Total Knee Arthroplasty Rehabilitation Strategies for Avoiding Arthrofibrosis and Other Complications with the Goal of Return to Recreational Activities and Active Lifestyle.

Background and Purpose: The purpose of this investigation was to utilize objective measures on a younger population of patients following total knee arthroplasty (TKA) to allow a safe return to recreational and/or work activities and an active lifestyle. Study Design: Descriptive cohort. Methods: Patients 65 years of age and younger planning to undergo a TKA by a single surgeon were identified for inclusion in this prospective study. Males or females 65 years of age or younger who indicated a desire to return to activities of daily living (ADL), recreational and/or work activities, and willing to complete the full post-operative rehabilitation process and patient reported outcome measures (PROMs) were included. Patients with no desire to return to ADL, recreational and/or work activities, history of alcohol or drug abuse within three years of the operation, presence of significant connective tissue disease, autoimmune disease, HIV positive, or any other immune deficiency syndrome were excluded.Study participants were divided into two groups. Group 1 included participants who completed PROMs and surgical expectations pre- and postoperatively. Group 2 included participants who completed subjective and objective testing preoperatively and at 3, 6, and 12 months postoperatively. Patient expectations were polled preoperatively and compared to postoperative outcomes. PROM's for all participants included the Cincinnati Knee Rating System (CKRS), the Knee Injury and Osteoarthritis Outcome Joint Replacement Survey (KOOS JR), and a return to activity scale. All participants underwent a robust rehabilitation program lasting six months or longer that involved prehabilitation and early treatment of motion loss. which resulted in no cases of arthrofibrosis.Additionally, Group 2 completed the Star Excursion Balance Test, the single-leg squat test, the single-leg hop test, a core endurance test, isometric strength testing, the 6-minute walk test, the American Heart Association fitness guideline test, and the stair climbing test. Results: One hundred and one participants (104 knees) 65 years of age or less, who had undergone TKA, were enrolled in this prospective study. Group 1 included 51 participants (54 knees), with a mean age of 58 ± 7 years and a follow up evaluation of 4.4 ± 0.5 years (3.4-5.6 years). The scores for the CKRS patient perception scale improved from 2.0 ± 1.1 to 8.2 ± 1.9 (p<0.0001). Scores for the KOOS JR improved from 43 ± 18 points to 87 ± 18 points after TKA (MCID 14 points). Additionally, responses to patient specific questionnaires reported 91% were able to perform low-impact recreational activities, and 83% could perform a brisk 20-minute walk, five days per week. Ninety-six percent of the participants stated that the surgery was worthwhile and 85% stated the knee was a great deal better.Group 2 included 50 participants (50 knees) with a mean age of 57.5 ± 6.5 years. At three months postoperative, less than 50% of participants were able to meet age and sex criteria for the single leg squat test, 6-minute walk test, muscle strength testing and Y-Balance testing. Major improvements occurred in all tests at six months with participants passing most return to sports parameters. Continued improvements were also found at 12 months postoperative. There were no cases of arthrofibrosis. Conclusions: A structured and tailored rehabilitation program for TKA patients achieved high patient satisfaction and return to recreational activities. Despite subjective improvement noted in Group 1, significant functional deficiencies noted in Group 2 indicate careful consideration is needed regarding discharge from rehabilitation for patients who desire a return to an active lifestyle. Major objective improvements occurred at 6 to 12 months postoperative that allowed patients to achieve return to activity guidelines in this younger population. Level of Evidence: 3b.