Functional Problems and Treatment Solutions After Total Hip and Knee Joint Arthroplasty

Although most patients who undergo total hip or knee joint arthroplasty have an excellent clinical result with routine postoperative interventions, substantial dysfunction develops in 15% to 20% of patients for various reasons1. These patients do not respond to standard physical therapy modalities and need a very aggressive regimen of management that may include both invasive and noninvasive therapeutic options. The purpose of this study was to identify these patients with functional limitations and to assess the results of treatment with a customized regimen. We defined soft-tissue problems as those not directly related to the implant. Implant-related problems due to malalignment or loosening were ruled out radiographically or by specialized testing by two of the authors (M.M. and G.E.). We identified several functional problems following total hip arthroplasty and total knee arthroplasty that were related to muscle weakness, muscle tightness, limb-length differences, and nerve problems (Table I).