Total Knee Replacement and Exercise Rehabilitation

The knee, also known as the tibiofemoral joint, is a highly complex joint that when healthy, has a significant function in gait and weight bearing activities. In a perfect world, the articular cartilage and meniscus that allows smooth mobility and shock absorption throughout the joint would remain undamaged. Unfortunately, damage is extremely common through aging and trauma and this kind of impairment is essentially the definition of osteoarthritis. Given the consistent forces the joint experiences in flexion and extension, it is no wonder that this degenerative disease can result in chronic knee pain – and is the leading cause for 98% of knee replacement surgery in Australia.

There is a lot to consider before going under the knife. Your GP and specialist may try several non-invasive options including pharmacological pain management, walking aids and weight loss/ muscle strengthening through exercise. If these options are deemed inadequate, a total knee replacement (or total knee arthroplasty), may be the best choice. It is a significant yet common procedure where the tibia and femur are cut, diseased bone removed and a prosthetic knee joint is applied – essentially resurfacing the joint. This of course is a very simplified description and the complexity of such surgery should not be underestimated.

In Australia, we have seen significant growth in the popularity of the procedure. According to the Australian Commission on Safety and Quality in Health Care, between 2003 and 2014 the number of knee replacement procedures undertaken per year increased by 88%. They indicate that “the increase is partly due to population ageing but also to the growing use of this intervention for people at earlier ages, as a result of rising levels of obesity, which have increased the need for knee replacements.”

So, let’s assume knee replacement surgery is in your best interest – one can expect to experience impairment to range of motion, muscle flexibility, strength, endurance, balance and muscular recruitment patterns. Whilst all muscles around the knee joint are important, atrophy of the quadriceps is the significant contributor to these listed impairments. Quite positively however, exercise intervention can address all of these implications. A study completed by Mizner, Patterson and Snyder-Mackler (2005), showed that “following 6 weeks of rehabilitation, quadriceps strength improved significantly at each following assessment (2, 3, and 6 months postsurgery).” In addition, functional performance enhanced significantly at each assessment, correlating with that of increased quadricep strength. This study and a wealth of others show that muscle impairment and functional limitations can be reversed following a total knee replacement.

Each individual is unique in their recovery after surgery and this remains true throughout the whole rehab process. Common practise will have you moving very shortly after the procedure and in this stage treatment from a physiotherapist may have the best outcome. Up to 3 months post-surgery however, concurrent or sole treatment with the services of an exercise physiologist would be most suitable. The EP’s at Absolute Balance are experts in knee rehabilitation and use only the most up to date, evidence based research when providing exercise therapies. For the best outcomes in your recover, contact us today!

Ed Daccache

B.Ex.SpSc, Grad.Dip.Ex.Sc (AEP, AES) (ESSAM)
Accredited Exercise Physiologist

 

 

 

References:

Australian Commission on Safety and Quality in Health Care. (2017). The Second Australian Atlas of Health Care Variation (Knee replacement hospitalisations 18 years and over). 243-255. Retrieved from https://safetyandquality.gov.au/atlas-assets/The%20Second%20Australian%20Atlas%20of%20Healthcare%20Variation.pdf

Meir, W., Mizner, R., Marcus, R., Dibble, L., Peters, C., Lastayo, P. (2008) Total Knee Arthroplasty: Muscle Impairment, Functional Limitations, and Recommended Rehabilitation Approaches. Journal of Orthopaedic & Sports Physical Therapy. 38(5), 246-256. Retrieved from https://www.jospt.org/doi/pdf/10.2519/jospt.2008.2715

Mizner, R., Petterson, S., Snyder-Mackler, L. (2005). Quadricep Strength and the Time Course of Functional Recovery After Total Knee Arthroplasty. Journal of Orthopaedic & Sports Physical Therapy. 35(7), 424-436. Retrieved from https://www.jospt.org/doi/pdf/10.2519/jospt.2005.35.7.424