Rehabilitation strategies for optimisation of functional recovery after major joint replacement

Thomas Bandholm, Thomas W Wainwright, Henrik Kehlet, Thomas Bandholm, Thomas W Wainwright, Henrik Kehlet

Abstract

Exercise-based interventions applied before and after total hip and knee arthroplasty (THA and TKA, respectively) have been investigated for a number of years, based on the assumption that they will enhance post-operative recovery. Although recent studies suggest that high-volume, pre-operative exercise may enhance post-operative recovery after TKA, studies of post-operative exercise-based interventions, have not found superiority of one exercise regime over another. It seems, however, that post-operative, exercise-based, rehabilitation is superior to no or minimal rehabilitation after THA and TKA.The goal of this commentary is to summarize recent evidence for the efficacy of different peri-operative exercise-based interventions to enhance recovery after THA and TKA, and to propose new strategies to further enhance post-operative recovery.There is a major need to improve functional recovery after THA and TKA. We propose a strategy of "enriched" trials where specific rehabilitation interventions are applied to different patients based on, for example, their expectations for post-operative recovery, willingness to undertake exercise and physical activity, and pre-operative functional performance.

Keywords: Exercise therapy; Hip arthroplasty; Knee arthroplasty; Physical therapy; Rehabilitation.

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Competing interests

Thomas Bandholm - has received speaker’s honoraria for various enhanced recovery after surgery symposia, but has no relevant conflict of interest related to this work. The manuscript represents a narrative update on recent scientific data, all of which have been independent of industry or agencies. The author has not been paid to write the article nor is in any way dependent on any pharmaceutical/medical device company or other agencies. Thomas Bandholm is a Physical Therapist and Exercise Physiologist, hence, a potential cognitive bias is the love of exercise.

Thomas Wainwright - has received speaker’s honoraria for various enhanced recovery after surgery symposia, but has no relevant conflict of interest related to this work. The manuscript solely represents an update on recent scientific data, all of which have been independent of industry or agencies. The author has not been paid to write the article nor is in any way dependent on any pharmaceutical/medical device company or other agencies. He is a director/treasurer of The Enhanced Recovery after Surgery Society (UK) c.i.c. (not-for-profit organisation - Company No. 10932208).

Henrik Kehlet - has received speaker’s honoraria for various enhanced recovery after surgery symposia, but has no relevant conflict of interest related to this work. The manuscript solely represents an update on recent scientific data, all of which have been independent of industry or agencies.

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