Rehabilitation after knee replacement surgery for osteoarthritis

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The replacement of the knee joint relieves pain for most patients with chronic symptomatic knee osteoarthritis, with the maximum achievable benefit appearing around six months after surgery. However, the magnitude of improvement is smaller than after total hip replacement surgery. About 15% still report moderate to severe pain and 40% report limited functional improvement a year after surgery, despite an absence of radiographic abnormalities. Many years after surgery, patients are left with the same greatly reduced lower limb muscle strength and gait abnormalities evident prior to surgery. Worldwide, there is evidence of considerable practice variation in post-acute rehabilitation after knee replacement surgery. Any active supervised exercise program after discharge from the orthopaedic ward, if provided, is generally completed within a few weeks of surgery. One probable reason for the lack of demonstrable long-term benefit of current usual practice is that patients are still experiencing the anaemia, pain and oedema inevitably associated with recovery from major orthopaedic surgery. Training intensity is therefore rarely able to be progressed sufficiently to achieve meaningful sustainable improvements in lower limb muscle strength or gait quality beyond the immediate pre-surgery levels. In fact, current approaches may not be adding benefit to long-term patient outcomes above that resulting from natural recovery from surgery alone. There is preliminary evidence that achieving optimal lower limb muscle strength, gait patterns and symmetry, and knee joint loading patterns may be crucial for long-term clinical benefits, integrity of other lower limb joints and implant longevity after knee replacement surgery. Adequately addressing ongoing physical impairments after knee replacement surgery has potential to allow these patients to safely commence a more active lifestyle, improving their general health and reducing the risk of serious co-morbidity and ongoing health care costs.