Home physiotherapy with vs. without supervision of physiotherapist for assessing\xa0manipulation under anaesthesia after total knee arthroplasty

Sanjay Bhalchandra Londhe,Kavita Subhedar,Prashant Mukkannavar,Krishnan Iyengar,Shubhankar Sanjay Londhe,Ravi Vinod Shah,Amit Pankaj Doshi

doi:10.1186/s42836-020-00063-3

Sanjay Bhalchandra Londhe, Kavita Subhedar + Show 5 more

Open Access

https://doi.org/10.1186/s42836-020-00063-3

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Abstract

The aim of this retrospective cohort study was to compare home physiotherapy with or without supervision of physiotherapist for assessing manipulation under anaesthesia after total knee arthroplasty.MethodsA total of 900 patients (including 810 females and 90 males) who had undergone total knee arthroplasty were divided into group A (n = 300) and group B (n = 600). Patients in group A had home physiotherapy on their own after discharge from hospital. The physiotherapist did not visit them at home. Patients in group B received home physiotherapy under supervision of physiotherapist for 6 weeks after discharge from hospital. Patients’ age, range of motion of the knee, and forgotten joint score-12 were assessed. A p < 0.05 was considered statistically significant.ResultsIn group A, the mean age was 69.1 ± 14.3 years (range: 58 to 82 years); in group B, the mean age was 66.5 ± 15.7 years (range: 56 to 83 years) (p > 0.05). Preoperatively, the mean range of motion of the knee in group A and B was 95.8° ± 18.1° and 95.4° ± 17.8°, respectively (p > 0.05). The mean forgotten joint score-12 of group A and B were 11.90 ± 11.3 and 11.72 ± 12.1 (p > 0.05), respectively. Six weeks after total knee arthroplasty, the mean ROM of the knee in group A and B was 109.7° ± 22.3° and 121° ± 21.5°, respectively (p < 0.05). The mean postoperative forgotten joint score-12 of the group A and B was 24.5 ± 16.4 and 25.6 ± 17.4, respectively (p > 0.05). The rate of manipulation under anaesthesia was 3% in group A and 0.2% in group B (p < 0.05).ConclusionAfter total knee arthroplasty, frequent physiotherapist’s instruction helps the patients improve knee exercises and therefore decrease the risk of revision surgery. The home physiotherapy under supervision of physiotherapist lowers the rate of manipulation under anaesthesia.Level of evidenceTherapeutic study, Level IIa.

Highlights

Total Knee Arthroplasty (TKA) is one of the most successful operations in modern orthopaedics [1]
Huge advances have been made in the implant designs, refinement of the surgical treatment of TKA and patient selection
Gait analyses and biomechanical studies showed that the knee should achieve at least 83° of flexion to ascend stairs, 90° to 100° of flexion to descend stairs, 93° to 105° flexion to rise from a chair, and more than 120° of flexion to squat or kneel [15,16,17]

Summary

Introduction

Total Knee Arthroplasty (TKA) is one of the most successful operations in modern orthopaedics [1]. TKA is highly effective in relieving pain and improving functions, including activities of daily living [2,3,4,5,6]. Huge advances have been made in the implant designs, refinement of the surgical treatment of TKA and patient selection. One of the common reasons in these 19% unsatisfied patients is development of knee stiffness after the TKA surgery. A stiff knee is confirmed when the knee flexed less than 90° after TKA [18,19,20]. Some factors may be associated with knee stiffness, including a decreased preoperative ROM, younger age, diabetes mellitus, socioeconomic status, and previous knee surgery, malpositioning of implant, inadequate resection, and overstuffing of the component [21,22,23,24]

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