Early Rehabilitation After Total Knee Replacement Surgery: A Multicenter, Noninferiority, Randomized Clinical Trial Comparing a Home Exercise Program With Usual Outpatient Care

Abstract

Objective. To determine, at 6 weeks postsurgery, if a monitored home exercise program (HEP) is not inferior to usual care rehabilitation for patients undergoing primary unilateral total knee replacement (TKR) surgery for osteoarthritis. Methods. We conducted a multicenter, randomized clinical trial. Patients ages 45-75 years were allocated at the time of hospital discharge to usual care rehabilitation (n ‫؍‬ 196) or the HEP (n ‫؍‬ 194). Outcomes assessed 6 weeks after surgery included the Western Ontario and McMaster Universities Osteoarthritis Index pain and physical function subscales, knee range of motion, and the 50-foot walk time. The upper bound of the 95% confidence interval (95% CI) mean difference favoring usual care was used to determine noninferiority. Results. At 6 weeks after surgery there were no significant differences between usual care and HEP, respectively, for pain (7.4 and 7.2; 95% CI mean difference [MD] ؊0.7, 0.9), physical function (22.5 and 22.4; 95% CI MD ؊2.5, 2.6), knee flexion (96°and 97°; 95% CI MD ؊4°, 2°), knee extension (؊7°and ؊6°; 95% CI MD ؊2°, 1°), or the 50-foot walk time (12.9 and 12.9 seconds; 95% CI MD ؊0.8, 0.7 seconds). At 6 weeks, 18 patients (9%) allocated to usual care and 11 (6%) to the HEP did not achieve 80°knee flexion. There was no difference between the treatment allocations in the number of hospital readmissions. Conclusion. The HEP was not inferior to usual care as an early rehabilitation protocol after primary TKR.

Self‐Reported Knee Instability Before and After Total Knee Replacement Surgery

“…Age, sex, height, and weight were determined, and participants were required to complete the Self-Administered Comorbidity Questionnaire (9). For each of 12 common conditions, participants were asked whether they had the condition and received treatment for it, and whether the condition caused limitation in function.…”

“…Exclusion criteria were previous unicompartmental replacement or tibial osteotomy on the same knee, previous lower-limb joint replacement surgery within the last 6 months, anticipation of other lowerlimb joint replacement surgery in the next 12 months, comorbidity that precluded exercise at 50-60% maximum heart rate, rheumatoid arthritis, major neurologic conditions, and inability to return to a participation site for the intensive exercise classes (9). For the purpose of the present analysis, data from participants undergoing bilateral TKR were excluded.…”

“…The MARKER study was a randomized clinical trial comparing usual postacute rehabilitation care with an intensive 2-3-month exercise program after TKR (9). As this was a multicenter study, ethics approval was obtained through the Australian National Ethics Application Form with Royal Prince Alfred Hospital, Camperdown, New South Wales, as the primary clinical center.…”

“…Participants of the Maximum Recovery After Knee Replacement (MARKER) study were recruited between September 2009 and October 2012, from 12 large public and private hospitals in New South Wales, Queensland, and Victoria, Australia (9). The MARKER study was a randomized clinical trial comparing usual postacute rehabilitation care with an intensive 2-3-month exercise program after TKR (9).…”

Effects of exercise on physical limitations and fatigue in rheumatic diseases

“…Moreover, the training should be gradually changed, according to the improvement of the patients to facilitate the more complex activities of daily living, and also in the late stages when the patients return to work [58] . In addition to the exercises performed during the subacute and chronic stages, shoulder, wrist, hand, hip and knee joint exercises (flexion and extension), full abduction, extension and flexion exercises for abdominal, sacrospinal, iliopsoas, gluteus maximus, gluteus minimus, hamstring, and quadriceps muscles, and resistive exercises for oblique abdominal muscles are recommended to be performed at home [59] . Exercises to increase respiratory capacity are continued.…”