Ann Rehabil Med.  2019 Dec;43(6):650-661. 10.5535/arm.2019.43.6.650.

Functional Outcomes After Critical Pathway for Inpatient Rehabilitation of Total Knee Arthroplasty

• Kim JH
• Kim BR
• Kim SR
• Han EY
• Nam KW
• Lee SY
• Kim WB

• KMID: 2468692
• DOI: http://doi.org/10.5535/arm.2019.43.6.650

Abstract

OBJECTIVE
To investigate functional outcomes after the application of a critical pathway for inpatient rehabilitation of total knee arthroplasty (TKA).
METHODS
A total of 184 patients (57 males and 127 females; average age, 71.5±5.9 years) who underwent unilateral or bilateral TKA were included. The critical pathway included early, intensive individualized rehabilitation exercises. Patients completed the following performance-based physical function tests: the stair climbing test (SCT), 6-minute walk test (6MWT), and Timed Up and Go test (TUG) as well as measurement of isometric knee flexor and extensor strength of the operated knee, gait speed, and range of knee flexion and extension. Self-reported physical function and pain were measured using the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and visual analog scale (VAS), respectively, and self-reported quality of life was measured using the EuroQoL 5 dimension (EQ-5D) questionnaire. These evaluations were performed preoperatively and at 1 month and 3 months postoperatively.
RESULTS
Performance-based and self-reported physical function and quality of life measures improved nonlinearly over time. Specifically, the 6WMT, TUG, gait speed, WOMAC-pain, WOMAC-function, VAS, and EQ-5D scores showed a significant improvement at 1-month post-TKA, whereas SCT, peak torque of the knee extensors and flexors, and WOMAC-stiffness scores showed gradual, but substantial, improvements over 3 months. There were between-group differences (unilateral and bilateral TKA groups) in the time course of the SCT, 6MWT, TUG, VAS, WOAMC-stiffness, and WOMAC-function results.
CONCLUSION
Patients who underwent critical pathway rehabilitation after TKA showed significant improvements in functional measurements during the first 3 months post-surgery.

Keyword

Arthroplasty; Knee; Osteoarthritis; Rehabilitation; Critical pathways

MeSH Terms

Arthroplasty
Arthroplasty, Replacement, Knee*
Critical Pathways*
Exercise
Female
Gait
Humans
Inpatients*
Knee
Male
Ontario
Osteoarthritis
Quality of Life
Rehabilitation*
Torque
Visual Analog Scale

Figure

• 

  Fig. 1. Flow chart of patient inclusion with reason for exclusion and total study population. CP, critical pathway; TKA, total knee arthroplasty.

• 

  Fig. 2. The progressive resistance exercises consisted of (A) incline leg press, (B) leg press, (C) leg extension, (D) leg curl, (E) hip abduction, and (F) hip adduction using air-resistance machines (HUR Co., Kokkola, Finland).

• 

  Fig. 3. The gait training exercises consisted of Alter G anti-gravity treadmill (Model M320; Alter G Inc., Fremont, CA, USA).

• 

  Fig. 4. Critical pathway after total knee arthroplasty. OS, orthopedic surgeon; TKA, total knee arthroplasty; POD, post-operation day; CPM, continuous passive motion; CP, critical pathway; PRE, progressive resistance exercise; OPD, outpatient department.

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