This special issue of Topics in Geriatric Rehabilitation focuses on the rehabilitation of geriatric clients who have undergone one of the most common surgical procedures this demographic group experiences, namely, total knee arthroplasty (TKA). The selected topics in the issue are intended to offer the clinician direction in making treatment decisions, information on new operative and rehabilitation techniques, and insight into poorly discussed issues related to the TKA rehabilitation including treating the cancer survivor and returning these patients to higher-level activity or even return to sports. Information in this issue is derived from the best available evidence; however, outcome measures for this procedure vary widely across the rehabilitation literature, making comparisons difficult.1 Finally, this issue provides clinicians with information about perisurgical techniques that can improve their outcomes including the use of clinical predictors, implementing prehabilitation programs, and personalizing the frequency of rehabilitation visits.
A physical therapist was recently heard describing the comments about how an orthopedic surgeon visiting a physical therapist's facility seemed to always minimize the importance of the rehabilitation professionals who “rehabilitated” his patients following knee arthroplasty. The therapist continued in his description of the surgeon, recounting instructions the orthopedist would give every patient early in a postoperative visit that optimal recovery from knee replacement required the patient to concentrate on the 3 most important concepts of recovery. With patients straining to hear every important word that was about to be delivered by their doctor, the surgeon described concept 1 to be “bending and straightening that knee.” Now even more eager to hear concepts 2 and 3, the patients directed every fiber of their being toward what was about to emanate from the lips of their surgeon only to hear concept 2 to be “bending and straightening” and concept 3, “bending and straightening.”
Everyone, including the patient, knows that the surgeon recognizes that rehabilitation following TKA is more complicated than these 3 circuitous phrases and that optimal outcomes require the skills of talented rehabilitation personnel. However, this seemingly uncomplicated description of required and necessary patient involvement in the rehabilitation process gave the impression that rehabilitation could be accomplished easily and largely independently.
This special issue seeks to reinforce the notion that rehabilitating patients following knee arthroplasty is more involved than simply teaching and monitoring patients in their performance of a set of exercises or activities. The practice of physical therapy is a dynamic profession, performed by licensed professionals who use an established theoretical and scientific basis.2 As such, physical therapists consider the impact of many variables unique to each patient and situation and then tailor a rehabilitation program unique to each individual patient, using optimal treatment interventions best able to accomplish the goals established by everyone involved.2 Any description of physical therapy, or that of a physical therapist, short of these definitions, means that we have failed our patients and society. It is hoped that this issue can assist in bringing everyone one step closer to success, because TKA rehabilitation is not just bending and straightening any more.
I trust that the reader of this issue will gain as much valuable information related to providing optimal care for their postoperative TKA patients as was intended during team building of this talented and amazing group of authors and reviewers. I also hope that this compendium of reviews, research, and analysis will spur the rehabilitation community toward renewed interest in an old topic and that many will be inspired to undertake to design and conduct the needed studies in this area and to share their findings in an attempt to generate best practice guidelines for our patients.
—Kevin E. Brueilly, PhD, PT
Doctor of Physical Therapy Program
Associate Professor of Physical Therapy
Wingate, North Carolina
1. Kauppilla A-M, Kyllonen E, Ohtonen P, Leppilahti J, Sintonen H, Arokoski JP. Outcomes of primary total knee arthroplasty: the impact of patient-relevant factors on self-reported function and quality of life. Disabil Rehabil. 2011;33(17/18):1659–1667.
2. Interactive Guide to Physical Therapist Practice. About Physical Therapists. Alexandria, VA: American Physical Therapy Association; 2003.