Formal physical therapy may be unnecessary following total knee arthroplasty: A prospective randomized study

Objectives: Total knee arthroplasty (TKA) is the most commonly performed joint replacement surgery in the United States. With an aging population, the incidence of TKA is expected to significantly increase in future decades. Historically, outpatient physical therapy was considered a crucial aspect of TKA postoperative care. But in recent years, its necessity has been questioned, with national trends moving towards self-directed home exercise programs (HEP) in lieu of formal PT. Methods: A prospective randomized control study was conducted on 341 patients with TKA from January 2017 to December 2018. At 2 weeks, if 90 degrees of flexion was observed, patients were recommended (1) no PT with homeexercises or (2) formal PT. Range of motion was recorded at 6 weeks and 3 months postoperatively. Results: Of the 341 eligible patients who underwent primary TKA, 248 patients were enrolled and randomized to formal PT or HEP. Patients assigned to HEP achieved an average of 109 degrees and 118 degrees of flexion at 6 weeks and 3 months respectively, while patients randomized to PT achieved 106 degrees and 121 degrees of flexion (p > 0.05). All patients achieved a target range of motion greater than 100 degrees at 6 weeks and 110 degrees at 3 months. Patients assigned HEP had an associated average cost savings of $900 per patient compared to PT patients. Conclusion: Formal PT may not be necessary if patients are progressing appropriately after surgery. Instead, a home exercise plan could be a more efficient and cost-effective component of postoperative rehabilitation. Level of evidence: I.