Knee osteoarthritis (OA) is a common cause of severe pain, disability within the community, and dependence on others. In the U.S., a total knee arthroplasty (TKA) is one of the most commonly performed orthopedic procedures and 95% of them are attributed to OA. Following a TKA, pain and walking ability are the most important factors that need to be addressed. The purpose of this case report is to describe comprehensive PT management for a patient following a TKA with severe OA of the contralateral knee and report the outcomes.https://dune.une.edu/pt_studcrposter/1108/thumbnail.jp

Ikemura, Michael

English

University of New England

Outpatient Physical Therapy Management of a Total Knee Arthroplasty with Severe Contralateral Knee Osteoarthritis: A Case ReportMichael Ikemura, BS, DPT Student University of New England, Department of Physical Therapy, Portland, MaineOutcomesBackground InterventionsPurpose• Knee osteoarthritis (OA) is a common cause ofsevere pain, disability within the community,and dependence on others.1• In the U.S., a TKA is one of the most commonlyperformed orthopedic procedures and 95% ofthem are attributed to OA.2• Following a TKA, pain and walking ability arethe most important factors that need to beaddressed.3• Describe comprehensive PT management for apatient following a TKA with severe OA of thecontralateral knee and report the outcomes.• A combination of manual therapy and therapeutic exercisedirected towards hip and knee strengthening along withbalance, may be beneficial for functional mobility.• Future research should be performed to further investigateideal PT interventions for patients following a unilateral TKAwith severe contralateral knee OA.ConclusionsCase Description• 64-year-old male s/p three weeks right TKAwith multiple significant co-morbidities (severeobesity, hypertension, DM Type II).• X-rays demonstrated severe OA of his left knee• Highly motivated and great social support fromwife• Completed six outpatient PT sessions over aseven week period• Ambulated using a rolling walker, had bilateralknee pain, impaired right knee ROM, strength,joint play, muscular endurance, and balance.020406080Session 1 Session 4 Session 623 39 29Lower Extremity Functional Scale  References1. What is osteoarthritis? National Institute of Arthritis and Musculoskeletal and Skin Diseases. 2016.Accessed July 29, 2017.2. Martin GM, Thornhill TS, Katz JN. Total Knee Arthroplasty. UpToDate. 2016. Accessed June 24, 2017.3. Yuksel E, K alkan S, Cekmece S, Unver B, Karatosun V. Assessing minimal detectable changes andtest-retest reliability of the TUG and the 2MWT in patients with total knee arthroplasty. J Arthroplasty.2017; 32(2):426-430. doi: 10.1016/j.arth.2016.07.031.Home Exercise ProgramFigure 1. Right TKA at 10weeks post-opStraight Leg Raise, 3x10 dailySide-lying Straight Leg Raise, 3x10 dailyFigure 2. EZ Stretch used for 10 min. sessions, 4-6x/day. Allowed him to stretch his knee in both flexion and extension via mechanical overpressure.0100200300Session 1 Session 4 Session 6178 221 2512 Minute Walk Test (feet)• Patient demonstrated improvement in activity tolerance,walking ability, confidence, pain level, balance, lowerextremity strength, range of motion, and joint mobility.Joint Mobilizations Strengthening Balancewww.hep2go.comwww.hep2go.comwww.mindbodymovement.orgwww.scalpacupuncture.org• Patellofemoral• Tibiofemoral• Total Gym Squats• Partial Lunges• Single Leg StanceFigure 1. Total Gym 26000 allowed patient to perform squats at half of his BW. AcknowledgementsBridging, 3x10 dailywww.hep2go.com• Mike Fillyaw, PT, MS, for assistance with case report conceptualization and Warren Hucks, PT, DPT, OCS, for supervision on the case.T & M Initial DischargeAROM Flexion 76° 117°AROM Extension -12° 0°Pain Rating 7/10 6/10QuadricepsStrength4/5 5/5Hip Abductor Strength3+/5 4/5Assistive Device RW Rollator

Outpatient Physical Therapy Management Of A Total Knee Arthroplasty With Severe Contralateral Knee Osteoarthritis: A Case Report

Background and Purpose: Osteoarthritis (OA) of the knee is a common cause of severe pain, disability within the community, and dependence on others. If conservative treatments fail, orthopedic surgeons often perform a total knee arthroplasty (TKA), in which damaged articular parts of the knee are resurfaced with prosthetics. To maximize physical function, the underlying cause of gait speed limitation must be determined and treated. The purpose of this case report was to examine the impairments following a TKA with concurrent severe OA of the contralateral knee, develop an effective plan of care, describe physical therapy (PT) interventions, and report the outcomes. Case Description: The patient was a 64-year-old male status-post three weeks right TKA with severe contralateral knee OA. He received outpatient PT once a week for seven weeks to improve range of motion (ROM), strength, muscular endurance, balance, and functional mobility. Outcomes: At discharge, the patient demonstrated improved mobility, knee ROM, and strength. The 2 Minute Walk Test score improved from 178 feet to 251 feet, Lower Extremity Functional Scale improved from 23/80 to 29/80, and Numeric Pain Rating Scale improved from 7/10 to 6/10. At discharge, the patient improved right knee flexion to 117 degrees and extension to 0 degrees, and increased quadriceps and hip abductor strength. Discussion: This report suggests that a combination of manual therapy and therapeutic exercise directed towards hip and knee strengthening along with balance is beneficial for function and quality of life for patients following a TKA. Future research should be performed to further investigate ideal PT interventions to improve function for patients with a unilateral TKA and concurrent contralateral knee OA

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Outpatient Physical Therapy Management Of A Total Knee Arthroplasty With Severe Contralateral Knee Osteoarthritis: A Case Report

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