Knee replacement surgeries have increased in frequency in the U.S. In fact, from 2000–2012, Total Knee Arthroplasty (TKA) surgeries increased from 250,000 to more than 600,000 per year. This could be due, in part, to our aging population of baby boomers, as well as the uptick in cases of obesity. However, another possibility is that patients are receiving the surgery well in advance of needing it. What’s worse, some TKA patients experience only minimal benefits from the surgery and may even experience decreased mobility because of it. All of these factors give physical therapists an important teaching opportunity for patients, as well as providers.

Post–Total Knee Arthroplasty (TKA) surgery results

A recent article on medbridge.com uncovered some unsettling statistics on patients’ experiences after knee replacement surgery, which might make patients and providers take pause before agreeing to it:

• Though TKA is reported to reduce pain in 90 percent of patients, 30 percent reported a lack of satisfaction in their physical abilities a full year post-surgery.
• One year after surgery, TKA patients experienced the following in comparison to patients who had not received the surgery:
  • Walking 18 percent slower
  • Climbing stairs 51 percent slower
  • A 40 percent reduction in quadriceps strength
  • Difficulty using stairs in 75 percent of patients
  • Falls during the first year post-op in 24 percent of patients

In addition to these numbers,  a recent study from Virginia Commonwealth University examined whether the TKA received by 205 study participants was actually medically necessary. They discovered that one-third of the TKA surgeries conducted were not needed because patients’ arthritis wasn’t advanced enough to warrant surgery. Also, a follow-up study indicated that only patients with advanced knee damage experienced the maximum benefits of pain reduction and improved knee function from TKA.

The bottom line? Put your Physical Therapy training to work!

These studies should be shared with patients who have been recommended by a doctor for TKA. Physical Therapists— especially if knees are your specialty — can be on the front lines of helping patients determine whether or not to pursue a TKA. Therapists can also remind patients of other alternative treatments that may relieve their knee pain. In addition to physical therapy, these include:

• Weight loss, if appropriate.
• Low-impact exercise.
• Knee injections, such as hyaluronic acid, steroid or cortisone.

Also indicated by the medbridge.com article, only 26 percent of patients receiving TKA were referred for outpatient rehab therapy. So if a patient will be undergoing this surgery, remind them to request adequate post-surgery therapy.

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