Really Early Rehab after Knee Replacement Surgery

Replacement of a knee joint is generally considered to be a painful procedure, although much can be done to relieve pain. Physical therapy to rehabilitate the tissues around the new joint is often delayed for a few days, until the immediate post-operative pain has subsided. However, this may not be the best approach, as shown by new research in the journal Clinical Rehabilitation.

Spanish researchers investigated whether early physical therapy would improve recovery from knee arthroplasty. They compared patients who began treatment within 24 hours of surgery with those who began 48 to 72 hours post-operative lay, using a randomized design; over 300 patients were randomly allocated to start rehab within 24 hours or 48 - 72 hours after surgery. They measured the joint range of motion, muscle strength, pain, gait and balance.

The patients were aged 50 to 75 years. The post-operative treatment began with a series of leg exercises, breathing exercises, and advice on posture. By the second day patients walked short distances with walking aids, and in following days this was increased towards activities of daily life – e.g. beginning to climb stairs on day 4.

Compared with the controls, the early rehab patients had a significantly shorter hospital stay (2.09 days), fewer rehab sessions until discharge, less pain, greater joint range of motion in flexion and extension, improved strength in quadriceps muscles and hamstring muscles, and higher scores for gait and balance.

Present-day economic pressures are helped by shorter hospital stays. Other benefits of early mobilization after this type of surgery are fewer complications such as deep vein thrombosis, pulmonary embolism, chest infection, and urinary retention. Shorter hospitalization also lowers the risk of contracting a hospital-acquired infection, such as MRSA (methicillin-resistant staphylococcal aureus) infection.

This study has results that are almost too good to be true.  But early rehab is being used in many (even most?) hospitals throughout the USA, and we would certainly have heard if there are serious disadvantages to early mobilization after knee replacement surgery.