TKA with prehabilitation after failed arthroplasty for treatment of OA
Type of Presentation
Event
Location
Hall of Governors
Start Date
4-7-2017 4:00 PM
End Date
4-7-2017 6:00 PM
Abstract
Background and Purpose: Osteoarthritis is a highly prevalent and debilitating disease that is a global contributor to disability. The purpose of this case is to analyze the impact of a total knee arthroplasty with prehabilitation for treating osteoarthritis. Case Description: Subject was a 67 year old male with osteoarthritis who had pre-habilitation and a total knee arthroplasty (TKA) following a failed. Initial treatment for patient knee pain associated with osteoarthritis was arthroscopy and physical therapy which was unsuccessful in relinquishing patient's symptoms. Roughly five months post arthroscopy patient began prehabilitation prior to undergoing TKA. Prehab focused on maximizing patient function in strength and range of motion prior to surgery with the intent of improving post-operative baseline scores for shorter rehabilitation duration post operatively. Following TKA, intervention focused on gentle LE strengthening concentrating on quadriceps activation, stretching of hamstrings and calf, as well as patellar tracking with progression into more closed chain and functional intervention.
Outcomes: Patient progress was tracked utilizing goniometry for range of motion, active knee extension test (AKET) for hamstring flexibility, manual muscle test (MMT), numerical pain rating scale (NPRS), and lower extremity functional scale (LEFS). By discharge, 7 weeks post-op, patient recorded significantly improved scores in ROM, MMT, NRPS, and LEFS. Patient obtained equal bilateral lower extremity strength scores as 5/5. ROM for the knee reached normal range and was comparable to other LE as well as AKET being equal bilaterally. The minimal detectable change and minimally clinically importance difference were obtained for NRPS and LEFS.
Discussion: In accordance with the results of this case, the use of TKA was successful in treating OA and the limiting symptoms experienced by the patient. Post operatively the patient was able to gain full extension but was limited in flexion. The overall post-operative rehabilitation time was 7 weeks from initial evaluation, which is shorter than the normal 12 weeks TKA patients are usually seen. Evidence in this case support prehabilitation can lead to decreased post-op rehab time. Further research on this topic is recommended to compare results of patients undergoing TKA with and without prehabilitation.
TKA with prehabilitation after failed arthroplasty for treatment of OA
Hall of Governors
Background and Purpose: Osteoarthritis is a highly prevalent and debilitating disease that is a global contributor to disability. The purpose of this case is to analyze the impact of a total knee arthroplasty with prehabilitation for treating osteoarthritis. Case Description: Subject was a 67 year old male with osteoarthritis who had pre-habilitation and a total knee arthroplasty (TKA) following a failed. Initial treatment for patient knee pain associated with osteoarthritis was arthroscopy and physical therapy which was unsuccessful in relinquishing patient's symptoms. Roughly five months post arthroscopy patient began prehabilitation prior to undergoing TKA. Prehab focused on maximizing patient function in strength and range of motion prior to surgery with the intent of improving post-operative baseline scores for shorter rehabilitation duration post operatively. Following TKA, intervention focused on gentle LE strengthening concentrating on quadriceps activation, stretching of hamstrings and calf, as well as patellar tracking with progression into more closed chain and functional intervention.
Outcomes: Patient progress was tracked utilizing goniometry for range of motion, active knee extension test (AKET) for hamstring flexibility, manual muscle test (MMT), numerical pain rating scale (NPRS), and lower extremity functional scale (LEFS). By discharge, 7 weeks post-op, patient recorded significantly improved scores in ROM, MMT, NRPS, and LEFS. Patient obtained equal bilateral lower extremity strength scores as 5/5. ROM for the knee reached normal range and was comparable to other LE as well as AKET being equal bilaterally. The minimal detectable change and minimally clinically importance difference were obtained for NRPS and LEFS.
Discussion: In accordance with the results of this case, the use of TKA was successful in treating OA and the limiting symptoms experienced by the patient. Post operatively the patient was able to gain full extension but was limited in flexion. The overall post-operative rehabilitation time was 7 weeks from initial evaluation, which is shorter than the normal 12 weeks TKA patients are usually seen. Evidence in this case support prehabilitation can lead to decreased post-op rehab time. Further research on this topic is recommended to compare results of patients undergoing TKA with and without prehabilitation.