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Assessing Recovery and Establishing Prognosis Following Total Knee Arthroplasty

DM Kennedy, BScPT, MSc, is Manager of Program Development, Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, 43 Wellesley St E, Toronto, Ontario, Canada M4Y 1H1. She also is Instructor, Department of Physical Therapy, University of Toronto, and Part-time Assistant Clinical Professor, School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
PW Stratford, PT, MSc, is Professor, School of Rehabilitation Science, and Associate Member, Department of Clinical Epidemiology and Biostatistics, McMaster University, and Scientific Affiliate, Department of Surgery, Sunnybrook Health Sciences Centre.
DL Riddle, PT, PhD, FAPTA, is Otto D Payton Professor, Department of Physical Therapy, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, Va.
SE Hanna, PhD, is Associate Professor, Department of Clinical Epidemiology and Biostatistics and School of Rehabilitation Science, McMaster University.
JD Gollish, BASc, MD, FRCSC, is Medical Director, Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, and Assistant Professor, Department of Surgery, Faculty of Medicine, University of Toronto.

d.kennedy{at}utoronto.ca

Background and Purpose: Information about expected rate of change after arthroplasty is critical for making prognostic decisions related to rehabilitation. The goals of this study were: (1) to describe the pattern of change in lower-extremity functional status of patients over a 1-year period after total knee arthroplasty (TKA) and (2) to describe the effect of preoperative functional status on change over time.

Subjects: Eighty-four patients (44 female, 40 male) with osteoarthritis, mean age of 66 years (SD=9), participated.

Methods: Repeated measurements for the Lower Extremity Functional Scale (LEFS) and the Six-Minute Walk Test (6MWT) were taken over a 1-year period. Data were plotted to examine the pattern of change over time. Different models of recovery were explored using nonlinear mixed-effects modeling that accounted for preoperative status and gender.

Result: Growth curves were generated that depict the rate and amount of change in LEFS scores and 6MWT distances up to 1 year following TKA. The curves account for preoperative status and gender differences across participants.

Discussion and Conclusion: The greatest improvement occurred in the first 12 weeks after TKA. Slower improvement continued to occur from 12 weeks to 26 weeks after TKA, and little improvement occurred beyond 26 weeks after TKA. The findings can be used by physical therapists to make prognostic judgments related to the expected rate of improvement following TKA and the total amount of improvement that may be expected.

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