With Knee Replacement Rehabilitation, the Sooner the Better New Study Shows.

In a recent study 1 published in the journal Clinical Rehabilitation, a group of Spanish researchers looked to determine if there was any benefit to beginning exercises within the first 24 hours following Knee Replacement versus waiting an additional 1-2 days to begin therapy.

The researchers compared two groups, each consisting of 153 total knee replacement patients. All patients underwent knee replacement for the treatment of advanced osteoarthritis. Following their knee replacement, the experimental group began rehabilitation within 24 hours after surgery. The other group (control) began their rehabilitation between 48 and 72 hours post-op.

When comparing the two groups, the researchers looked at several factors in order to gauge performance of each group. They looked at things such as range of motion, muscle strength and pain

What the scientists found was that the group of patients that stared their rehabilitation within 24 hours of their surgery performed significantly better. This group enjoyed a shorter hospital stay, fewer rehabilitation sessions while in the hospital and less pain. In addition the quicker rehab group also experienced greater range of motion (ROM) in flexion and extension, improved strength in the quads and hamstring muscles as well as better gait and balance. The table below summarizes the major results.

Measure Result
Hospital Length of Stay 24 Hr. group in hospital 2.09 days less (on average) than 48-72 Hr. group
Rehab Sessions 24 Hr. group had 4.95 fewer rehab sessions (on average) before discharge that the 48-72 hr. group
ROM-Flexion 24 Hr. group could flex knee on average 16.29 degrees further than 48-72 hr. group
ROM-Extension 24 Hr. group could extend knee on average 2.12 degrees further than 48-72 hr. group

This interesting article is available online in full text format at the Clinical Rehabilitation Journal website.
1 Labraca NS, Castro-Sanchez AM, Mataran-Penarrocha GA, Arroyo-Morales M, del Mar Sanchez-Joy M, Moreno-Lorenzo C. Benefits of starting rehabilitation within 24 hours of primary total knee arthroplasty: randomized clinical trial. Clinical Rehabilitation, March 2011

Comments

3 Responses to “With Knee Replacement Rehabilitation, the Sooner the Better New Study Shows.”

  1. JET on March 17th, 2011 3:50 am

    I don’t really think it matters if you start rehab right away or not, but rather, I think the recovery totally depends on the ortho surgeon’s technique and skills (or lack thereof).

    Case in point, I had my right knee replaced in 2007. I couldn’t even sit up much less walk for the first 2 post-op days due to pain med issues, and it wasn’t until Day 3 that I was able to get up and start walking. Fast forward — in 2011 the right knee is doing very well… well, at least it was until…

    I had my left knee replaced in 2009 by a different ortho surgeon. I was up and walking the afternoon of the surgery, and 2-3 times daily during the 4-day hospital stay. But after being discharged the IV pain meds wore off and I woke up with sciatica, then my lower back started giving me a lot of problems, then the muscles in my right leg started seizing up, and then I landed in the E.R. on post-op Day 10 where they discovered two large blood clots in the left leg, and a third clot was found during the recheck. The hospitalist commented that the ortho surgeon must have really been wrenching things around to cause so many problems. (I do not have a predisposition to clotting; the clots were caused by trauma during the TKR surgery.)

    Long story short, having the left knee replaced is the worst decision I ever made in my entire life. After a year of physical therapy I was discharged and told I would never recover. The PT remarked that he’d never, ever encountered anyone in his entire career with such rigid muscles that will absolutely not respond no matter what.

    So, what was supposed to restore mobility and get me back into an active lifestyle actually gave me a permanent seat on the disability bench and left me far worse off than if I’d just let OA take its course — and I’d take the bone-on-bone pain in a heartbeat compared to what I have now.

    Perhaps this got a little off the topic, but I just wanted to point out that while I had a 2-day delayed start on exercising the right TKR it did fine and I had a good ROM outcome. Whereas, I got a really early start on the left TKR but it’s been hell ever since. SO, to reiterate my initial statement–I don’t really think it matters if a TKR patient starts early or a little later as my late-starting right TKR had a far superior outcome than the left TKR–my posit is that the quality of recovery is totally dependent on the ortho surgeon’s skills and techniques. Period.

  2. PJ on February 4th, 2012 5:46 am

    Just wanted to know how you were doing today and how long it has been now? I had two at once total knee five months Go and feel the metAl, sharp pain, shooting electrical pains, numbness on one side of each knee, fever, red blotches all down the shin, burning and swelling. I can bend and flex excellently but can barely do stairs or walk more thAn a block….I m
    Am 51 hrs old am
    Nd regret this like crazy.

  3. JET on February 5th, 2012 6:41 am

    Hi PJ,

    Omigosh! You had both done at the same time?! You are definitely braver than I am! My hat is off to you! After my experiences, I can’t even fathom doing that!

    I am sorry to hear of the pain and agony you are dealing with — post-TKR pain tends to really push one’s coping skills far beyond what was anticipated… wouldn’t you agree? (I don’t think there is a way to truly prepare one for what they’ll REALLY experience in a TKR!)

