French Study Shows No Advantage to Therapy Prior to Knee Replacement

Sarasota, FL (WorkersCompensation.com) – Osteoarthritis is one of the top five reasons for short-term disability. In fact, one study showed that osteoarthritis and associated pains can costs businesses up to four times more in sick days alone.

In the lower body, the knees are the most common place for osteoarthritis to occur. The first line if of treatment is usually conservative with the goal of not only pain management, but avoiding or delaying the need for joint replacement. Conservative treatment may include supportive therapies such as the use of a cane or strength training, over the counter pain medications, anti-inflammatory prescriptions and injections. After those therapies have failed, then a total joint replacement or arthroplasty is often the only option.

Some studies have shown that the physical and functional status before a joint replacement are directly related to outcomes. Surgeries performed later in the natural progression of osteoarthritis result in worse outcomes than those done earlier on while the patient is more mobile. Additionally, numerous studies show that physiotherapy, as well as exercise and occupational therapy along with education may reduce the length of hospital stay, and slightly improve physical and functional outcomes perioperative.  The problem however, is that large clinical trials assessing the short-term and midterm effects of physical therapies prior to surgery are lacking.

French researchers set out to determine how multi-faceted therapy prehabilitation compared to traditional care for functional independence and activity limitations after surgery. Participants aged 50 to 85 with knee osteoarthritis with a total joint surgery scheduled were recruited for the clinical trial. A total of 262 patients were included, with an average age of 68, and 68 percent women. The average pain duration in the group was 9.9 years.

The test group received four sessions of multidisciplinary rehabilitation and education, 2 sessions a week at least 2 month before surgery. The therapy was done in groups of 4 to 6, with a session lasting 90 minutes, which included 30 minutes of education and 60 minutes of exercise. The control group received the usual care, which included an information booklet and standard orthopedic advice.

Thirty-four percent of the experimental group and 27 percent of the control group achieved functional independence on average of 4 days after surgery.  At the 6 month mark, the average scores for pain, stiffness, and function were only slightly better by 2.5 points for the test group. The researchers found no evidence of reduced pain or activity limitations, improved quality of life, or increased number of steps in 6 to 12 months after surgery.

The average cost for surgery in the test group equated to $17,200 in U.S. dollars, compared to $17,600 in the control group.

Overall, the researchers found not solid evidence that multidisciplinary prehabilitation prior to a total knee replacement in osteoarthritis cases improved short-term functional independence, or reduced midterm activity limitations after surgery.

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