Do people fare better after knee surgery with at-home exercise or clinic-based physical therapy (PT)? That is the question posed in a 2014 Australian study in the journal Arthritis Care & Research. Researchers found that those patients who had total knee replacement and followed a structured, at-home exercise program did no worse – in terms of pain and range of motion – than those who participated in a standard clinic-based physical therapy program.
According to the Centers for Disease Control and Prevention, more than 700,000 knee replacement surgeries, also called total knee arthroplasty, are done every year. That number is expected to rise as the population ages and grows heavier.
However, there is little guidance outlining the type and amount of rehabilitation a patient should receive after surgery, and few studies explore the issue, despite the large number of people having joint replacement surgery and the importance of rehabilitation to its ultimate success.
Is At-home or Clinic Exercise Better?
Researchers from the University of Sydney recruited 390 knee replacement patients between the ages of 45 and 75. Approximately half of them were assigned to an at-home exercise program, while the other half were assigned to a clinic-based program; both programs lasted six weeks.
Patients in the at-home program got one instruction session from a physical therapist before being discharged from the hospital with a written copy of the exercise instructions. They were also offered one clinic-based “monitoring” appointment during the first week after discharge and received brief weekly telephone calls to monitor adherence. Patients in the second group were given access to clinic-based physical therapy as recommended by their hospital or surgeon.
After six weeks, there were no significant differences between the two groups on measures of pain and physical function, nor were there significant differences in 50-foot walk times or knee range-of-motion. Nine percent of those in the clinic-based group and six percent of patients in the home exercise group weren’t able to bend their knee 80 degrees. (Bending the knee 90 degrees or more is a target used by many hospitals because it indicates a patient can function well after surgery.)
Personal Preference and Goals
“Some patients enjoy the companionship of attending rehabilitation at an outpatient clinic setting where they are with providers and similar patients,” says Dr. Tubb. Others, he says, prefer to be in their own homes or to individually visit a physical therapist.
Dr. Tubb says that during the last decade, physical therapists have become more focused on patients’ functional goals. “It is not enough to just measure strength or range of motion,” says Dr. Tubb. “We need to translate these rehab goals into functional activities, such as how well they can get up and down the stairs, ride a bike, garden and swing a golf club.”
Although this study offers a beginning in understanding best options for postoperative recovery, the researchers say more studies are needed.
Importance of Post-op Rehab
According to Dr. Creighton C. Tubb, a spokesperson for the American Academy of Orthopaedic Surgeons and vice chairman, department of orthopaedics and rehabilitation at Brooke Army Medical Center in San Antonio, Texas, it is imperative for patients to take part in a structured postoperative rehabilitation program to maximize knee motion and strength, and regain as much knee function as possible following the surgery.