Skip to main content
SpringerLink
Log in

Range of motion after total knee arthroplasty: the effect of a preoperative home exercise program

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Preoperative range of motion (ROM) is the most important variable to determine final flexion after total knee arthroplasty (TKA). The purpose of this study was to determine whether a preoperative home exercise program could improve ROM in the arthritic knee and whether this influenced ROM and functional recovery following primary TKA.

Methods

During the period between 2005 and 2006, one hundred and twenty-two patients with gonarthrosis were included in a prospective study and randomly allocated to either the control or the treatment group. The sixty-one subjects in the treatment group underwent a 6-week home-based exercise program before TKA surgery. All one hundred and twenty-two patients were assessed before and after this exercise intervention. Postoperative assessments were at 6 weeks, 6 months and 1 year. Each evaluation included knee ROM and the Knee Society Clinical Rating System. Length of hospital stay and postoperative duration before achieving 90° of knee flexion were also recorded.

Results

Exercise program improves knee motion in the presence of gonarthrosis. After TKA, the patients in the exercise group achieved 90° of knee flexion faster and had a shorter hospital stay. There is no prolonged effect on knee motion or patient function between 6 weeks and 1 year postoperatively.

Conclusion

Preoperative exercise of the arthritic knee facilitates immediate postoperative recovery following primary TKA.

Levels of evidence

Therapeutic study, Level I.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Akagi M, Nakamura T, Matsusue Y, Ueo T, Nishijyo K, Ohnishi E (2000) The bisurface total knee replacement: a unique design for flexion: four-to-nine year follow-up study. J Bone Jt Surg Am 82-A:1626–1633

    CAS  Google Scholar 

  2. Anouchi YS, McShane M, Kelly F, Elting J, Stiehl J (1996) Range of motion in total knee replacement. Clin Orthop Relat Res 331:87–92

    Article  PubMed  Google Scholar 

  3. Babis GC, Trousdale RT, Pagnano MW, Morrey BF (2001) Poor outcomes of isolated tibial insert exchange and arthrolysis for the management of stiffness following TKA. J Bone Jt Surg Am 83-A:1534–1536

    CAS  Google Scholar 

  4. Bautch JC, Malone DG, Vailas AC (1997) Effects of exercise on knee joints with osteoarthritis: a pilot study of biological markers. Arthritis Care Res 10:48–55

    Article  CAS  PubMed  Google Scholar 

  5. Beaupre L, Davies DM, Johnston DB (2004) The effect of a preoperative exercise and education program on functional recovery, health related quality of life, and health service utilization following primary TKA. J Rheumatology 31:1166–1173

    Google Scholar 

  6. Brown K, Swank AM, Quesada PM, Nyland J, Malkani A, Topp R (2010) Prehabilitation versus usual care before total knee arthroplasty: a case report comparing outcomes within the same individual. Physiother Theory Pract 26(6):399–407

    Article  PubMed  Google Scholar 

  7. D’Lima DD, Colwell CW Jr, Morris BA, Hardwick ME, Kozin F (1996) The effect of preoperative exercise on TKR outcomes. Clin Orthop Relat Res 326:174–182

    Article  PubMed  Google Scholar 

  8. Esler CAN, Lock K, Harper WM, Gregg PJ (1999) Manipulation of total knee replacements. J Bone Jt Surg Br 81-B:27–29

    Article  Google Scholar 

  9. Ettinger WH, Burns R, Messier SP, Applegate W, Rejeski WJ, Morgan T, Shumaker S, Berry MJ, O’Toole M, Monu J, Craven T (1997) A randomized trial comparing aerobic exercise and resistance exercise with a health education programme in older adults with knee osteoarthritis. The fitness arthritis and senior trial (FAST). J Am Med Assoc 227:25–31

    Article  Google Scholar 

  10. Feland JB, Myrer JW, Schulthies S, Fellingham GW, Meason GW (2001) The effect of duration of stretching of the hamstring muscle group for increasing range of motion in people aged 65 years or older. Phys Ther 81:1100–1117

    Google Scholar 

  11. Gandhi R, de Beer J, Leone J, Petruccelli D, Winemaker M, Adili A (2006) Predictive risk factors for stiff knees in total knee arthroplasty. J Arthroplasty 21(1):46–52

    PubMed  Google Scholar 

  12. Harvey IA, Barry K, Kirby SPJ, Johnson R, Elloy MA (1993) Factors affecting the range of movement of total knee arthroplasty. J Bone Jt Surg Br 75-B:950–955

    Google Scholar 

  13. Hurley MV, Scott DL (1998) Improvements in quadriceps sensorimotor function and disability of patients with knee osteoarthritis following a clinically practicable exercise regime. Br J Rheum 37:1181–1187

    Article  CAS  Google Scholar 

  14. Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the knee society clinical rating system. Clin Orthop Relat Res 248:13–14

    PubMed  Google Scholar 

  15. Insall J, Scott WN, Ranawat CS (1979) The total condylar knee prosthesis: a report of two hundred and twenty cases. J Bone Jt Surg Am 61-A:173–180

    Google Scholar 

  16. Kovar PA, Allegrante JP, MacKenzie CR, Peterson MG, Gutin B, Charlson ME (1992) Supervised fitness walking in patients with osteoarthritis of the knee. A randomized, controlled trial. Ann Intern Med 116:529–534

    Article  CAS  PubMed  Google Scholar 

  17. Laubenthal KN, Smidt GL, Kettelkamp DB (1972) A quantitative analysis of knee motion during activities of daily living. Phys Ther 52:34–42

