Fast track rehabilitation for Total Knee Replacements

Could it yield greater range of motion and decreased pain following knee replacement?

With an increase in the global aging population, total knee arthroplasty (TKA) surgeries are on the rise. In public and private sectors, the rehabilitation is often driven by the patient and their tolerance following surgery.

This article looks to examine a Fast Track protocol over the course of 3 days post-operatively, and the associated outcomes on function, range of motion and pain. 

In comparison, there was not a significant difference in the Modified Barthel Index for either group with function, but this study did note that range of motion (both passive and active) was improved with the Fast Track protocol, and overall pain levels were lower with that of the Fast Track group.

While this study does a good job in outlining the specific role of rehabilitation after surgery, it does not draw a great direct correlation between what rehabilitation approaches are helpful. The authors discuss in detail around the daily post-operative plans while the patient is in the hospital, but do not reference the control group enough to note minimal levels of input that would be below the Fast Track protocols.

However, the proposed rehabilitation plan over 3 days with associated activities of daily living goals and range of motion targets can be translated into patient care. This article does provide support for earlier mobilization, and setting a clear timeline of 3 days (pending no serious complications) for patients to be mobilizing well. Therefore, it is felt that this notion of early and frequent rehabilitation following TKA is imperative for pain reduction. Given that pain is one of the most common reasons for TKA, and early and more intensive approach to rehab should be considered.  

> From: Castorina et al., Muscles Ligaments Tendons J 7 (2018-03-05 09:12:02) 504-513 (Epub ahead of print). All rights reserved to The Author(s). Click here for the online summary.

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