Pedaling-Based Protocol Superior to a 10-Exercise, Non-Pedaling Protocol for Postoperative Rehabilitation After Total Knee Replacement

Abstract

Background: Despite Total Knee Replacement (TKR) patients routinely receiving physical therapy in the immediate and early post-operative phase, there is a paucity of research into the optimal exercise protocols in both the acute inpatient setting and early period after discharge. The acute period after TKR has become increasingly important for post-operative rehabilitation as average length of stay (LOS) rates decline worldwide. Pedaling has often been recommended by clinicians after TKR for rehabilitation, but to our knowledge, there has been no investigation into its utility in the acute post-operative setting. Therefore, we performed a randomized controlled trial evaluating the efficacy of pedaling in the acute postoperative period. Methods: Sixty TKR patients were randomized into either a three exercise pedaling (Pedaling-based) or ten exercise non-pedaling (Multi-exercise) physical therapy postoperative protocol. Outcomes were assessed at 2 days, 2 weeks and 4 months, and included physical tests of function, patient reported outcomes, and other perioperative measures. Results: The primary outcome, the Six Minute Walk Test (6MWT), was significantly greater in the Pedaling-based group than the Multi-exercise group at 2 days post-operatively (mean difference 66 meters, p = .001). Other functional tests, the 10-meter walk speed (10MWT) and the Timed Up and Go (TUG) test, were both significantly superior in the three exercise pedaling group at 2 days (10MWT p = .016; TUG p = .020) as was the patient reported Oxford Knee Score (OKS) (p = .034). The OKS, continued to be superior at 2 weeks (p = .007), and the VAS score was significantly better for the Pedaling-based group at all timepoints assessed. Length of stay was also significantly shorter by a half day, for the

Cycle Sprint Test for the Evaluation of Lower Limb Muscle Power After Total Knee Arthroplasty: A Proof-of-Concept Study

“…Stationery cycling is recommended and widely used in rehabilitation after TKA which has been the stimulus for the development of a cycle muscle power test [ 11 ]. This has been facilitated by the availability of power meter cranks and pedals which can be fitted to a road bicycle or spin bike.…”

Reporting of post-operative rehabilitation interventions for Total knee arthroplasty: a scoping review

“…There were 64 (57%) studies that had mentioned exercise adherence within their study [ 18 , 19 , 22 – 24 , 27 , 29 , 31 , 33 , 34 , 36 – 38 , 42 – 47 , 50 , 53 , 54 , 58 , 59 , 63 , 65 – 69 , 73 , 74 , 78 , 79 , 82 – 84 , 86 , 90 – 93 , 96 – 100 , 102 – 104 , 107 – 109 , 111 , 112 , 114 , 117 , 118 , 121 , 123 , 126 , 127 , 129 , 131 ]. Of these studies only 41 (65%) reported sufficient information (e.g.…”

“…Of these studies only 41 (65%) reported sufficient information (e.g. measurement used and outcome) to assess exercise adherence [ 19 , 22 , 31 , 33 , 34 , 36 , 38 , 42 – 45 , 53 , 58 , 66 – 68 , 74 , 78 , 79 , 82 , 83 , 86 , 90 – 93 , 96 – 98 , 102 – 104 , 107 – 109 , 112 , 114 , 117 , 123 , 126 , 127 ]. There were 15 studies that had a pre-defined cut-off for exercise adherence (see Table 1 ).…”

Changes to rehabilitation after total knee replacement

“…The most effective physiotherapy exercise protocol during the acute hospital stay is based on restoring safe functional mobility and performing exercises with a focus on increasing knee range-of-motion such as bike pedalling (Figures 1-3). 30 In 2019, a randomised controlled trial investigated early exercise therapy protocols after TKR surgery and was published in the Journal of Bone and Joint Surgery. It showed that a simple self-directed, low-cost, three-exercise bike pedalling-based protocol was superior to a therapist-led standard multi-exercise regimen, for both functional and patientreported outcomes.…”

“…It showed that a simple self-directed, low-cost, three-exercise bike pedalling-based protocol was superior to a therapist-led standard multi-exercise regimen, for both functional and patientreported outcomes. 30 Based on the results of this trial, patients who have had a TKR can complete a few simple home-based exercises -focusing on bike pedalling, knee extension and heel-toe walking practice -for the first two weeks following their knee surgery and expect optimal outcomes. Following this early recovery , patients yet to gain 90-degree knee flexion or those who are having difficulty progressing with their mobility may benefit from some supervised physiotherapy treatment, with no significant difference shown between patients supervised in the home or outpatient setting.…”