Early post-operative physiotherapy rehabilitation after primary unilateral unicompartmental knee replacement: a systematic review

Abstract

BackgroundUnicompartmental Knee Replacement (UKR) is an established treatment for end stage arthritis affecting one compartment of the knee. UKR lends itself to rapid recovery and early discharge. The content, type, timing and dose of early post-operative physiotherapy treatment has yet to be reviewed. ObjectiveTo review the content of early physiotherapy in the first eight weeks following unilateral UKR. Data sourcesA literature search of Medline, CINAHL, AMED and PubMed and the Physiotherapy Evidence Database (PEDRo) plus citation searching. Eligibility criteriaRandomised controlled trials (RCTs) and observational studies reporting a physiotherapy intervention for UKR involving a form of post-operative exercise/education/advice delivered within the first eight weeks of surgery and commencing as an in-patient. Two reviewers independently performed screening, data extraction and risk of bias assessment. Data synthesisNarrative syntheses were undertaken due to the heterogeneity of the primary outcomes. ResultsEleven studies were included (n = 1293 participants), three RCTs and eight observational studies. The dose and content of post-operative physiotherapy was highly variable with a move in recent years to rapid recovery and same day discharge with more self-directed rehabilitation. No studies had a low risk of bias. LimitationsSmall sample sizes and high heterogeneity limit our findings ConclusionsThis review highlights the range of post-operative physiotherapy provision following UKR with a recent move to minimal physiotherapy input. Further research is required to identify those patients who may need additional physiotherapy above that now routinely provided, along with the most effective timing, type, and dosage of the intervention. Systematic review registration numberPROSPERO CRD42021243238. Contribution of the Paper•Early physiotherapy to regain knee ROM should be performed within a comfortable range to reduce pain and facilitate rapid mobilisation.•Regaining flexion is rarely problematic following UKR.•Enhanced recovery and same day discharge after UKR is now commonplace.•A recent move to self-directed physiotherapy has been successful.