Total Knee Arthroplasty Assessments Should Include Strength and Performance-Based Functional Tests to Complement Range-of-Motion and Patient-Reported Outcome Measures

Jacob J Capin; Michael J Bade; Jason M Jennings; Lynn Snyder-Mackler; Jennifer E Stevens-Lapsley

doi:10.1093/ptj/pzac033

Total Knee Arthroplasty Assessments Should Include Strength and Performance-Based Functional Tests to Complement Range-of-Motion and Patient-Reported Outcome Measures

Phys Ther. 2022 Jun 3;102(6):pzac033. doi: 10.1093/ptj/pzac033.

Authors

Jacob J Capin^{1

2

3}, Michael J Bade^{1

2}, Jason M Jennings^{4

5}, Lynn Snyder-Mackler⁶, Jennifer E Stevens-Lapsley^{1

2}

Affiliations

¹ Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA.
² Eastern Colorado Veterans Affairs Geriatric Research Education and Clinical Center (GRECC), Aurora, Colorado, USA.
³ Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin, USA.
⁴ Colorado Joint Replacement, Porter Adventist Hospital, Denver, Colorado, USA.
⁵ Department of Mechanical and Materials Engineering, University of Denver, Denver, Colorado, USA.
⁶ Department of Physical Therapy, Department of Biomedical Engineering, and Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA.

Abstract

Range of motion (ROM) and pain often define successful recovery after total knee arthroplasty (TKA), but these routine clinical outcomes correlate poorly or not at all to functional capacity after TKA. The purpose of this Perspective is to underscore the importance of muscle strength and performance-based functional tests in addition to knee ROM and patient-reported outcome (PRO) measures to evaluate outcomes after TKA. Specifically: (1) muscle strength is the rate-limiting step for recovery of function after TKA; (2) progressive rehabilitation targeting early quadriceps muscle strengthening improves outcomes and does not compromise ROM after TKA; (3) ROM and PROs fail to fully capture functional limitations after TKA; and (4) performance-based functional tests are critical to evaluate function objectively after TKA. This Perspective also addresses studies that question the need for or benefit of physical therapy after TKA because their conclusions focus only on ROM and PRO measures. Future research is needed to determine the optimal timing, delivery, intensity, and content of physical therapy.

Keywords: Function; Range of Motion; Rehabilitation; Strength; Total Knee Arthroplasty.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Arthroplasty, Replacement, Knee* / rehabilitation
Humans
Knee Joint
Muscle Strength / physiology
Patient Reported Outcome Measures
Quadriceps Muscle
Range of Motion, Articular / physiology
Recovery of Function

Grants and funding

F32 AG066274/AG/NIA NIH HHS/United States