Rehabilitation after Total Knee Replacement (TKR) is typically considered essential after surgery. Most surgeons, physio’s and allied health professionals would agree that the earlier you start moving the knee and commence strengthening, the better. One of the key goals, and often most worried about part of the rehabilitation is getting the bend (or range of motion) back into the knee after surgery.So what rehabilitation program currently available in the community have been evaluated in the research, and how do they compare.
Han et al (2014) investigated the first 6 weeks of rehabilitation comparing a usual care approach, versus a structured home exercise program. In this instance, usual care was defined as essentially surgeon recommendations, at an early follow-up, certainly nothing structured, or explicitly prescribed. The home exercise program group received a strict home-based exercise program, with exercises involving 10 repetitions, 3 times per day, with weekly phone calls to patients ensuring they were compliant with their exercises.
The results showed a small improvement in knee range of motion for the more structured, home-based program at 97 deg of flexion. We then compared these results to a sample of 200 patients who attended HFRC following knee replacement over the same period.
The figure below shows the mean knee ROM of our patients at HFRC, following TKR who received supervised therapy by an Exercise Physiologist, 2 to 3 times per week achieved 108° after the 6 weeks of therapy. That’s a 10 deg difference, which is often the difference between you being able to use the stairs or ride a bike.
Figure 1. The mean knee ROM progression for patients up to 7 weeks post TKA.
Why are our results at HFRC so much better?
HFRC has been specially designed and equipped to provide you with the optimal outcome following orthopaedic surgery. Through our continual involvement in cutting-edge research and specialised equipment, we can provide accelerated recovery following surgery. Some of our keys to success are:
Early Passive & Active-assisted ROM – We have developed techniques to allow you to begin effective early movement of the joint through a pain-free range of motions whilst continually improving your knee movement. This is combined with sessions on the CPM (continuous passive motion) machine, and lymphatic drainage techniques to reduce post-operative swelling, which reduces pain and improves movement.
Early neuromuscular stimulation – Following surgery, the pain and swelling in your knee inhibits the contraction of the Quadriceps muscle. This muscle is key to good knee function. Without specific training, this muscle inhibition can remain and slow your progress. To accelerate the return of the Quadriceps muscle activation and strength, we use early neuromuscular stimulation to kick-start the muscle, and accelerate its return to full activity. This subsequently accelerates your return to good knee function.
Early “modified” recumbent cycling - Regular recumbent bikes typically require between 100 and 110 degrees of knee flexion to fulfil a full pedal revolution. The unique modified orthopaedic bikes at HFRC reduce this knee flexion barrier to 90 degrees (a hospital discharge requirement after knee surgery), allowing patients with limited knee range of motion to get back on the bike earlier and more comfortably than traditional upright or recumbent bike, accelerating recovery and rehabilitation. It has been shown, that similar muscle synergies are present in recumbent cycling to those activities such as sit-to-stands, step-ups and normal gait. Therefore, recumbent cycling is recommended as an early rehabilitation tool, especially in the early stages of rehabilitation when an individual is unable to perform functional tasks.
These treatment options are not available in the usual care of home-based environments, which is one of the key reason why patients, and you, will receive a greater outcome from your joint replacement when conducting your rehabilitation at HFRC. Your outcome could be further advanced by participating in HFRC pre-surgery program, to get you in the best physical shape for surgery. To find out more, contact us through our website www.hfrc.com.au
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