If you’re interested in the process involved in knee replacement surgery, here’s a video from the surgeon’s point of view. Orthopedic surgery can be similar to carpentry, but with much cleaner tools. As is typical with this type of surgery, there’s plenty of blood and bone chips involved. The video is graphic. You’ve been warned.
An Epub ahead of print at the Journal of Orthopaedic & Sports Physical Therapy (JOSPT) describes a study done comparing outcomes following Total Knee Arthroplasty (TKA; also sometimes known as TKR for ‘Total Knee Replacement’). Two rehabilitation protocols were followed by the two different groups in the study.
The two groups 8 were age and sex-matched. One group followed a standard, lower intensity rehabilitation program while the second group followed a higher intensity program that progressed as tolerated. The high intensity (HI) group had an additional month of treatments but there were already significant differences between the two groups at the 3.5 weeks post TKA. The HI group also utilized machine-based strengthening while the lower intensity group only progressed to ankle weights or resistive bands.
The study found that those in the higher intensity group had superior strength and functional outcomes while not experiencing any increase in pain or decrease in range of motion (ROM). The HI group showed significantly greater short-term and long-term strength and function as measured at 3.5 weeks, 12weeks and 52 weeks .
It’s worth noting that the study only involved a small sample size and lacked randomization and blinding. However, the researchers believe that this illustrates that larger similar studies are warranted.
Clinical Orthopaedics and Related Research recently published an article entitled “Quadriceps and Hamstrings Muscle Dysfunction after Total Knee Arthroplasty.” The article discusses a study of dysfunction in the quadriceps and hamstring muscles following Total Knee Arthroplasty (TKA).
Using bilateral isometric strength tests and EMG measures of quads / hams co-activation the study found that the difference in loss of strength between the muscle groups was not significant; both were weakened equally.
The authors claim that in post TKA rehab the hamstrings are often neglected relative to the emphasis placed on quadricep strengthening and retraining. Their conclusion from this study is that the hamstrings should be included with the quadriceps as the primary focus in post total knee arthroplasty rehabilitation.
Many physical therapists use orthopaedic/orthopedic rehab protocols frequently throughout their daily practice. Former Calgary Flames and Canadian Olympic Team Physical Therapist, Terry Kane, used to run a website called OrthopaedicProtocols.com . The site linked to dozens of orthopaedic/orthopedic protocol documents from all over the internet. Unfortunately he has since taken the site down. The documents included come from sites such as:
Advanced Orthopaedics and Sports Medicine
Bringham and Womens Hospital
Cappagh National Orthopaedic Hospital
Massachusetts General Hospital
Cincinnati Sportsmedicine and Orthopaedic Center
Dr. Millet / Steadman Hawkins
University of Kentucky
University of Minnesota Orthopaedics
University Sports Medicine – University of Buffalo
Massachusetts General Hospital
Kevin Freedman MD, Orthopaedic Specialists
…and many more. Protocol documents available are varied, from ankle sprains to post-op artificial discs and almost everything in between. Outcome and radiological documents are also available.
From the site:
Ownership / Editor: The site is 100% privately owned and edited by Licensed Canadian Physical Therapist, Terry Kane (www.terrykane.ca)
Authors: This database consists of hypertext links to protocols authored by licensed healthcare professionals or academic institutions. All protocols are currently part of the public domain on the internet or have been submitted by the authors themselves.
Mission: The site was designed to help students and clinicians find diagnostic, treatment and rehabilitative protocols to help them in managing their patients. The protocols are not presented to replace the care and advice of a licensed healthcare professional but rather for educational purposes of healthcare professionals only. This website does not endorse any of the protocols presented, but rather, provides them as a library for visitors to access and evaluate for themselves independently.
Target Audience: The site was designed and authored for an audience of licensed healthcare professionals and students.
Terry had put together a very useful resource with this vast collection of protocols available online. Much can be learned from studying the differences and similarities between the many available. The site also offers the ability for practitioners to submit their own protocols to be added to the system.
One feature that I would like to see added to the site is the ability for site visitors to rate the various protocols available. Doing so would require that users register with the site, something that is not currently required or possible. I believe the lack of registration required is for ease of use and to prevent people from being concerned about privacy issues. However, I feel that allowing those interested in registering to give their ratings would make the site even better.