    The fact that you can bend and flex well at 5 months post-op is great news! Don’t give up hope of better days ahead cuz at five months you’re still just wobbling out of the starting gates in the TKR recovery game – that was meant as encouragement, not discouragement! I think the medical community does a great disservice to TKR patients (doctors, nurses, therapists) by insisting that we all have the same recovery/response times and if we aren’t where the textbook says we “should” be, then we’re lagging behind – that just stresses people out who are already stressed about their recovery. My gosh, we’re all different! We all heal differently. We all have different emotional and mental make-ups and social support systems (or lack thereof), all of which play a huge part in the recovery process. SCREAM: I AM NOT A TEXTBOOK CASE!! I am a real person, so please pay attention to my REAL issues here and now and not what some textbook says I “should” be experiencing… EH?!

    Take heart, my right TKR actually took 18 months before I was finally able to reach the point where I could sit back and, all things considered, say, “Yeah, yeah, this is good, this works!” and I was happy with the result; enough so that I felt very confident moving head to get the left knee done. The left TKR, unfortunately, was and still is and no doubt always will be a totally different story. I am now at 2 years 5 months post-op and it remains the biggest mistake I ever made in my entire life. I don’t know what happened during the left TKR surgery, but the less-than-acceptable aftermath experiences have left me a different person than I was before this life-altering surgery.

    You speak of metal sharp pain, fever, red blotches, burning, shooting electrical pains, numbness, swelling. Please note that I am NOT providing any medical advice here as I am not a doctor… I just pick their brains during my medical appointments and have researched a lot trying to figure out what the heck happened in my left TKR surgery that seemingly messed my entire body up. So the following comments are simply based on what I’ve experienced, observed, or learned over the past 2.5 years of struggling with my left TKR.

    Swelling. Swelling is expected with any invasive surgery and should subside over time . . . unless you get multiple blood clots like I did with the left TKR and end up with post-thrombotic syndrome, then you have it for life.

    Metal sharp pain. You need to tell your surgeon about this type of pain and the severity and frequency of it – is it involved with a certain movement or just all the time? The prosthesis might possibly be misaligned or, depending where you are feeling this sensation; such as the inner knee where the fat pad is – I was told women have more soft tissue here than men do and it can sometimes get pinched by the prosthesis and holy cow! It hurts like the dickens! I have this issue with the left knee (oh, gee, what a surprise!) and it has not resolved one iota over the past 2.5 years so I’ll get a stabbing pinch that momentarily paralyzes me – happens when I’m in bed and just move my leg a certain way or when walking. It’s unpredictable.

    Fever. Red blotches. Burning. Fever generally indicates infection; your body is fighting something that the brain has signaled is foreign and shouldn’t be there. Coupled with the burning and red blotches – is one or both knees warm/hot to the touch? This is something your surgeon or doctor needs to know about. An infected TKR or negative reaction to the prosthesis materials is not a good thing—and it does happen—so if the surgeon/doc blow you off then you need to get a second opinion from one who WILL listen. Case in point, I have a friend/co-worker whose negative symptoms never resolved even though her blood tests were all “fine” so the docs just blew her off. But she knew something just wasn’t right (listen to your gut feeling!) and finally went to another ortho surgeon for a 2nd opinion. He found her entire leg was infected — it was full of green pus! He cleaned it out, put in an antibiotic spacer for like six weeks and she had to take an antibiotic, and then the original TKR was eventually replaced altogether. She gets around great now and has had no issues whatsoever with the replacement, but if she hadn’t persisted in finding someone to listen to her she could have lost her entire leg to that infection. So you gotta be your own advocate to get the care and attention you need, particularly with a TKR.

    Shooting Electrical Pains. I didn’t have those with the right TKR, but I sure had them with the left TKR and they still persist today, although they have finally toned down some (AMEN!). You should mention them to your surgeon/doc about them or possibly see a neurologist. I was sent for an EMG because the ortho I saw for a 2nd opinion thought the shooting electrical pains might be originating from my back and not the leg. Unfortunately, they had to stop the test about half way through cuz my left leg was so hyper-tender it became impossible to do what they needed to do.

    Numbness. Not to be the bearer of not-so-great news, but the numbness on one side of each knee will more than likely be permanent since the nerves are cut during the surgery and generally don’t come back. It’s rather unnerving at first (no pun intended), but once you are able to get out and about and resume a more normal lifestyle again the numbness really isn’t a big deal. I think it can be quite disturbing in the first stages of recovery while you’re overwhelmed in dealing with everything else – TKR recovery is a HUGE adjustment physically and psychologically! My right knee is coming up on its 5th anniversary and the outer side of the knee remains somewhat numb – it’s just something that goes with the territory of knee replacement. It doesn’t hurt – it just feels rather weird, but it’s not disabling, per se.

    Stairs. My knees don’t do well with stairs and I avoid them whenever possible. I have to take them one step at a time like a child does using the same leading leg, which happens to be the right leg. My right leg can ascend okay although it doesn’t feel particularly good, and absolutely has to be the leading leg to descend. My right knee did, however, fare better on stairs before I had the left TKR done. The left knee is pretty worthless when it comes to stairs.

    My best to you PJ and happy recovery! Before you know it, you’ll be coming up on your five year anniversary and wondering where the years went!! :-)

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