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Physical Therapy after TKR

- See: Function and Activity after TKR 

- Post Operative ROM:
    - most important factor predicting ultimate ROM is range of motion before surgery; 
           - ref: Range of Motion Correlates with Patient Perception of TKA Outcome.
    - patients with significant stiffness before surgery will have the most difficulty gaining range of motion;
    - lateral retinacular release & sacrifice or retention of posterior cruciate ligament, do not significantly affect knee ROM after surgery;
           - final ROM after knee arthroplasty is fairly similar among various prosthetic designs, and usually approximates 100-115 deg; 
    - Knee Extension: - Flexion Contracture Post TKR
           - closed chain - press against the wall exercise;
           - patient places his/her back and buttocks agaist the wall - standing and slight crouched;
           - the operative leg is extended as much as possible with the foot on the floor;
           - the patiet then extends the knee, trying to fire the quadriceps as much as possible;
           - references: 
                 - Flexion Contracture Persists If the Contracture is More Than 15° at 3 Months After Total Knee Arthroplasty

    - Continuous Passive Motion: 
           - may decrease DVT/PE in TKR:
           - use of CPM may result in faster recovery of motion immediately after surgery, but appears not to
                    ultimately increase ROM at one year post surgery; 
           - references:
                    - Beneficial effects of continuous passive motion after total condylar knee arthroplasty.
                    - A controlled evaluation of continuous passive motion in patients undergoing total knee arthroplasty.
                    - Deep-vein thrombosis and continuous passive motion after total knee arthroplasty.
                    - The influence of continuous passive motion on outcome in total knee arthroplasty
                    - The role of continuous passive motion following total knee arthroplasty
                    - The effect of continuous passive motion on wound-healing and joint mobility after knee arthroplasty
                    - A Comparison of 2 Continuous Passive Motion Protocols After Total Knee Arthroplasty:
                    - Blood loss after total knee replacement. Effects of tourniquet release and continuous passive motion
                    - Continuous passive motion improves active knee flexion and shortens hospital stay but does not affect other functional outcomes after knee arthroplasty. 
                    - The use of Continuous Passive Motion (CPM) in the rehabilitation of patients after total knee arthroplasty.
                    - Continuous passive motion following total knee arthroplasty.
                    - Knee flexion significantly reduces blood loss and transfusion rate after uncemented total knee arthroplasty
                    - Blood loss after total knee replacement. Effects of tourniquet release and continuous passive motion.

- Early Loss of ROM:
    - manipulation may be indicated in some cases of limited postoperative knee flexion (up to 7% of patients);; 
    - manipulation: 
         - in the study by Esler CNA, et al, manipulation under anesthesia was performed on 47 knees;
               - patients were considered for manipulation if their flexion was less than 80 deg at at mean of 11 weeks postop;
               - goal was to overcome intra-articular adhesions.
               - delaying manipulation well beyond the timing of earlier studies was important in maintaining gains in flexion;
               - it was found that the mean gain in flexion at one year was 33 deg;
         - complications of manipulation:
               - hemarthrosis;
               - supracondylar femur fracture;
               - wound dehiscence
               - patellar tendon rupture;
         - reference:
               - Manipulation of total knee replacements. Is the flexion gained retained?  
               - The role of manipulation following total knee replacement.
               - Total condylar knee replacement. A study of factors influencing range of motion as late as two years after arthroplasty.
               - Stiffness After Total Knee Arthroplasty. Prevalence of the Complication and Outcomes of Revision.
               - Management of Stiffness Following Total Knee Arthroplasty. 
               - Predictors of Range of Motion in Patients Undergoing Manipulation After TKA  
               - Stiffness after total knee arthroplasty: does component alignment differ in knees requiring manipulation? A retrospective cohort study of 281 patients.

 - Arthroscopy Following TKR

- References:

A conservative approach is feasible in unexplained pain after knee replacement: a selected cohort study.

 Does a Standard Outpatient Physiotherapy Regime Improve the Range of Knee Motion After Primary Total Knee Arthroplasty?

Incidence and Reasons for Nonrevision Reoperation After Total Knee Arthroplasty

Anabolic steroids after total knee arthroplasty. A double blinded prospective pilot study

Mast cells and hypoxia drive tissue metaplasia and heterotopic ossification in idiopathic arthrofibrosis after total knee arthroplasty 

The influence of immediate knee flexion on blood loss and other parameters following total knee replacement