements)

References 45 publications

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“…The outcomes of TKA are pain relief and improved range of motion and function of the knee. Rehabilitation training is necessary following TKA [ 10 , 11 ] to prevent joint contracture, deep vein thrombosis (Reviewer #1 point 7) or hypostatic pneumonia. The tension is distributed uniformly along the entire incision in running subcuticular closure, whereas that in the intermittent closure method is restricted to the elevated stitch compared to the region between consecutive stitches.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcome of different skin closure in total-knee arthroplasty: running subcuticular closure vs intermittent closure

et al. 2020

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An intermittent closure with silk suture is routinely used for closing different surgical wounds. However, subcuticular closure with absorbable sutures has gained considerable attention due to convenience and better cosmetic appearance. To compare the clinical outcomes and risk of surgical-site infection of subcuticular and intermittent closure after total-knee arthroplasty (TKA), 106 patients that underwent TKA between January 2017 to June 2019 at the Department of Orthopedics in Xiangya Hospital of Centre South University were retrospectively assessed. Forty-three had received running subcuticular closure (group A) and 58 underwent intermittent closure (group B). The Knee Society score was measured before and 6 months after operation. Inflammation markers including the serum levels of procalcitonin, interleukin-6, and C-reactive protein, and the erythrocyte sedimentation rate were evaluated before operation, 1 day after and 1 month after operation. Patient satisfaction with the closure was evaluated using the Likert scale at the last follow-up. No significant difference was seen in the 6-month postoperative Knee Society score, or in the 1-day and 6-month postoperative inflammation marker levels between both groups ( P > .05). Likert scores were higher in group A compared to group B (4.0 ± 1.0 vs 3.6 ± 1.2, P < .05). Running subcuticular closure after TKA results in a better appearance compared to intermittent closure, although neither method has an advantage in terms of efficacy and risk of infection.

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Section: Discussionmentioning

confidence: 99%

Clinical outcome of different skin closure in total-knee arthroplasty: running subcuticular closure vs intermittent closure

et al. 2020

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“…6 While most patients experience improvements in pain after TKA or THA, deficits in functional performance and strength commonly persist a year after surgery for many patients. [7][8][9][10] Physical rehabilitation is commonly offered to patients undergoing either TKA or THA with the goal of optimizing postoperative outcomes, including strength, physical function, pain reduction, and return to normal activities of daily living (ADLs). Increasingly, "prehabilitation" (i.e., rehabilitation services provided before surgery) is considered by patients, providers, and health systems as a potential approach to maximize patients' functional status before surgery to improve postoperative outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…While most patients experience improvements in pain after TKA or THA, deficits in functional performance and strength commonly persist a year after surgery for many patients 7–10 . Physical rehabilitation is commonly offered to patients undergoing either TKA or THA with the goal of optimizing postoperative outcomes, including strength, physical function, pain reduction, and return to normal activities of daily living (ADLs).…”

Section: Introductionmentioning

confidence: 99%

Prehabilitation for Total Knee or Total Hip Arthroplasty: A Systematic Review

Konnyu

Thoma

Cao

et al. 2022

Am J Phys Med Rehabil

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We sought to systematically review the evidence on the benefits and harms of prehabilitation interventions for patients who are scheduled to undergo elective, unilateral total knee arthroplasty or total hip arthroplasty surgery for the treatment of primary osteoarthritis. We searched PubMed, Embase, The Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, Scopus, and ClinicalTrials.gov from January 1, 2005, through May 3, 2021. We selected for inclusion randomized controlled trials and adequately adjusted nonrandomized comparative studies of prehabilitation programs reporting performancebased, patient-reported, or healthcare utilization outcomes. Three researchers extracted study data and assessed risk of bias, verified by an independent researcher. Experts in rehabilitation content and complex interventions independently coded rehabilitation interventions. The team assessed strength of evidence. While large heterogeneity across evaluated prehabilitation programs limited strong conclusions, evidence from 13 total knee arthroplasty randomized controlled trials suggest that prehabilitation may result in increased strength and reduced length of stay and may not lead to increased harms but may be comparable in terms of pain, range of motion, and activities of daily living (all low strength of evidence). There was no evidence or insufficient evidence for all other outcomes after total knee arthroplasty. Although there were six total hip arthroplasty randomized controlled trials, there was no evidence or insufficient evidence for all total hip arthroplasty outcomes.

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“…In addition, hospital physiotherapists supervise active home exercises to improve knee range of motion, muscle strength, and weight-bearing while walking. High-intensity outpatient physical therapy directly after discharge improves the functional performance of patients who had undergone TKR [ 11 ]. Nonetheless, rehabilitation after discharge is mainly the patient’s responsibility.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Gamification in Knee Replacement Rehabilitation: Protocol for a Randomized Controlled Trial With a Qualitative Approach

Aartolahti¹,

Janhunen²,

Katajapuu³

et al. 2022

JMIR Res Protoc

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Background Exergames can provide encouraging exercise options. Currently, there is limited evidence regarding home-based exergaming in the postoperative phase of total knee replacement (TKR). Objective This study aimed to investigate the effects of a 4-month postoperative home-based exergame intervention with an 8-month follow-up on physical function and symptoms among older persons undergoing TKR compared with home exercise using a standard protocol. In addition, a concurrent embedded design of a mixed methods study was used by including a qualitative component within a quantitative study of exergame effects. Methods This was a dual-center, nonblinded, two-arm, parallel group randomized controlled trial with an embedded qualitative approach. This study aimed to recruit 100 patients who underwent their first unilateral TKR (aged 60-75 years). Participants were randomized to the exergame or standard home exercise arms. Participants followed a custom-made exergame program independently at their homes daily for 4 months. The primary outcomes at 4 months were function and pain related to the knee using the Oxford Knee Score questionnaire and mobility using the Timed Up and Go test. Other outcomes, in addition to physical function, symptoms, and disability, were game user experience, exercise adherence, physical activity, and satisfaction with the operated knee. Assessments were performed at the preoperative baseline and at 2, 4, and 12 months postoperatively. Exergame adherence was followed from game computers and using a structured diary. Self-reported standard exercise was followed for 4 months of intervention and physical activity was followed for 12 months using a structured diary. Qualitative data on patients’ perspectives on rehabilitation and exergames were collected through laddering interviews at 4 and 12 months. Results This study was funded in 2018. Data collection began in 2019 and was completed in January 2022. The COVID-19 pandemic caused an unavoidable situation in the study for recruitment, data collection, and statistical analysis. As of November 2020, a total of 52 participants had been enrolled in the study. Primary results are expected to be published by the end of 2022. Conclusions Our study provides new knowledge on the effects of postoperative exergame intervention among older patients with TKR. In addition, this study provides a new understanding of gamified postoperative rehabilitation, home exercise adherence, physical function, and physical activity among older adults undergoing TKR. Trial Registration ClinicalTrials.gov NCT03717727; https://clinicaltrials.gov/ct2/show/NCT03717727 International Registered Report Identifier (IRRID) RR1-10.2196/38434

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Benefits of direct patient discharge to outpatient physical therapy after total knee arthroplasty

Cited by 7 publications

References 45 publications

Clinical outcome of different skin closure in total-knee arthroplasty: running subcuticular closure vs intermittent closure

Clinical outcome of different skin closure in total-knee arthroplasty: running subcuticular closure vs intermittent closure

Prehabilitation for Total Knee or Total Hip Arthroplasty: A Systematic Review

Effectiveness of Gamification in Knee Replacement Rehabilitation: Protocol for a Randomized Controlled Trial With a Qualitative Approach

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