title: Rehabilitative Guidelines after Total Knee Arthroplasty: A Review.
abstract: Rehabilitation following total knee arthroplasty (TKA) continues to pose a challenge for both patients and providers. In addition, guidelines vary considerably between institutions, which often leave therapy regimens to the discretion of the provider. The lack of clear guidelines for rehabilitation may contribute to inadequate recovery of strength and range-of-motion, resulting in less optimal functional outcomes. Therefore, the aim of this review was to highlight and discuss a variety of post-TKA rehabilitative modalities currently available and to provide evidence regarding efficacy and practicality. Specifically, we assessed the role of and evidence for exercise therapy, aquatic therapy, balance training, continuous passive motion, cold therapy and compression, neuromuscular electrical stimulation, transcutaneous electrical nerve stimulation, and instrument-assisted soft-tissue therapy. Additionally, we proposed general recommendations for rehabilitation after TKA, and as we specifically described active and obese patients, we have included guidelines for these subsets as well. Our review examines the various rehabilitative modalities to offer suggestions for recovery of strength and range-of-motion after TKA, with a focus on the early incorporation of exercise therapy, balance training, aquatic therapy, cryopneumatic therapy, neuromuscular electrical stimulation, and transcutaneous electrical nerve stimulation. Dedication and commitment to rehabilitation may help patients attain and exceed their preoperative activity levels.
authors.affiliation: Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopaedics, Baltimore, Maryland.
authors.forename: Jaydev B
authors.initials: JB
authors.lastname: Mistry
authors.affiliation: Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopaedics, Baltimore, Maryland.
authors.forename: Randa D K
authors.initials: RD
authors.lastname: Elmallah
authors.affiliation: Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopaedics, Baltimore, Maryland.
authors.forename: Anil
authors.initials: A
authors.lastname: Bhave
authors.affiliation: Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopaedics, Baltimore, Maryland.
authors.forename: Morad
authors.initials: M
authors.lastname: Chughtai
authors.affiliation: Department of Orthopaedics, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania.
authors.forename: Jeffrey Jai
authors.initials: JJ
authors.lastname: Cherian
authors.affiliation: Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopaedics, Baltimore, Maryland.
authors.forename: Tanner
authors.initials: T
authors.lastname: McGinn
authors.affiliation: Department of Orthopaedic Surgery, Beth Israel Medical Center, New York, New York.
authors.forename: Steven F
authors.initials: SF
authors.lastname: Harwin
authors.affiliation: Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopaedics, Baltimore, Maryland.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Mont
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation*; D006801:Humans; D020370:Osteoarthritis, Knee / Q000601:surgery*; D017410:Practice Guidelines as Topic