Houston Methodist. Leading Medicine

Knee News

Physical Therapy Helps After Hip or Knee Replacement

Most patients have a good result after total hip or total knee replacement. Problems occur in about 15 to 20 percent of the rest. Physical therapists from the Sinai Hospital in Baltimore, Maryland studied what happens and how to help these patients.

Patients were divided into groups based on muscle weakness, muscle tightness, nerve problems, and differences in leg-length. X-rays were taken to rule out a problem with the implant itself. Hip abductor muscle weakness was the biggest problem in hips. Knee flexion contracture (unable to straighten the knee fully) was the biggest problem for knees.

In a smaller number of cases poor alignment in other joints caused problems once the hip or knee was replaced. Nerve entrapment causing burning pain and weakness was present in a few patients. A difference in leg length from side to side occurred for various reasons in another small group of patients. The authors reported the changes in function patients had with each of these problems.

Treatment for each soft tissue problem was reviewed. Muscle contractures were treated with aggressive physical therapy, injection, or surgery. In some cases, a custom made brace was used three times a day for 30 minutes (or more). Muscle weakness was treated with aquatic therapy, strength training, and electrical stimulation. Balance retraining was also included.

After three to six months of physical therapy, 92 percent of the patients had restored function. The rest of the patients needed surgery. The authors point out that in a small number of patients with failed joint implants, an aggressive and structured physical therapy program may be needed.

Anil Bhave, PT, et al. Functional Problems and Treatment Solutions After Total Hip and Knee Joint Arthroplasty. In Journal of Bone and Joint Surgery. February 2005. Volume 87-A. Supplement 2. Pp. 9-21.


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