Physical Therapist Management of Total Knee Arthroplasty.
Diane U Jette, Stephen J Hunter, Lynn Burkett and 10 others
PMID 32542403WHAT IT FOUND
PTs should start supervised care within 24 hours, use NMES and high-intensity strength training, and include motor function training.
Avoid continuous passive motion devices. Teach cryotherapy and preoperative exercise. Use group or individual sessions as needed, and collect KOOS JR, 30-Second Sit-to-Stand, and TUG scores.
Key findings
01PTs should not use continuous passive motion devices for primary uncomplicated TKA.
02PTs should use neuromuscular electrical stimulation to improve quadriceps strength, gait, and patient-reported outcomes.
03PTs should design high-intensity strength training programs starting within 7 days after surgery to improve function and strength.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The guideline focuses on physical therapist management, so evidence for other disciplines is limited. Some recommendations, like preoperative education and ROM exercises, are based on expert consensus or low-quality evidence because high-quality trials are lacking or unethical. The optimal timing and dosage for some interventions, such as knee flexion during rest, remain unclear. The guideline does not address revision arthroplasty, pediatric patients, or nonoperative management.
Declared interests
The American Physical Therapy Association funded the work group. The APTA provided coordination but played no role in the design, conduct, or reporting of the recommendations. All group members and methodologists declared no relevant conflicts of interest.
The easy way to misread this
Do not assume all recommendations have the same strength. Some, like preoperative education and ROM exercises, are based on consensus or low-quality evidence, while others, like avoiding CPMs and using NMES, are supported by high-quality studies. Do not apply the guideline to revision surgeries or pediatric patients.