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Why Pre-Hab Before A Total Knee Replacement?


Knee Osteoarthritis (OA) is characterized by not only the degeneration of the tibiofemoral (knee) joint, but also significant inflammation leading to pain and decline in function. Most commonly, people with knee OA experience pain with weight-bearing activities including squatting, ascending/descending stairs and walking on inclines.  As the disease progresses and becomes more severe, surgical intervention is required to restore function, most commonly in the form of a Total Knee Arthroplasty (TKA).

Making the decision to undergo surgery is not always an easy choice.  However, if you are currently suffering from knee OA and a likely candidate for joint replacement, there are several ways to optimize your post-surgical outcomes and maximize function.  Although conservative management of severe OA is not likely to make drastic improvements in decreasing pain an enhancing function, current research has demonstrated that pre-rehabilitation before undergoing surgery leads to better outcomes post-surgery.

For example, weakness of the quadriceps muscle (front thigh muscle) has been shown to be the single strongest predictor of functional limitations in people with knee OA.  Quad weakness is also correlated with higher risk of falls in the elderly.  After surgery, quad strength can diminish up to 60%, making regaining strength postoperatively one of the most important tasks of rehab.  However, evidence has demonstrated that preoperative quad strength is predictive of functional ability one year after having a TKA.  Even someone who attempted conservative treatment and failed, attending physical therapy for pre-rehabilitation emphasizing quadriceps strengthening will lead to better function postoperatively.

Another major limitation after TKA is significant loss of knee range of motion that must be restored during rehab in order to optimize function.  Knee stiffness is one complication that can occur after TKA and can lead to significant limitations in function.  Several different factors can contribute to stiffness after surgery.  Studies are finding that the more stiffness and limited mobility the knee has before TKA, the more likely one is to have stiffness as a complication.  This indicates that maximizing preoperative range of motion is an important prevention strategy.  With preoperative physical therapy, a patient can be provided manual therapy and specific therapeutic exercise to address impairments related to range of motion deficits so that mobility can restored without complication after surgery.

Comorbidities can also negatively affect success of TKA.  Diagnoses such as rheumatoid arthritis, diabetes, and obesity have all been shown to be higher risk factors for poor postoperative success.  However, compared to other comorbidities, obesity has the potential to be modifiable.  A recent study demonstrated that weight loss of 13.5 pounds was enough to lead to moderate improvements in pain and function in patients with knee OA.  Performing aerobic exercise under the supervision of a trained physical therapist in combination with nutrition education and diet modification before surgery can lead to better postoperative results.

If you are someone who is currently suffering from knee pain as a result of OA, physical therapy is a great option for management of symptoms and pre-habilitation.  In mild to moderate cases, physical therapy can lead to decreased pain and delay the need for TKA.  In the worst case scenario, if you are in need of a joint replacement, physical therapy before surgery will only improve prognosis and optimize recovery post operatively.

John Giametta DPT received his doctorate degree from Sacred Heart University. His clinical experience includes working with cardio-pulmonary, neurological and post-surgical conditions.  His special interests are in treating orthopedic and sports related injuries.  Amity Physical Therapy was founded by Michael Dow MSPT and CEO/Clinical Director twelve years ago.  The practice now maintains three offices in Woodbridge, Hamden, and Branford.  John Giametta can be reached at 203-389-4593 or visit amitypt.com.


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