Earlier Initiation of Postoperative Physical Therapy Decreases Opioid Use after Total Knee Arthroplasty

J Knee Surg DOI: 10.1055/s-0040-1721034For patients with advanced osteoarthritis of the knee, total knee arthroplasty (TKA) has been shown to provide significant pain relief and improved function with consistent, reproducible results. Post-operative physical therapy (PT) plays an important role is restoring muscle strength and range of motion (ROM). Yet, the impact of earlier physical therapy initiation after TKA has not been well defined. We assessed 205 patients that underwent primary TKA including 136 patients who started PT on the first post-operative day (POD1) and a second group that started PT 3 days after surgery (POD3), or later. Length of hospital stay (LOS), opioid use during hospital stay, complications, re-admissions, knee ROM and the need for subsequent hospitalized rehabilitation were recorded. LOS was not significantly shorter in the early PT group, compared with the delayed PT group (6.4 ± 2.2 days vs. 6.8 ± 2 days, respectively, P = .217). Patients in the delayed PT group consumed more opioids during their inpatient stay compared with the early PT group on both POD 3 (89% vs 82%, p = 0.013) and POD 4 (81% vs 66%, p = 0.005). There was no significant difference in the incidence of Immediate post-operative complications or final knee ROM between the two groups. While early postoperative PT did not impact hospital LOS or final knee ROM, it was associated with an earlier reductio...
Source: Journal of Knee Surgery - Category: Orthopaedics Authors: Tags: Original Article Source Type: research

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In Reply Dr Lei and colleagues correctly state that the positioning of the external pods of the biomechanical footwear in our trial was individually adjusted. The treatment protocol for adjusting the pods was described in detail in Supplement 3 in the article. This is considerably more detail than most physical therapy or exercise intervention trials provide. Adjustments were done according to this protocol by experienced and trained technicians based on gait patterns and patient-reported symptoms. The attempt to shift the center of pressure in the shoe and foot laterally in patients with medial knee osteoarthritis has bee...
Source: JAMA - Category: General Medicine Source Type: research
Abstract SOURCE CITATION: Deyle GD, Allen CS, Allison SC, et al. Physical therapy versus glucocorticoid injection for osteoarthritis of the knee. N Engl J Med. 2020;382:1420-9. 32268027. PMID: 32926813 [PubMed - as supplied by publisher]
Source: Annals of Internal Medicine - Category: Internal Medicine Authors: Tags: Ann Intern Med Source Type: research
Authors: Schlenk EA, Fitzgerald GK, Rogers JC, Kwoh CK, Sereika SM Abstract A 6-month self-efficacy intervention was compared with attention-control intervention on physical activity, clinical outcomes, and mediators immediate postintervention and 6-month postintervention in 182 older adults with knee osteoarthritis and hypertension using a randomized controlled trial design. The intervention group received six weekly individual physical therapy sessions for lower-extremity exercise and fitness walking and nine biweekly nurse telephone counseling sessions. The attention-control group received six weekly and nine bi...
Source: Journal of Aging and Physical Activity - Category: Geriatrics Tags: J Aging Phys Act Source Type: research
Femoroacetabular impingement (FAI) syndrome is one of the most rapidly evolving etiologies of hip pain. The 2016 Warwick Agreement consensus statement defined FAI syndrome as a triad of symptoms, signs, and radiographic findings. Cam morphology is more likely in athletes and is associated with repetitive hip loading in maximal flexion during adolescence. Much less is known about the development of pincer morphology. Physical therapy improves pain and function, justifying a trial before pursuing surgery. Musculoskeletal injections are utilized for FAI syndrome, but the evidence is limited. Arthroscopic surgery for FAI syndr...
Source: Current Sports Medicine Reports - Category: Sports Medicine Tags: Extremity and Joint Conditions/Section Articles Source Type: research
Knee osteoarthritis (KOA), with a high incidence in old-age population, adversely affects their life quality. The valgus knee bracing is an important physical therapy for KOA, but its clinical effects on pain ...
Source: Journal of Orthopaedic Surgery and Research - Category: Orthopaedics Authors: Tags: Research article Source Type: research
Abstract Femoroacetabular impingement (FAI) syndrome is one of the most rapidly evolving etiologies of hip pain. The 2016 Warwick Agreement consensus statement defined FAI syndrome as a triad of symptoms, signs, and radiographic findings. Cam morphology is more likely in athletes and is associated with repetitive hip loading in maximal flexion during adolescence. Much less is known about the development of pincer morphology. Physical therapy improves pain and function, justifying a trial before pursuing surgery. Musculoskeletal injections are utilized for FAI syndrome, but the evidence is limited. Arthroscopic sur...
Source: Current Sports Medicine Reports - Category: Sports Medicine Authors: Tags: Curr Sports Med Rep Source Type: research
This study aimed to compare the efficacy of four treatments in the management of knee osteoarthritis. We carried out a randomized clinical trial with four study arms in an outpatient Department of Physical Medicine and Rehabilitation at a University Hospital. In total, 120 patients with knee osteoarthritis ≥50 years of age were randomly allocated to four groups. The primary outcome was knee pain in visual analog scale and the secondary outcome was the Knee Injury and Osteoarthritis Outcome Score. The exercise was prescribed daily for all participants throughout the study. For physical therapy (group 1), participants rec...
Source: International Journal of Rehabilitation Research - Category: Rehabilitation Tags: Original Articles Source Type: research
CONCLUSIONS: Diabetes was associated with regional knee pain but not with localized or diffuse knee pain and was associated with moderate to severe knee pain while walking and slower walking speed in people with knee OA. IMPACT: Clinicians may use knee pain map for examining knee pain locations for people with diabetes and knee OA. knee pain during walk and walking speed should be screened for people with knee OA and diabetes because of diabetes influence on theses parameters in this population. PMID: 32750122 [PubMed - as supplied by publisher]
Source: Physical Therapy - Category: Physiotherapy Authors: Tags: Phys Ther Source Type: research
Conclusions For the first time, our review provides standardized clinical treatment parameters for neuromuscular electrical stimulation to be included in a strengthening program for the adult patient with knee OA. To Claim CME Credits Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME Objectives Upon completion of this article, the reader should be able to: (1) Recall the impact of quadriceps femoris weakness on joint stability; (2) Summarize the mechanism of action of neuromuscular electrical stimulation (NMES) on reducing pain and increasing muscle strength; and...
Source: American Journal of Physical Medicine and Rehabilitation - Category: Rehabilitation Tags: CME Article . 2020 Series . Number 8 Source Type: research
Conclusion: PPT is a reliable and valid tool for measuring pain, and it helps clinicians understand the prognostic effect of the intervention, especially in older adults. The tool is consistent at measuring pain and is a valid tool compared to subjective pain scoring.
Source: Nigerian Journal of Clinical Practice - Category: Rural Health Authors: Source Type: research
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