Nearly all patients with stiff, arthritic knees seen at Shelbourne Knee Center have developed a loss of knee extension. Even two to three degrees loss of knee extension compared to the opposite knee can cause weakness. Improving range of motion (ROM) in these patients decreases symptoms and improves function, often to the point where total knee arthroplasty (TKA) is no longer necessary.
Our Research-Based Knee OA Rehab Program
The Knee Rehabilitation Program for osteoarthritis (OA) at Shelbourne Knee Center is designed to provide a non-surgical solution for patients with stiff, arthritic knees. Led by Orthopaedic Surgeon Rodney Benner, MD, the program is based on the practice’s long-term data on ACL reconstruction patients, which shows the importance of full ROM in good long-term outcomes (1).
“We worked with our physical therapists to determine the functional improvements we could make with physical therapy and other non-surgical treatments to improve symptoms before surgery, with the goal of not needing the surgery,” says Dr. Benner. “If the patient does need surgery, we want the patient to have a good outcome by going in with the best ROM and strength.”
Dr. Benner and K. Donald Shelbourne, MD, orthopaedic surgeon and founder of Shelbourne Knee Center, have been studying patient results through the OA Rehab Study since 2013. Early results based on data on 396 patients show that:
- Most patients improved with non-operative treatment
- Only 24% went on to have a (TKA) (2).
Within four to six weeks, most patients have less pain and stiffness.
ROM before Strengthening
Unlike other rehab programs where patients with knee OA are sent to therapy for strengthening, the Shelbourne Knee Rehabilitation Program focuses on ROM first. “Physical therapy needs to be done in a specific order,” says Dr. Benner. “Once the patient’s ROM has been maximized, we move on to activities to improve overall function.” Patients work on extension first without also working on flexion or strengthening at the same time. Once extension ROM has been maximized (or has reached a plateau), they begin working on flexion. Strengthening is the last part of the rehab program.
For patients with chronic knee stiffness, a passive knee extension device is often helpful. Ice, compression and elevation can be used to reduce pain and swelling while working on extension and flexion. Cortisone injections can be used as an adjunct to rehabilitation in order to decrease pain so the patient can work on rehab more effectively.
With guidance from a physical therapist or athletic trainer, patients complete the rehab at home. Once patients achieve program goals, they continue to do the rehab at home on a maintenance basis.
Improved Surgical Outcomes
Surgery is reserved for patients who do not achieve adequate pain relief with specialized rehabilitation. For these patients, the pre-op improvements made during the OA Knee Rehabilitation Program facilitate a better surgical outcome and a faster, easier recovery.
Our OA Rehab Study
The OA Rehab Study has data on 396 Shelbourne Knee Center patients enrolled between January 2013 and October 2017:
- 206 women
- 190 men
- Average age: 62 years
- Knee OA:
- 275 unilateral
- 121 bilateral
Methods:
- Unilateral ROM data compared to non-involved knee
- Bilateral ROM data reported as right and left
- ROM and KOOS data at five time points up to one year (KOOS is the Knee injury and Osteoarthritis Outcome Score survey)
- Additional KOOS survey data at two years
Conclusion:
- Most patients improved with non-operative treatment
- Only 24% (110) went on to have a TKA
- Improvements in both ROM and KOOS scores:
- Were seen at one month after treatment
- Appear to be maintained through two years
- This non-operative treatment approach is a good alternative for patients with knee OA
The OA Rehab Study continues to enroll patients and collect data to learn more about factors that lead to success with non-surgical management of knee OA.
For more information about our OA rehab program, please call 888-FIX-KNEE.
References
- Shelbourne DK. Thirty-five Years of ACL Reconstruction, presentation at Andrews University, February 2018.
- Shelbourne DK. Nonoperative Treatment of Knee Osteoarthritis, presentation at the Herodicus Society Meeting, June 2018.