1. Ganz, S. B.
  2. Ranawat, C. S.

Article Content

The purpose of this prospective randomized blinded study was to compare the differences in achievement of postoperative day (POD) of transfers (TU), walker (WU), cane (CU), stairs ambulation (STU) unassisted, 90[degrees] active knee flexion, and discharge between patients who received formal knee flexion exercises and those who did not. Functional recovery following total knee arthroplasty (TKA) must occur at a rate that is consistent with fiscal constraints without compromising patient care. The primary physical therapy goals after TKA are TU, WU, CU, STU, and active knee flexion to 90[degrees]. Functional progression may be influenced by many factors including type of therapy patient receives. Forty consecutive patients with osteoarthritis of the knee underwent a unilateral TKA by a single surgeon. There were 16 males and 24 females ranging in age from 57 to 89 with a mean age of 70.6 years. The 20 randomized controls received continuous passive motion (CPM), transfer and gait training, formal knee flexion exercises, and knee strengthening exercises. The intervention group received the identical treatment as the controls without formal knee flexion exercises. A single physical therapist treated both groups. The Hospital for Special Surgery Functional Milestone Form was used to document the functional progression of POD of TU, WU, CU, STU, active knee flexion to 90[degrees], and discharge Range of motion (ROM) measurements were taken by both the treating physical therapist and a blinded physical therapist. ROM measurements were obtained at 1 week, 4 weeks, 12 weeks, and 52 weeks postoperation. Student t test, Fisher exact test, and Pearson's [chi]2 were used for data analysis. There were no differences between groups for age, sex, height, and weight. There were no differences between groups for POD of achievement of TU, CU, STU, and discharge. There were significant differences in the average degree of active knee flexion and achievement of 90[degrees] of active knee flexion at 1 week, P = .003, and at 4 weeks, P = .03, and significant differences in the percentages of subjects who achieved 90[degrees] of active knee flexion at discharge, P = .003. There were no differences at 3 months and 1 year. Although short-term active knee flexion was increased, the addition of formal knee flexion exercises did not alter the acquisition of functional milestones or long-term achievement of active knee flexion.