Focused Rehabilitation Treatment of Poorly Functioning Total Knee Arthroplasties

Patient dissatisfaction after total knee arthroplasty (TKA) is often linked to complications resulting from comorbidities, radiographic loosening, and poor prosthetic alignment. However, some patients report functional problems without obvious cause. We asked if focused physical therapeutic techniques influenced the clinical outcome in these patients. We identified functional problems in 56 patients after TKA and described outcomes following focused physical therapy modalities. Assessments included detailed physical examination, videotape analyses, electromyograms, nerve conduction studies, foot pressure studies, and isokinetic strength measurements in selected patients. Identified abnormalities were knee flexion contracture, quadriceps muscle weakness, knee flexion deficit, limb length difference, foot and ankle malalignment, and peroneal nerve entrapment. Focused treatment protocols for each of the six abnormalities included knee braces, shoe lifts, orthoses, electrical stimulation, peroneal nerve releases, and intramuscular botulinum toxin injections. Fifty-three patients (95%) had Knee Society scores greater than 80 points at final minimum followup of 24 months (mean, 43 months; range, 24-73 months). Patient satisfaction was a mean of 9.1 out of 10 possible points. Our results suggest focused physical therapy may help patients with difficult functional problems after TKA.

Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.