Preoperative physical therapy in primary total knee arthroplasty

Area of Science:

• Orthopedics
• Rehabilitation Medicine
• Sports Medicine

Background:

• Total knee arthroplasty (TKA) is a common procedure for severe knee osteoarthritis.
• Preoperative physical therapy (PT) is often recommended to optimize patient outcomes.
• Evidence supporting the routine use of PT before TKA is limited.

Purpose of the Study:

• To evaluate the efficacy of a 6-week preoperative physical therapy program in patients undergoing elective primary total knee arthroplasty.
• To assess the impact of preoperative PT on strength, muscle mass, and functional recovery post-TKA.

Main Methods:

• A randomized controlled trial comparing a preoperative PT group (n=10) with a control group (n=10).
• Outcome measures included the Hospital for Special Surgery knee rating scale, range of motion, thigh circumference, walking speed, isokinetic strength testing (flexion/extension), and computed tomography (CT) for muscle area.
• Assessments were conducted at baseline, pre-surgery, 6 weeks post-surgery, and 3 months post-surgery.

Main Results:

• Preoperative PT showed modest gains in isokinetic knee flexion strength but no significant difference in extension strength.
• Postoperative strength decrease was not significantly affected by preoperative PT.
• The PT group maintained thigh muscle cross-sectional area, while the control group showed a significant decrease after surgery.
• No significant differences in postoperative strength were demonstrated between groups.

Conclusions:

• Preoperative physical therapy preserved thigh muscle area after total knee arthroplasty but did not significantly improve postoperative strength or functional outcomes.
• The clinical significance of preserving muscle mass without concurrent strength improvements is uncertain.
• This study does not support the routine use of preoperative physical therapy for patients undergoing elective primary total knee arthroplasty.