Rehabilitation of Knee Arthroplasty

Review Article

Austin Phys Med. 2019; 2(1): 1005.

Rehabilitation of Knee Arthroplasty

Khalfaoui S* and Abbassi EI M

¹Department of Physical Medicine and Rehabilitation of the Military Instruction Hospital Mohammed, Morocco

*Corresponding author: Khalfaoui S, Department of Physical Medicine and Rehabilitation of the Military Instruction Hospital Mohammed Assistant professor, V Rabat, Morocco

Received: April 23, 2019; Accepted: May 15, 2019; Published: May 22, 2019


The knee arthroplasty is a surgical indication set in an analgesic and functional aim. Its success depend on a global reeducational support before and after surgery in which the patient plays a signification role in order to improve quality of life respecting the advises and instructions.

Keywords: Knee arthroplasty; Rehabilitation; Monitoring


Osteoarthritis is a degenerative pathology inflammatory, due to the wear of cartilage present at the surfaces of sliding. Gradually, the different components of the knee joint irreversibly degrade causing painful stiffness and a reduction of the walking distance. The goal of total knee arthroplasty is to remove the pain, recover the joint mobility and resume activities of daily life in particular walking, transfers and stairs.

Rehabilitation after arthroplasty knee adapts to each patient according to his health status, background, abilities functional and especially its previous state before fitting the prosthesis. Its duration with the physiotherapist lasts a few weeks relayed by self-education that the patient must continue for up to 12 months Postoperative.

A study conducted by Eschalier has shown that the delivery of an information booklet concerning the overall care of knee osteoarthritis has no effect on improving knowledge and beliefs of the patient candidate to a total knee prosthesis [1]. In addition, the rehabilitation treatment preoperative encompassing physiotherapy and education has demonstrated its effectiveness in gonarthrosis [2]. The duration of hospitalization in the service of surgery was reduced by the improvement techniques of implantation of PTG, Medical control conditions and perioperative paramedical and economic imperatives.

In 1987, the transition to a center specialized rehabilitation after completion a PTG remained mandatory for Darnault et al. In order to improve the patient’s autonomy before returning to home [3]. In 1999, this choice was justified by the difficulties encountered in rehabilitation specialized as well as the need for a close medical supervision until the 18th postoperative day [4]. In 1992, it was demonstrated by a study by the Belgians, that the care early return allowed home two to three weeks [5]. The functional prognosis of arthroplasty total knee would depend on the quality of early rehabilitative management in surgery [6-8]. In the literature, we often report the interest and the positive effect of rehabilitation pre, peri and post-operative on the function and the quality of life [9].

In operated patients, able to return at home directly, the prescription of systematic physiotherapy is not recommended. However, it could facilitate trophic recovery and strength muscle as well as recovery functional.

It is therefore beneficial for these patients to prescribe a series of session physiotherapy for the purpose of improvement functional, according to the professionals of surgery and physical medicine and Rehabilitation.

Preoperative rehabilitation aims to alleviate pain, improve walking by increasing the walking distance, facilitate joint mobility of the knee, and to prepare for the surgical procedure.

The results obtained after an implantation of PTG are different despite a well-conducted surgical technique, good prosthetic implants and existence complications.

The functional result depends largely part of the anterior mobility of the knee, pre-operative muscle strength, the existence of risk factor without forget the voluntary mentality or not patient candidate for this surgery.

The decrease in muscle strength is a considerable factor because it is present from concrete way given the decline in activity physical caused by osteoarthritis; and the surgical procedure aggravates even more this loss of strength and voluntary contraction; hence the importance of emphasizing Analytical muscle and global preoperative by simple exercises, easy to achieve at home.

It is thus advisable to learn some exercises to be repeated at home twice day to walk type 20 minutes without pain, aerobics exercises, bike 10 minutes, muscle stretching, etc. [10-12].

After completion of the PTG implant, the purpose of surveillance is to detect post-operative complications and evaluate functional and clinical results.

She can be divided into 3 steps [13]:

1. During hospitalization in surgery

2. During rehabilitation functional

3. Long term.

During hospitalization in the orthopedic surgery service

The surgeon checks the presence of a mechanical compression as soon as you wake up patient, eliminates the sciatic nerve external poplitia by checking the sensitivity and motor skills, palpate peripheral pulses distal, without forgetting the loco-regional state of the knee as well as the general signs.

The Redon drain is removed to the second day if more flow, and the dressings are redone with supervision skin condition in search of a cicatricial disunion, dry necrosis or wet or possible infection.

Thromboembolic complications are clinically screened and prevented by anti-coagulant treatment covering four weeks postoperatively. The rehabilitation is started gradually, and in the case of a mobility deficit, an early mobilization under anesthesia general could be proposed.

Pain is a surveillance factor, which could disrupt the course of the functional rehabilitation protocol.

It must be taken care of early and preferably the day before anesthesia, as well as throughout the convalescence.

During functional rehabilitation [14]

It takes place classically in the reeducation center. Removal of staples or threads is made from J12 post-operative according to the cutaneous state and the scar (Figure 1). Cutaneous disorders gradually regress with the application of icing for ten minutes 5 to 6 times a day covering the skin by a towel to avoid the burn. The goal of rehabilitation is to get a knee, stable and painless.