Functional Problems and Treatment Solutions After Total Hip and Knee Joint Arthroplasty

Abstract

A lthough most patients who undergo total hip or knee joint arthroplasty have an excellent clinical result with routine postoperative interventions, substantial dysfunction develops in 15% to 20% of patients for various reasons1. These patients do not respond to standard physical therapy modalities and need a very aggressive regimen of management that may include both invasive and noninvasive therapeutic options. The purpose of this study was to identify these patients with functional limitations and to assess the results of treatment with a customized regimen. We defined soft-tissue problems as those not directly related to the implant. Implant-related problems due to malalignment or loosening were ruled out radiographically or by specialized testing by two of the authors (M.M. and G.E.). We identified several functional problems following total hip arthroplasty and total knee arthroplasty that were related to muscle weakness, muscle tightness, limb-length differences, and nerve problems (Table I). View this table: TABLE I Problems Following Total Hip and Knee Arthroplasty After identification of the problems, management was initiated with either noninvasive treatment such as physical therapy, customized bracing, electrical stimulation, or iontophoresis or with invasive treatment such as injections of Botox (botulinum toxin type A; Allergan, Irvine, California), intraarticular injections, nerve blocks, or muscle-lengthening procedures. For patients exhibiting joint stiffness, a lack of extension, or a lack of flexion (<90°) following total knee arthroplasty, we developed a special customized protocol utilizing a customized hinged cast and adjunctive physical therapy. We identified problems with the soft-tissue envelope that were directly related to the joint in the majority of patients. In addition, some patients had problems affecting an adjacent joint that resulted in poor gait and function, such as malalignment of the knee joint in a patient who had had a total hip arthroplasty or malalignment of the foot in a patient who had had …