Asia Pac J Sports Med Arthrosc Rehabil Technol. 2020 Jul; 21: 11–16

Initiating range of motion exercises within 24 hours following total knee arthroplasty affects the reduction of postoperative pain: A randomized controlled trial

Kentaro Iwakiri,a,∗ Yoichi Ohta,b Yuuki Shibata,a Yukihide Minoda,b Akio Kobayashi,a and Hiroaki Nakamurab

Knee

Background

Postoperative limitations in the range of motion (ROM) after TKA may occur occasionally and restrict a patient’s ADL. Although ROM exercise is a means of increasing the ROM after TKA, the optimal time of initiating ROM exercise is still unclear. The purpose of this study is to examine different initiation timings of postoperative ROM exercises after TKA and to compare the results in terms of postoperative pain, swelling, and ROM improvement to determine the optimal time of initiating ROM exercises following TKA.

Methods

This was a prospective, single-center, single-blinded randomized controlled trial involving 109 patients scheduled for unilateral TKA. All patients underwent the physiotherapist assisted passive and active same rehabilitation program that only differed in the starting time of ROM exercise on postoperative day 1 or day 7. Postoperative assessment was performed with all attending personnel blinded to group assignment. Visual analog scale (VAS) of pain, ROM, thigh swelling, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and adverse outcomes were compared between groups on postoperative days within 2 years after surgery.

Results

VAS scores during the postoperative period from 18 to 72 h were significantly lower in the group with starting time of ROM exercise on postoperative day 1. The ROM, laboratory data, thigh girth, WOMAC and the incidence of complications did not differ between the two groups at any postoperative time-point.

Conclusions

The results of this study suggested that ROM exercises beginning in the early postoperative stage are advantageous in reducing the postoperative pain after TKA.

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Introduction

Total knee arthroplasty (TKA) is an effective procedure for alleviating pain and improving activities of daily living (ADL) in patients with end-stage osteoarthritis of the knee.1 However, postoperative limitations in the range of motion (ROM) may occur occasionally and restrict a patient’s ADL.1^,2 The ROM after TKA is reported to be strongly influenced by the preoperative ROM.3^,4 It has also been reported that the postoperative ROM is influenced by nerve block, changes in ligament balance in the knee joint, accurate implant positioning and by the implant design adopted4, 5, 6, 7, 8, 9, 10 and the improved ROM after TKA affect the patient function and satisfaction.11

Although ROM exercise is known to be a means of increasing the ROM after TKA1^,12 and starting early rehabilitation within 24 h have benefits for the early recovery,13^,14 the optimal time of initiating only ROM exercise has not been discussed in the literature; it still remains to be unclear and varies per institution. In particular, it has been reported that local inflammation and swelling may occur in an early stage after TKA15, 16, 17; therefore, we speculated and hypothesized that ROM exercises beginning in the early postoperative stage are disadvantageous in restoring the ROM and relieving pain postoperatively, for eliciting local inflammation and swelling. However, there has been no report that denied the propriety of ROM exercise during the early postoperative stage.

In this study, we aimed to examine different initiation timings of postoperative ROM exercises after TKA and to compare the results in terms of postoperative pain, swelling, and ROM improvement to determine the optimal time of initiating ROM exercises following TKA.

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