Why the Best Total Knee Replacement Recovery Might Not Be Rehab

In the world of injury management, there are some procedures that come standard with a long road to recovery. When a joint is replaced in the body, as is done in a total knee arthroplasty, the patient goes through a literal rebuilding phase; not just rebuilding his or her knee, but also rebuilding quality movement patterns that enhance daily activities. Postoperative patients are typically up and moving before they even leave the hospital (with limitations, of course), which can be scary, painful and overwhelming for some. With the right preparation, however, clinicians can give their patients peace of mind as well as a better chance at successful rehabilitation.

Prehabilitation, or pre-hab, mimics a normal rehabilitation program given to the patient after they’ve undergone the procedure.

“Prehabilitation is an exercise program designed to prepare a person physically and mentally for surgery to optimize the chance for a successful outcome and a quick recovery. It’s well known that the inactivity associated with surgery stresses the body and leads to a decline in physical function. Generally, the more fit and active you are going into surgery the more likely you are to retain a higher level of function after surgery and rehab more quickly. Often, there is a period of waiting involved before a surgery and it’s this time that a person can use to get in the best shape possible.”[1]

The relationship between pre-hab and total knee replacement recovery outcomes has been diligently studied throughout the years, and all signs point to pre-hab as one of the most rewarding treatment measures a clinician can prescribe:

• In a 2009 study, patients who underwent a pre-hab program before a total knee arthroplasty saw improvement in their performance of 3 of the 4 functional tasks, a decrease in all pain measures and an increase in both surgical and non-surgical quadricep strength. The authors concluded that these findings appear to indicate the efficacy of prehabilitation among total knee replacement patients and support the theory of prehabilitation.[2]


• In 2011, exercise before total knee arthroplasties was proven to improve leg strength and the ability to perform functional tasks for older adults with severe osteoarthritis and pain. “Increases in leg strength and performance of functional tasks before surgery may result in improved postoperative recovery because pre-operative performance of functional tasks has been shown to be a predictor of postoperative performance of functional tasks.”[3]


• Another study showed that knee osteoarthritis patients who engage in exercise prior to total knee arthroplasty reported higher physical function as well as a higher general, health-related quality of life three months post-op compared to those who did not perform pre-hab.[4]

Based on these studies and more, it’s clear that early intervention with preoperative patients is a worthwhile investment of time and resources. To help you get the most out of each session, let’s take a look at some fundamental components of an effective total knee replacement prehabilitation program.

Throughout his long career in outpatient and long-term care settings, Dr. Shawn Burger PT, DPT, CSCS has perfected the art of the total knee recovery, and his approach is anything but ordinary. Instead of relying on the routine flexion and extension exercises, he prefers to treat patients in positions that mimic their everyday patterns of movement.

“The exercises that I chose to incorporate for a total knee are very similar to those for a total hip and they’re designed around functional principles,” said Dr. Burger. “If we are just doing exercises in supine or horizontal position on a table, patients will have a hard time engaging with those types of exercises. So, by utilizing this and things like the TheraBand CLX, we can engage patients in a much more functional position, and we know from research that this increases compliance and adherence.”

Although Dr. Burger manages each case individually and creates customized prehabilitation and rehabilitation plans that fit each patient just right, he has a suite of exercises that are foundational to his method. In this installment of the Injury Management Series, learn his five favorite exercise for patients undergoing a total knee replacement; all you’ll need is a TheraBand CLX Band and a TheraBand CLX Door Anchor!

Hear from Dr. Burger himself while you check out the full playlist of his exercises

Sources:

1. https://www.burke.org/blog/2014/7/what-you-need-to-know-about-prehabilitation/19
2. Topp R et al. 2009. The effect of prehabilitation exercise on strength and functioning after total knee arthroplasty. Phys Med Rehabil 1(8):729-35.
3. Swank et al. 2011. Prehabilitation before total knee arthroplasty increases strength and function in older adults with severe osteoarthritis. J Strength Cond Res 25(2):318-25.
4. Brown, K et al. 2012. Prehabilitation and quality of life three months after total knee arthroplasty: a pilot study. Perceptual and Motor Skills: Physical Development and Measurement. 155(3):1-10.