Early Regain of Function and Proprioceptive Improvement Following Knee Arthroplasty

Abstract

Background: Techniques that allow early muscle activation, such as closed kinetic chain (CKC) and open kinetic<br />chain (OKC) exercises, may play a beneficial role in the early rehabilitation of the reconstructed knee. However,<br />current rehabilitation regimens have not been shown to reverse post-operative quadriceps activation failure<br />and weakness. To investigate whether patients who use a continuous active motion (CAM) device that follows<br />closed kinetic chain principles have better early post-operative functional improvements than patients who use a<br />continuous passive motion (CPM) device that follows the principles of open kinetic chain principles. A prospective<br />randomized controlled trial with non-blinded study staff. A tertiary care clinic at a teaching hospital. A total of 110<br />patients signed the consent form and 83 patients participated in the study.<br />Methods: Patients were randomly assigned to use either the CPM device for 4 hours daily for 3 weeks (control<br />group), or a CAM device for 3 sessions of 20 minutes for 3 weeks (intervention group), starting 24 hours after<br />knee replacement surgery.The primary outcome measure was to identify the superiority, inferiority, or equivalence<br />of one device at week 4 after knee arthroplasty using various functional outcome measures such as kinesthesia,<br />quadriceps strength, coordination, general orthopaedic outcome measures and narcotic consumption.<br />Results: At 4 weeks, all outcome measurements were comparable between the two groups, with the exception<br />of sit-to-stand test: in the treatment group the time was significantly shorter compared to the control group<br />(P=0.016). Balance was significantly better in both control (P=0.001) and treatment group (P=0.032) compared<br />to prior surgery.<br />Conclusion: Most clinical centers would like to expedite functional recovery of knee arthroplasty patients without<br />increasing the risk of falls. We observed balance and kinesthesia improvements after surgery using either<br />device which may be important to benefit fast recovery programs. Further research is warranted to see whether<br />additional active closed kinetic chain exercised following knee replacement surgery could improve specific<br />functional outcomes such the observed sit-to-stand test.