Fast track rehabilitation for Total Knee Replacements
With an increase in the global aging population, total knee arthroplasty (TKA) surgeries are on the rise. In public and private sectors, the rehabilitation is often driven by the patient and their tolerance following surgery.
This article looks to examine a Fast Track protocol over the course of 3 days post-operatively, and the associated outcomes on function, range of motion and pain.
This study was conducted retrospectively and included 132 patients, 95 of which were given the Fast Track protocol. These were compared retrospectively to 37 other patients treated with standard care approaches following TKA. The patients all received similar surgical approaches by the same surgeon.
For the Fast Track protocol, each patient underwent rehab 3 hours after their operation, ankle motion and quadricep isometric contractions were started, and they were mobilized from supine to seated to standing positions. They were also mobilized to walking with a walking frame for 10-15 minutes.
Post-Operative Day 1: straight leg raises were added, and the patient was progressed to mobilizing with crutches.
Post-Operative Day 2: continuation of straight leg raises and progression to walking 60-70 metres with crutches was trialed.
Post-Operative Day 3: activities of daily living were reviewed for mobility at home, and ascending and descending stairs were practiced with crutches.
Following surgery, patients were seen twice each day for 30 minutes, and a continuous passive motion machine was used each day. The patients were measured for range of motion: 0 degrees of extension and 90 degrees of flexion was required upon discharge.
Pain was monitored by the Visual Analogue Scale (VAS) and functional outcome measures such as the Modified Barthel Index were used to note progression of each patient.
In comparison, there was not a significant difference in the Modified Barthel Index for either group with function, but this study did note that range of motion (both passive and active) was improved with the Fast Track protocol, and overall pain levels were lower with that of the Fast Track group.
While this study does a good job in outlining the specific role of rehabilitation after surgery, it does not draw a great direct correlation between what rehabilitation approaches are helpful. The authors discuss in detail around the daily post-operative plans while the patient is in the hospital, but do not reference the control group enough to note minimal levels of input that would be below the Fast Track protocols.
However, the proposed rehabilitation plan over 3 days with associated activities of daily living goals and range of motion targets can be translated into patient care. This article does provide support for earlier mobilization, and setting a clear timeline of 3 days (pending no serious complications) for patients to be mobilizing well. Therefore, it is felt that this notion of early and frequent rehabilitation following TKA is imperative for pain reduction. Given that pain is one of the most common reasons for TKA, and early and more intensive approach to rehab should be considered.
> From: Castorina et al., Muscles Ligaments Tendons J 7 (2018-03-05 09:12:02) 504-513 (Epub ahead of print). All rights reserved to The Author(s). Click here for the online summary.