Evaluation of a Custom Device for the Treatment of Flexion Contractures after Total Knee Arthroplasty

McGrath, Mike; Mont, Michael A.; Siddiqui, Junaed A.; Baker, Erin A.; Bhave, Anil

doi:10.1007/s11999-009-0804-z

Cited by 27 publications

(22 citation statements)

References 34 publications

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“…Goals should include an emphasis on improvement of functional independence and mobility, normalization of gait mechanics, pain reduction, and attainment of early ROM. 21,22,33 We agree with the research by Ebert et al 119 that suggests active knee flexion of 80 degrees at the initial outpatient visit (1-2 weeks post-TKA) is strongly correlated with active knee flexion of 110 degrees at 7 to 8 weeks after TKA. The achievement of 110 degrees of knee flexion has been shown to provide a satisfactory function for most patients to complete most activities of daily living.…”

Section: Recommendationssupporting

confidence: 89%

“…[28][29][30] Knee flexion contractures resulting in ROM reduction occur in 1 to 15% of primary TKA patients and can cause significant functional limitations. 31,32 In a study conducted at the author's institution, 33 47 patients with knee flexion contractures (mean, 22 degrees; range, 10-40 degrees) after primary or revision TKA were treated with a custom knee device in supervised therapy sessions. After a mean treatment time of 9 weeks (range, 6-16 weeks), 27 of 29 patients who received primary TKAs achieved full extension, which was preserved at an 18-month follow-up.…”

Section: Exercise Therapymentioning

confidence: 99%

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Rehabilitative Guidelines after Total Knee Arthroplasty: A Review

et al. 2016

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Rehabilitation following total knee arthroplasty (TKA) continues to pose a challenge for both patients and providers. In addition, guidelines vary considerably between institutions, which often leave therapy regimens to the discretion of the provider. The lack of clear guidelines for rehabilitation may contribute to inadequate recovery of strength and range-of-motion, resulting in less optimal functional outcomes. Therefore, the aim of this review was to highlight and discuss a variety of post-TKA rehabilitative modalities currently available and to provide evidence regarding efficacy and practicality. Specifically, we assessed the role of and evidence for exercise therapy, aquatic therapy, balance training, continuous passive motion, cold therapy and compression, neuromuscular electrical stimulation, transcutaneous electrical nerve stimulation, and instrument-assisted soft-tissue therapy. Additionally, we proposed general recommendations for rehabilitation after TKA, and as we specifically described active and obese patients, we have included guidelines for these subsets as well. Our review examines the various rehabilitative modalities to offer suggestions for recovery of strength and range-of-motion after TKA, with a focus on the early incorporation of exercise therapy, balance training, aquatic therapy, cryopneumatic therapy, neuromuscular electrical stimulation, and transcutaneous electrical nerve stimulation. Dedication and commitment to rehabilitation may help patients attain and exceed their preoperative activity levels.

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Section: Recommendationssupporting

confidence: 89%

Section: Exercise Therapymentioning

confidence: 99%

Rehabilitative Guidelines after Total Knee Arthroplasty: A Review

et al. 2016

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“…30,43 If full extension is not achieved by week 2, low-load long-duration stretching techniques, such as prone hangs (FIGURE 1) or bag hangs, are needed to effectively restore full knee extension. 55,61 …”

Section: Isolated Acl Reconstructionmentioning

confidence: 99%

Current Concepts for Anterior Cruciate Ligament Reconstruction: A Criterion-Based Rehabilitation Progression

Adams¹,

Logerstedt²,

Hunter‐Giordano³

et al. 2012

Journal of Orthopaedic & Sports Physical Therapy

428

409

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SYNOPSIS The management of patients after anterior cruciate ligament reconstruction should be evidence based. Since our original published guidelines in 1996, successful outcomes have been consistently achieved with the rehabilitation principles of early weight bearing, using a combination of weight-bearing and non–weight-bearing exercise focused on quadriceps and lower extremity strength, and meeting specific objective requirements for return to activity. As rehabilitative evidence and surgical technology and procedures have progressed, the original guidelines should be revisited to ensure that the most up-to-date evidence is guiding rehabilitative care. Emerging evidence on rehabilitative interventions and advancements in concomitant surgeries, including those addressing chondral and meniscal injuries, continues to grow and greatly affect the rehabilitative care of patients with anterior cruciate ligament reconstruction. The aim of this article is to update previously published rehabilitation guidelines, using the most recent research to reflect the most current evidence for management of patients after anterior cruciate ligament reconstruction. The focus will be on current concepts in rehabilitation interventions and modifications needed for concomitant surgery and pathology.

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“…Furthermore, case series [28,29] and small trials [30] are available demonstrating that in patients before and following a TKA, rehabilitation interventions – for example, such as manual therapy and splinting – increased knee ROM and improved physical function. Overall, our large study using longitudinal change scores extends the previous literature to suggest that knee extension ROM is an important correlate of physical function in TKA.…”

Section: Discussionmentioning

confidence: 99%

Knee extension range of motion and self-report physical function in total knee arthroplasty: mediating effects of knee extensor strength

Pua

Ong

Chong

et al. 2013

BMC Musculoskelet Disord

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BackgroundKnee extensor strength and knee extension range of motion (ROM) are important predictors of physical function in patients with a total knee arthroplasty (TKA). However, the relationship between the two knee measures remains unclear. The purpose of this study was to examine whether changes in knee extensor strength mediate the association between changes in knee extension ROM and self-report physical function.MethodsData from 441 patients with a TKA were collected preoperatively and 6 months postoperatively. Self-report measure of physical function was assessed by the Short Form 36 (SF-36) questionnaire. Knee extensor strength was measured by handheld dynamometry and knee extension ROM by goniometry. A bootstrapped cross product of coefficients approach was used to evaluate mediation effects.ResultsMediation analyses, adjusted for clinicodemographic measures, revealed that the association between changes in knee extension ROM and SF-36 physical function was mediated by changes in knee extensor strength.ConclusionsIn patients with TKA, knee extensor strength mediated the influence of knee extension ROM on physical function. These results suggest that interventions to improve the range of knee extension may be useful in improving knee extensor performance.

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Evaluation of a Custom Device for the Treatment of Flexion Contractures after Total Knee Arthroplasty

Cited by 27 publications

References 34 publications

Rehabilitative Guidelines after Total Knee Arthroplasty: A Review

Rehabilitative Guidelines after Total Knee Arthroplasty: A Review

Current Concepts for Anterior Cruciate Ligament Reconstruction: A Criterion-Based Rehabilitation Progression

Knee extension range of motion and self-report physical function in total knee arthroplasty: mediating effects of knee extensor strength

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