Structured Rehabilitation Program for Patients With Total Knee Replacement
Condition: Knee
Study type: Interventional

Summary: 
      This study will be a randomized controlled trial. This study will be conducted in Horizon
      Hospital Lahore. A sample size of 26 patients will be taken. Patients will be divided into
      two groups by lottery method. Group A will be treated with Structured Rehabilitation program
      along with conventional physiotherapy while Group B will be treated with conventional
      physiotherapy only. Both groups will receive treatment for 4 weeks,3 sessions per week. The
      outcome measures Numeric pain rating scale(NPRS),6 minutes' walk test and Womac scale will be
      measured at baseline and at the end of 4th week. Data will be analyzed by SPSS 25.
    

Detailed description: 
      Total knee replacement (TKR) is the most common, gold standard surgical intervention in
      relieving pain, improving physical functions and quality of life in end-stage
      osteoarthritis.An estimated 25-47% of patients who are eligible for primary joint replacement
      in the United Kingdom have isolated unicompartmental osteoarthritis, and would be eligible to
      receive either implant.

      Adequate post-operative pain control in TKR patients is very important as inadequate pain
      control can lead to delayed mobilization, prolonged hospital stay, deep vein thrombosis with
      embolic events, increased psychological stress thereby increasing morbidity and mortality of
      TKR patients.Physiotherapy, principally exercise prescription and gait re- education, is
      advocated for people after THR and TKR.Surgeons are particularly concerned regarding
      cementless implants, given they rely on press fit fixation in the surrounding bone for
      primary stability.Patients undergoing total knee arthroplasty often have unfulfilled
      expectations from the surgery that can lead to dissatisfaction.Patients have a poor
      understanding of outcomes related to total knee replacement (TKR) surgery, with most patients
      underestimating the potential benefits and overestimating the risk of complications.To
      prevent chronic pain after TKR, several perioperative interventions show benefits and merit
      further research. Enhanced Recovery After Surgery (ERAS) has been successfully adopted across
      a range of procedures with using rehabilitation program. This study will focus on effects of
      structured rehabilitation program of 4 weeks with different goals in each week for reducing
      pain and improving function in patients with knee osteoarthritis. Study will provide a
      structured rehabilitation program for the physiotherapist to achieve all goals in three
      phases (protective, Recovery & Activity phase).

      AP Antony-Leo 2019 in this RCT study improvements occurred by following structured
      rehabilitation care,quality of life and joint specific outcomes through medial parapatellear
      approach.Andrew David Beswick. In TKR to prevent chronic pain, showing benefits by using
      several perioperative interventions.In this systematic review the patients with
      osteoarthritis achieve long term outcomes after TKR by using perioperative interventions. In
      evidence base review enhanced recovery after surgery had already been used successfully in
      various surgical specialities. This evidence-based review provides an insight into the best
      evidence linked to each component and their rationale for inclusion in the proposed enhanced
      recovery after surgery protocol. Arijit Goshi 2019. In this evidence base review enhanced
      recovery programmes require a multidisciplinary team of dedicated professionals, principally
      involving preoperative education, multimodal pain control and accelerated rehabilitation;
      this will be enhanced if combined with minimally invasive surgery. The current economic
      environment and restricted healthcare budget further necessitate brief hospitalisation while
      minimising costs.MS Ibrahim 2019.C.E.H Scott 2019. The patient satisfaction rate of 81.4 % at
      12 month in this study is comparable to other studies.In this prospective study it is
      important to clear that whether dissatisfaction is a consequence of surgical technique,
      implant design, patient selection, or counselling and the management of expectation. This
      study provided knowledge about to help patient selection and counselling. Soren T.Sku 2019 in
      an RCT study in patients with knee osteoarthritis who were eligible for total knee
      replacement, treatment with total knee replacement followed by nonsurgical treatment resulted
      in greater pain relief and functional improvement after 12 month as compared to nonsurgical
      treatment.Literature shows that postoperative rehabilitation for total knee replacement is of
      prime importance and improves postoperative outcomes and it would be more beneficial to
      divide outcome goals in phases so as to achieve these goals according to week wise
      distribution
    

Intervention name(s): Structured Rehabilitation Program; Conventional Physical Therapy
Intervention type(s): Other; Other
Intervention description(s): Early Function Phase (Protective phase) week 1 Progressive Function Phase (Recovery Phase) 2nd and 3rd week Advance Function Phase (Activity Phase) 4th week; • Rapid post-operative mobilization • Range of motion exercises started • Passive extension by placing pillow under foot • Flexion-by dangling the leg over the side of bed • Muscle strengthening exercises • Weight bearing is allowed on 1st post-operative
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: Knee pain; knee Replacement; Degenerative knee disease