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Aquatic therapy soon after total knee arthroplasty improves
outcomes Public release date: 21-Dec-2011
Opposite effect found after total hip
arthroplasty in a new study in the Archives of Physical Medicine and
Rehabilitation
Philadelphia, PA – Despite increased use of total hip arthroplasty (THA)
and total knee arthroplasty (TKA), there is a notable lack of
consensus about optimal postoperative treatment. Aquatic therapy has
been shown to have a beneficial effect, and it is typically begun
two weeks after surgery, after the wound has healed. According to a
new study published in the Archives of Physical Medicine and
Rehabilitation, beginning aquatic therapy just 6 days after TKA may
lead to improved results, while delaying its onset an additional
week may be more appropriate after a THA.
"This multicenter study demonstrates that the timing of
physiotherapy measures, such as aquatic therapy, has clinically
relevant effects after TKA," says lead investigator Thoralf R. Liebs,
MD, of the Department of Orthopaedic Surgery, University of
Schleswig-Holstein Medical Center, Kiel, Germany. "Ours is one of
the few studies that demonstrates a clinically important effect on
the health-related quality of life after TKA by a factor that can be
influenced by the healthcare professional. The intervention is
simple to administer, and requires limited extra input from the
health care professional."
THA and TKA patients were randomly assigned to receive aquatic
therapy beginning either 6 days or 14 days after the procedure. In
both groups, therapy lasted 30 minutes, three times a week, up to
the fifth postoperative week. Physical function, pain, and stiffness
were evaluated 3, 6, 12, and 24 months after the procedure.
After hip arthroplasty, all measurements at every follow-up period
were better in the patients who began aquatic therapy after the
wound had healed. In contrast, all mean outcomes were better in the
group that began therapy 6 days after knee arthroplasty.
"THA has a high rate of patient satisfaction, and patients report an
improved quality of life after the procedure. Additional
interventions, such as early aquatic therapy, may not lead to much
improvement," Dr. Liebs hypothesizes. "After TKA, patients are less
satisfied, so the additional intervention has a greater effect. The
hydrostatic force of water reduces effusion in the knee joint.
Because the knee capsule is closed after TKA, reduced effusion leads
to less pain. In THA, the joint capsule is not closed, so the effect
of reduced effusion is less."
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The article is "Multicenter Randomized Controlled Trial Comparing
Early Versus Late Aquatic Therapy Following Total Hip or Knee
Arthroplasty," by Thoralf R. Liebs, MD, Wolfgang Herzberg, MD,
Wolfgang Rüther, MD, PhD, Jörg Haasters, MD, PhD, Martin Russlies,
MD, PhD, Joachim Hassenpflug, MD, PhD, on behalf of the Multicenter
Arthroplasty Aftercare Project, MAAP. It will appear in the Archives
of Physical Medicine and Rehabilitation, Volume 93, Issue 2
(February 2012), published by Elsevier.
doi:10.1016/j.apmr.2011.09.011.
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