What is the role of the physical medicine and rehabilitation unit after total knee arthroplasty? Clinical practice recommendations.
OBJECTIVE
To develop clinical practice guidelines concerning the interest of post-operative rehabilitation in physical medicine and functional rehabilitation (PMR) ward after total knee arthroplasty (TKA).


METHODS
The SOFMER (French Physical Medicine and Rehabilitation Society) methodology, associating a systematic literature review, collection of everyday clinical practice, and external review by a multidisciplinary expert panel, was used. Main outcomes were impairment, disability, medico-economic implications and postoperative complications.


RESULTS
Post-operative rehabilitation in a PMR ward after TKA is recommended for patients because of preoperative joint stiffness, and/or associated co-morbidities. The other parameters used by French physician for post-operative rehabilitation in a PMR ward after TKA are: the self-governing of the patient at home, the wishes of the patient and the opinion of the surgeon on the post-operative functional evolution of the patients. For patients in whom sustained rehabilitation is not necessary but who cannot return home, a stay in a non-specific (non-PMR) post-operative centre could be recommended. Post-operative rehabilitation in a PMR ward after TKA could reduce the length of stay in a surgical ward and increase the functional status of patients with co-morbidities. Studies with good methodological quality are needed to evaluate the cost/benefit ratio in the French health care system.


CONCLUSIONS
This study suggests a value of rehabilitation in a PMR ward after TKA, but good methodological quality studies are needed to evaluate the cost/benefit ratio of rehabilitation in a PMR ward after TKA in the French health care system.
Barrois
B
B
Service de MPR, centre hospitalier de Gonesse, 25, rue Pierre-de-Theilley, BP 30071, 95503 Gonesse cedex, France. brigitte.barrois@ch-gonesse.fr
Ribinik
P
P
Gougeon
F
F
Rannou
F
F
Revel
M
M
D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation*; D005602:France; D006757:Hospital Units; D006801:Humans; D011182:Postoperative Care; D020127:Recovery of Function