Demand for total knee arthroplasty (TKA), one of the most common orthopedic procedures performed in the U.S., is likely to exceed the supply of joint replacement surgeons in the coming years. One projection says that the number of TKAs will increase 5% every year (1). A more conservative projection calls for a 143% increase in TKA volume by 2050 compared with 2012 (1).
“These data emphasize the need for the deployment of innovative prevention and treatment strategies for knee osteoarthritis, especially among younger persons,” says Rodney Benner, MD, orthopedic surgeon at Shelbourne Knee Center.
Innovative Non-Surgical Treatment for OA
Shelbourne Knee Center already has an innovative non-surgical treatment: The Knee Rehabilitation Program for Osteoarthritis (OA).
Led by Dr. Benner, the program is based on the practice’s long-term data on ACL reconstruction patients, which shows the importance of full range of motion (ROM) in good long-term outcomes (2). Unlike other rehab programs where patients with knee OA are sent to therapy for strengthening, the Knee Rehabilitation Program for OA 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. With guidance from a Shelbourne Knee Center physical therapist or athletic trainer, patients complete the program at home.
Most Patients Avoid TKA
Most patients improved with non-operative treatment, according to early results of the OA Rehab Study on 396 patients:
- Only 24% went on to have a (TKA) (3).
- Within four to six weeks, most patients have less pain and stiffness and are able to return to their normal daily activities (3).
The OA Rehab Study began in 2013 and includes:
- 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.
“This non-operative treatment approach is a good alternative for patients with knee OA,” says Dr. Benner. Surgery is reserved for patients who do not achieve adequate pain relief with the Knee Rehabilitation Program for OA. For these patients, the pre-op improvements made during the Knee Rehabilitation Program for OA facilitate a better surgical outcome and a faster, easier recovery.
Lifetime Pain Relief
The Knee Rehabilitation Program for OA is appropriate for patients of all ages. Most patients are discharged from the program after 2–4 months. To continue pain relief and the ability to perform normal activities, patients need to do the exercises and strengthening at least 3 times a week. Over time, patients may be able to do their exercises less often, however, they may need to go back to the full rehab protocol when they’re more active.
For more information about the Knee Rehabilitation Program for OA at Shelbourne Knee Center, call 888-FIX-KNEE.
References
- Inacio MCS, Paxton EW, Graves SE, Namba RS, Nemes S. Projected increase in total knee arthroplasty in the United States – an alternative projection model. Osteoarthritis and Cartiladge. November 2017; 25(11), 1797–1803. https://www.oarsijournal.com/article/S1063-4584(17)31130-5/fulltext.
- 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.