Focused Rehabilitation Treatment of Poorly Functioning Total Knee Arthroplasties.

Ulrich SD, Bhave A, Marker DR, Seyler TM, Mont MA

This study asked if focused physical therapeutic techniques influenced the clinical outcome in patients who report functional problems following total knee arthroplasty (TKA) without obvious cause. 56 patients with functional problems after TKA were identified and outcomes following focused physical therapy modalities are described. Assessments included detailed physical examination, videotape analyses, electromyograms, nerve conduction studies, foot pressure studies, and isokinetic strength measurements in selected patients. Identified abnormalities were knee flexion contracture, quadriceps muscle weakness, knee flexion deficit, limb length difference, foot and ankle malalignment, and peroneal nerve entrapment. Focused treatment protocols for each of the six abnormalities included knee braces, shoe lifts, orthoses, electrical stimulation, peroneal nerve releases, and intramuscular botulinum toxin injections. Fifty-three patients (95%) had Knee Society scores greater than 80 points at final minimum followup of 24 months. Patient satisfaction was a mean of 9.1 out of 10 possible points. The results suggest focused physical therapy may help patients with difficult functional problems after TKA.

Clinical Orthopaedics and Related Research, August 2007, online article ahead of print

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wheelchair training for physiotherapists and physical therapists

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