What is the effect of supervised rehabilitation regime vs. self-management instruction following unicompartmental knee arthroplasty? – a pilot study in two cohorts

Abstract

Purpose The optimal rehabilitation strategy after a unicompartmental knee arthroplasty (UKA) is unclear. This study aims to compare the effect of transitioning from a supervised to a self-management rehabilitation regime by pilot study of patient outcomes subsequent to UKA surgery. Methods Fifty consecutive patients scheduled to undergo unilateral UKA surgery at our institution between 22nd February 2016 and 18thof January 2017 were prospectively identified via local medical database and included. Performed UKAs were grouped into two cohorts, Supervised Cohort and Self-management Cohort, temporally separated by introduction of new rehabilitation. Self-management Cohort(n = 25) received an extensive inpatient rehabilitation regime along with outpatient referral to rehabilitation center. The Self-management Cohort(n = 25) were only instructed in use of crutches and free ambulation at own accord. Follow-up (F/U) was 1 year from receiving UKA. A range of outcomes were recorded, and between-cohort differences compared: knee joint range of motion, pain and functional limitations, length of stay (LOS), readmission rate, pain during activity and rest, and knee circumference. Results Complete data was obtained for n = 45 patients. The mean between-cohort difference in ROM (range of motion) from preoperatively to discharge was 15.4 degrees (CI:5.2,25.8, p = 0.004), favoring the supervised regime, with no difference detected in any outcome at 3- or 12 months F/U. Median LOS was 1 day in both cohorts. Conclusion Transition to a simple rehabilitation regime following UKA surgery was associated with decreased ROM at discharge, which was not present at 3-month F/U. We found no other between-cohort differences for any other outcomes at 3- and 12-month F/U including functional limitations, although the study was likely underpowered for these outcomes. We encourage large-scale replication of these findings using randomized designs. Level of evidence Therapeutic level II

On the generalizability of same-day partial knee replacement surgery—A non-selective interventional study evaluating efficacy, patient satisfaction, and safety in a public hospital setting

“…Plausible explanations for the comparably high percentages found in the current study may include a total confidence in the logistics, the preoperative multidisciplinary effort to thoroughly inform each patient about the SDD procedure, and a continued optimization of the perioperative multimodal pain management–all equally important for minimizing the physical and psychological stress that are associated with PONV symptoms [ 3 , 36 , 40 , 41 ]. Other factors may include the protocol´s advice against early knee flexion [ 20 , 21 ] and a desire for operations under general anesthesia [ 41 ], which may have further reduced the risk of pain, fatigue, swelling, and wound leakage as well as increased the chance of early mobilization right after surgery.…”

“…To further optimize the perioperative JRS pathway, with potential gains in both satisfaction [ 2 ] and costs [ 2 , 13 , 14 ], the minor PKR procedure seems the natural candidate when aiming to investigate whether SDD may be more easily repeatable. One deviation from current practice, which traditionally includes prompt commencement of knee flexion, was highlighted in two recently published articles on PKR procedures where delayed flexion [ 20 ] or even absence of supervised physiotherapy (other than to facilitate safe walking with crutches) [ 21 ] were evaluated. Neither study found any negative effect on range of motion, even in the short-term perspective.…”