Assessing recovery and establishing prognosis following total knee arthroplasty

Background and Purpose Information about expected rate of change after arthroplasty is critical for making prognostic decisions related to rehabilitation. The goals of this study were: (1) to describe the pattern of change in lower-extremity functional status of patients over a 1-year period after total knee arthroplasty (TKA) and (2) to describe the effect of preoperative functional status on change over time. Subjects Eighty-four patients (44 female, 40 male) with osteoarthritis, mean age of 66 years (SD=9), participated. Methods Repeated measurements for the Lower Extremity Functional Scale (LEES) and the Six-Minute Walk Test (6MWT) were taken over a 1-year period. Data were plotted to examine the pattern of change over time. Different models of recovery were explored using nonlinear mixed-effects modeling that accounted for preoperative status and gender. Results Growth curves were generated that depict the rate and amount of change in LEES scores and 6MWT distances up to 1 year following TKA. The curves account for preoperative status and gender differences across participants. Discussion and Conclusion The greatest improvement occurred in the first 12 weeks after TKA. Slower improvement continued to occur from 12 weeks to 26 weeks after TKA, and little improvement occurred beyond 26 weeks after TKA. The findings can be used by physical therapists to make prognostic judgments related to the expected rate of improvement following TKA and the total amount of improvement that may be expected.