Home Rehabilitation in Patients After Primary Total Knee Arthroplasty
Condition: Osteoarthritis; Rehabilitation
MeSH terms: Osteoarthritis
Study type: Interventional

Summary: 
      The investigators include patients attending the outpatient clinic in the area of Orthopedics
      and Traumatology of the investigators hospital with a diagnosis of knee osteoarthritis, which
      treatment requires surgery. Patients will be divided into two groups. In both groups, they
      will be given verbal, clear and detailed information on the approach to follow, the exercises
      given in brochures, and in the study group a schedule will be given in order to record
      rehabilitation exercises in patients after total knee replacement (TKA). Both groups will be
      assessed before and after surgery, together with outpatient follow-up by, WOMAC, Visual
      Analogue Scale and OKS (Oxford Knee Score).
    

Detailed description: 
      Osteoarthritis (OA) is the most common rheumatic disease worldwide. OA cause joint pain and
      occupational disability in the adult population. In Mexico, OA is one of the top ten reasons
      of consultation in primary attention care.

      Joint arthroplasty is a major advance in the treatment of chronic joint pain. It is indicated
      in patients in whose conservative medical therapy has failed. Total knee arthroplasty (TKA)
      is a surgery that reduces pain and improves function and quality of life in patients with
      knee disorders, actually is one of the most successful medical procedures. However, a
      critical consideration in patients with TKA is the successful control of postoperative pain.
      An adequate pain control allows faster rehabilitation, reduces complications and is highly
      correlated with patient satisfaction. A multimodal pain management decreases the use of
      narcotics, improve pain scores, increase patient satisfaction and allows early recovery.

      Regarding postoperative rehabilitation, its suggested that rehabilitation programs are based
      on a biopsychosocial philosophy and integrate exercises and self-management interventions are
      effective in the treatment of osteoarthritis. Rehabilitation therapy an important area that
      should be considered. It helps people recover faster from their illness, injury or medical
      procedures and make possible to get back to their daily activities.

      The World Health Organization describes rehabilitation as a process that aims to enable
      people to maintain and achieve their physical, sensory, intellectual, functional,
      psychological and social level in an optimal way. It is known that rehabilitation involves
      contributions from various health disciplines, including physical therapy and occupational
      therapy and offered in inpatient, outpatient and community patients.

      In patients with total knee replacement, rehabilitation interventions may involve education
      and exercise before surgery, early mobilization while being in the hospital and a
      postoperative program, along with an adequate pain management.

      Perioperative care has shown an improvement in the recovery, it reduces hospital day stay,
      convalescent and risk of postoperative medical complications.

      It has been shown that early initiation of rehabilitation within 24 hours after total knee
      arthroplasty reduces in-hospital time and decreases the number of sessions required to
      achieve autonomy, balance and normal gait. Madsen et al. demonstrated that rehabilitation
      exercises at home have the same effect as those made in rehabilitation group within six
      months postoperatively, based on a study of 80 patients randomly divided into a control-
      study group.

      Optimal pain management is vital seeking to achieve the goal of recovery called fast track.
      It involves early therapy with specialized protocols, early discharge and quick recovery.
      Lamplot et al. demonstrated in a prospective randomized study of 36 patients, using this
      method, a decrease in opioid consumption and its adverse effects, a decreased pain score, a
      shortening time for physical therapy and an increase in patient satisfaction.

      Postoperative analgesia can be achieved by a variety of techniques. These include:
      intravenous analgesia, epidural analgesia, techniques for peripheral nerve block and
      periarticular injections. All aim to control pain in patients and provide the better
      satisfaction.

      Integrating these interventions in a clinical pathway, better functional results are
      obtained, hospital stay is reduced and there is an improvement in the patient's recovery,
      mainly in short-term.
    

Intervention name(s): Schedule; Verbal Information and Booklet
Intervention type(s): Other; Other
Intervention description(s): Illustrative daily planner to point the day that the exercise was performed; Verbal information will be provided in order to explain how the patient should perform physical rehabilitation exercises. Furthermore, an illustrative booklet with representative exercises will be given. Also, an illustrative daily schedule to mark on the exact day in which the exercise was performed
Other intervention name(s): Planner; Verbal and Booklet Physical Rehabilitation information
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Arthritis, Degenerative; Recovery of function