Staying at Home for Knee Rehab

Total knee replacement patients who did physical therapy at home had similar results to those who went to a clinic

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) After a knee replacement, there's no place like home for your physical therapy — or at least home may be just as good a place as a clinic to do your exercises.

In a new study, knee replacement patients who followed a six-week, monitored exercise program at home showed similar progress to those who were in regular outpatient rehabilitation programs.

Patients could be more comfortable at home and save on health care costs if they weren't required to complete a standard physical therapy program, the authors of this study noted.

A research team led by Marlene H. Fransen, PhD, of the University of Sydney in Australia, recruited 390 patients from 10 hospitals in New South Wales, Queensland and Victoria, Australia. All patients had had total knee replacement surgeries. These patients were 45 to 75 years old.

Dr. Fransen and team assigned the patients to one of two groups when they were discharged from the hospital. The home exercise program group received one session with a physical therapist. They were given written instructions on exercises. Patients were instructed to do 10 sets of each exercise three times a day.

In the first week of the home exercise program, these patients visited a clinic to evaluate their progress. A project manager also called each patient once a week to check in.

Patients in the second group performed a similar exercise program under the direction of a physical therapist in a clinic or hospital. These patients received seven or more therapy sessions during the six weeks after surgery.

At the end of the study, a physical therapist who was not part of the study assessed each patient. The therapists did not know what sort of program the patients had completed.

The therapists found no difference in the patients’ ability to bend or straighten their knees. Patients in both groups reported similar levels of pain, and both groups of patients were able to walk 50 feet. Neither group of patients had high hospital readmission rates.

In knee replacement surgery, a surgeon removes a damaged or painful part of the patients' knee joint and replaces it with an artificial one. Total knee replacements have increased over the last 20 years in many countries, Dr. Fransen and colleagues noted. As people live longer and are more active, demand for surgery has increased and will likely continue to do so, they said.

Six to eight weeks of therapy is the norm for most patients after a total knee replacement.

One of the major implications of this study is related to the costs of physical therapy after a total knee replacement. If most patients do not need the therapy, health care costs can be reduced, Dr. Fransen and colleagues noted. Australia has a national insurance program similar to the US Medicare program. Both programs pay for physical therapy.

Also, driving is typically restricted after a total knee replacement. If the patient didn't have to travel to a clinic or hospital for physical therapy, recovery could be less difficult.

This study was published in December in Arthritis Care and Research.

The HCF Health and Medical Research Foundation and the Bupa Health Foundation, Australia, funded the research. None of the authors disclosed conflicts of interest.

Review Date: 
December 4, 2014
Last Updated:
December 7, 2014