    CAS  PubMed  Google Scholar 

  18. Lizaur A, Marco L, Cebrian R (1997) Preoperative factors influencing the range of motion after total knee arthroplasty for severe osteoarthritis. J Bone Jt Surg Br 79-B:626–629

    Article  Google Scholar 

  19. Marks R (1993) The effect of isometric quadriceps strength training in mid-range for osteoarthritis of the knee. Arthritis Rheum 6:52–56

    Article  CAS  Google Scholar 

  20. McCarthy CJ, McCarthy CJ, Mills PM, Pullen R, Richardson G, Hawkins N, Roberts CR, Silman AJ, Oldham JA (2004) Supplementation of a home-based exercise programme with a class-based programme for people with osteoarthritis of the knees: a randomised controlled trial and health economic analysis. Health Technol Assess 8(46):1–61

    Google Scholar 

  21. Mulholland SJ, Wyss UP (2001) Activities of daily living in non-western cultures: range of motion requirements for hip and knee joint implants. Int J Rehabil Res 24:191–198

    Article  CAS  PubMed  Google Scholar 

  22. O’Reilly SC, Muir KR, Doherty M (1999) Effectiveness of home exercise on pain and disability from osteoarthritis of the knee: a randomized controlled trial. Ann Rheum Dis 58:15–19

    Article  PubMed  Google Scholar 

  23. Parsley BS, Engh GA, Dwyer KA (1992) Preoperative flexion: does it influence postoperative flexion after posterior-cruciate-retaining total knee arthroplasty. Clin Orthop Relat Res 275:204–210

    PubMed  Google Scholar 

  24. Ranawat CS (2003) Design may be counterproductive for optimizing flexion after TKR. Clin Orthop Relat Res 416:174–176

    Article  PubMed  Google Scholar 

  25. Ritter MA, Harty LD, Davis KE, Meding JB, Berend ME (2003) Predicting range of motion after total knee arthroplasty: clustering, log-linear regression and regression tree analysis. J Bone Jt Surg B Am 85A:1278–1285

    Google Scholar 

  26. Ritter MA, Stringer EA (1979) Predictive range of motion after total knee replacement. Clin Orthop Relat Res 143:115–119

    PubMed  Google Scholar 

  27. Rodgers JA, Garvin KL, Walker CW, Morford D, Urban J, Bedard J (1998) Preoperative physical therapy in primary TKA. J Arthroplasty 13:414–421

    Article  CAS  PubMed  Google Scholar 

  28. Rooks DS, Huang J, Bierbaum BE, Bolus SA, Rubano J, Connolly CE, Alpert S, Iversen MD, Katz JN (2006) Effect of preoperative exercise on measures of functional status in men and women undergoing total hip and knee arthroplasty. Arthritis Rheum 5:700–708

    Article  Google Scholar 

  29. Rowe PJ, Myles CM, Walker C, Nutton R (2000) knee joint kinematics in gait and other functional activities measured using flexible electrogoniometry: how much knee motion is sufficient for normal daily life? Gait Posture 12:143–155

    Article  CAS  PubMed  Google Scholar 

  30. Schurman DJ, Parker JN, Ornstein D (1985) Total condylar knee replacement: a study of factors influencing range of motion as late as two years after arthroplasty. J Bone Jt Surg B Am 67-A:1006–1014

    Google Scholar 

  31. Swank AM, Kachelman JB, Bibeau W, Quesada PM, Nyland J, Malkani A, Topp RV (2011) Prehabilitation before total knee arthroplasty increases strength and function in older adults with severe osteoarthritis. J Strenght Cond Res 25(2):318–325

    Article  Google Scholar 

  32. Tew M, Forster IW, Wallace WA (1989) Effect of total knee arthroplasty on maximal flexion. Clin Orthop Relat Res 247:168–174

    PubMed  Google Scholar 

  33. Topp R, Swank AM, Quesada PM, Nyland J, Malkani A (2009) The effect of prehabilitation exercise on strength and functioning after total knee arthroplasty. PM R 1(8):729–735

    Article  PubMed  Google Scholar 

  34. Walls RJ, McHugh G, O’Gorman DJ, Moyna NM, O’Byrne JM (2010) Effects of preoperative neuromuscular electrical stimulation on quadriceps strength and functional recovery in total knee arthroplasty. A pilot study. BMC Musculoskelet Disord 11:119

    Article  PubMed Central  PubMed  Google Scholar 

  35. Winter SV, Burch D et al (2000) Effects of preoperative water exercise on TKR patients. J Aquatic Phys Ther 8:12–17

    Google Scholar 

  36. Zakas A, Balaska P, Grammatikopoulou MG, Zakas N, Vergou A (2005) Acute effects of stretching duration on the range of motion of elderly women. J Bodyw Mov Ther 9:270–276

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Orthopedic Clinic, University of Florence, Largo Palagi, 1, 50139, Florence, Italy

    Fabrizio Matassi

  2. Department of Orthopedics, University Hospital Leuven, KU Leuven, Leuven, Belgium

    Joris Duerinckx, Hilde Vandenneucker & Johan Bellemans

Authors
  1. Fabrizio Matassi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joris Duerinckx
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hilde Vandenneucker
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Johan Bellemans
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fabrizio Matassi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Matassi, F., Duerinckx, J., Vandenneucker, H. et al. Range of motion after total knee arthroplasty: the effect of a preoperative home exercise program. Knee Surg Sports Traumatol Arthrosc 22, 703–709 (2014). https://doi.org/10.1007/s00167-012-2349-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-012-2349-z

Keywords

Search

Navigation