There is an interesting article this month in the Journal of Orthopedic and Sports Physical Therapy about outcomes after a total knee replacement (link). This article looks at several outcome measures at 3 months and then again at 2 and 3 years after a total knee replacement. These measurements were compared to similar aged people who haven’t had knee surgery.
There were several measures of improvement that the patients excelled at. Patient’s range of motion, ability to walk and body mass index all showed improvement at 2 and 3 years after a total knee replacement. To me this is a great illustration of how life-changing a total knee replacement can be. I see this all the time in the clinic. Patients’ well-being and function can be dramatically improved with a total joint replacement. Patients often have to make compensations for a very arthritic knee. Sometimes they don’t even realize that they are not functioning at their normal level. Surgery can completely reverse this pattern.
There were also some interesting measures that patients did not improve with. At 3 years, patients’ knee straightening strength was symmetrical between legs. However, this was in large part due to the non-operated side weakening. There was also a reported decrease in perceived function between years 2 & 3 which went along with the opposite leg getting worse. To me this is an opportunity for improvement. While the surgical leg is recovering, the other leg takes the brunt of the work. The surgical knee should be functional within months after a TKA. I feel that it is the job of the physical therapist to address any movement patterns or compensations that could be leading to a weakening of the other leg.
So this is really a good news/bad news situation. The study shows that after a total knee replacement replacement you will be much better at most things in life. However, the non-surgical knee may suffer to some degree. I feel that this is a flaw in the rehab process. It is imperative that we take a holistic view of movement to maintain good joint health. I also think that there may be an opportunity for further physical therapy after patients have fully recovered from the operation.
If you are considering a knee replacement or have recently had a knee replacement there is an opportunity to address your opposite side and your movement patterns in general. For a holistic approach to total knee replacements contact us at Siskiyou Physical Therapy.
Jon Hill, DPT, Licensed Physical Therapist with Siskiyou Physical Therapy
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