Early post-operative physiotherapy rehabilitation after primary unilateral unicompartmental knee replacement: a systematic review

Cathy Jenkins; Catherine Minns Lowe; Karen L Barker

doi:10.1016/j.physio.2022.05.003

Early post-operative physiotherapy rehabilitation after primary unilateral unicompartmental knee replacement: a systematic review

Physiotherapy. 2023 Mar:118:39-53. doi: 10.1016/j.physio.2022.05.003. Epub 2022 Jun 1.

Authors

Cathy Jenkins¹, Catherine Minns Lowe², Karen L Barker³

Affiliations

¹ Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 7HE, UK. Electronic address: Cathy.Jenkins@ouh.nhs.uk.
² Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 7HE, UK. Electronic address: Catherine.MinnsLowe@ouh.nhs.uk.
³ Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 7HE, UK. Electronic address: Karen.Barker@ouh.nhs.uk.

PMID: 36257840
DOI: 10.1016/j.physio.2022.05.003

Abstract

Background: Unicompartmental Knee Replacement (UKR) is an established treatment for end stage arthritis affecting one compartment of the knee. UKR lends itself to rapid recovery and early discharge. The content, type, timing and dose of early post-operative physiotherapy treatment has yet to be reviewed.

Objective: To review the content of early physiotherapy in the first eight weeks following unilateral UKR.

Data sources: A literature search of Medline, CINAHL, AMED and PubMed and the Physiotherapy Evidence Database (PEDRo) plus citation searching.

Eligibility criteria: Randomised controlled trials (RCTs) and observational studies reporting a physiotherapy intervention for UKR involving a form of post-operative exercise/education/advice delivered within the first eight weeks of surgery and commencing as an in-patient. Two reviewers independently performed screening, data extraction and risk of bias assessment.

Data synthesis: Narrative syntheses were undertaken due to the heterogeneity of the primary outcomes.

Results: Eleven studies were included (n = 1293 participants), three RCTs and eight observational studies. The dose and content of post-operative physiotherapy was highly variable with a move in recent years to rapid recovery and same day discharge with more self-directed rehabilitation. No studies had a low risk of bias.

Limitations: Small sample sizes and high heterogeneity limit our findings CONCLUSIONS: This review highlights the range of post-operative physiotherapy provision following UKR with a recent move to minimal physiotherapy input. Further research is required to identify those patients who may need additional physiotherapy above that now routinely provided, along with the most effective timing, type, and dosage of the intervention.

Systematic review registration number: PROSPERO CRD42021243238. CONTRIBUTION OF THE PAPER.

Keywords: Knee arthroplasty; Physiotherapy; Post-operative; Rehabilitation; Unicompartmental knee replacement.

Publication types

Systematic Review
Review

MeSH terms

Arthroplasty, Replacement, Knee* / rehabilitation
Humans
Knee Joint
Physical Therapy Modalities