PREOPERATIVE PHYSICAL THERAPY IN PRIMARY TOTAL KNEE ARTHROPLASTY

In order to evaluate the efficacy of preoperative physical therapy for patients undergoing elective primary total knee arthroplasty, 10 pati ents completed 6 weeks of physical therapy before surgery (PT group). Ten patients served as controls (C group). Subjects were tested at bas eline (PT only), before surgery, 6 weeks after surgery, and 3 months a fter surgery using the Hospital for Special Surgery knee rating scale, range of motion, thigh circumference, walking speed, Cybex Ii isokine tic knee flexion, and extension testing, and computed tomography scann ing for cross-sectional muscle area. Hospital stay and need for physic al therapy after inpatient rehabilitation were also compared. Physical therapy produced modest gains in isokinetic flexion strength in these severely arthritic knees but no difference in extension strength. The decrease in isokinetic strength after surgery was not affected by pre operative physical therapy. Muscle area did not decrease significantly for the PT group, but it did decrease for the C group after surgery. While postoperative strength differences could not be demonstrated, pr eoperative physical therapy preserved thigh muscle area after surgery. The clinical significance of this finding is uncertain. Consequently, this study failed to support the routine use of preoperative physical therapy in knee replacement surgery.