Photo Credit: Mohammed Haneefa Nizamudeen

The following is a summary of “Total Knee Arthroplasty: Does Ultra-early Physical Therapy Improve Functional Outcomes and Reduce Length of Stay? A Retrospective Cohort Study,” published in the May 2024 issue of Surgery by Thwin et al.

The Enhanced Recovery After Surgery (ERAS) Society advocates for early mobilization following total knee arthroplasty (TKA), yet there remains uncertainty regarding the optimal timing for initiating physical therapy. The study investigates whether ultra-early physical therapy, defined as commencement within 12 hours postoperatively, yields superior outcomes. Conducted as a retrospective cohort investigation, the researchers analyzed data from 569 patients who underwent primary TKA at the institution between August 2017 and December 2019. 

Patients were categorized based on the timing of physical therapy initiation: within 24 hours or between 24 and 48 hours post-TKA. Subsequent subgroup analysis focused on patients receiving physical therapy within the first 12 hours postoperatively, compared to those receiving therapy between 12 and 24 hours. The comprehensive evaluation encompassed key metrics, including the Oxford Knee Scoring System score, Knee Society Scores, range of motion (ROM), length of stay (LOS), and ambulatory distance upon discharge. Statistical analysis, employing appropriate tests such as the student’s t-test, chi-squared test, or Fisher’s exact test, was utilized to discern the significance of the findings. Results revealed that patients undergoing physical therapy within 24 hours had a shorter stay than those receiving therapy between 24 and 48 hours (4.87 vs. 5.34 days, p = 0.002). 

Furthermore, subgroup analysis demonstrated a similar trend, with ultra-early physical therapy (<12 hours) correlating with a shorter length of stay compared to therapy initiated between 12 and 24 hours (4.75 vs. 4.96 days, p = 0.009). Nonetheless, the observed difference, while statistically significant, appears unlikely to be clinically meaningful. Notably, ultra-early physical therapy failed to confer additional benefits regarding functional scores, ROM, or ambulatory distance at the three-month postoperative mark. These findings underscore the importance of timely initiation of physical therapy following TKA, facilitating expedited patient discharge, though the precise timing within the ultra-early window may warrant further investigation.

Source: josr-online.biomedcentral.com/articles/10.1186/s13018-024-04776-y