Total knee replacement: are you getting the best results?
Traditionally, it is harder to get good results following a knee replacement than a hip replacement. A growing number of people are having joint replacements which is increasingly followed by up to six weeks of inpatient rehabilitation. We know from many studies and our own observations in the clinic, that despite the surgery and rehabilitation, many people are left with significant loss of strength, fitness and functional limitation following their knee replacement, with some even reporting severe pain up to 12 months following surgery. It seems also that the younger the person, the worse the outcome and higher the rate of revision surgery. This can be a big problem for those wanting to continue with full-time employment and active lives.
A recent study based in Sydney is following over 600 Australians and comparing the current model of early rehabilitation, ending at around six weeks, with one that doesn’t start formal rehabilitation until six weeks after surgery. This is the MARKER study. The evidence behind their study is that rehabilitation provided during the early post-surgical period is no more effective than a home-program or no treatment at all!! It is not until the wound healing, pain and swelling have subsided at or around six weeks that any effective gains can be made and an intensive strength training program can begin.
Commonly in our clinic in St Leonards, we often see people many months following a knee replacement with obvious strength and functional limitations that can be improved with intensive rehab. I think that there is a role for hydrotherapy early post knee replacement for pain and swelling relief, but agree that with more of an outpatient and strength training focus delivered intensively after the trauma of major orthopaedic surgery have settled we will get better results across the board.
With the study commencing in 2009 and anticipated to end by 2011 it will be exciting to see the final results. For more information follow the MARKER study conducted by Lin et al.
Categories: Feature Article, Hydrotherapy