Physical Therapy Treatment and Management of a Patient Following Total Knee Arthroplasty: A Case Report and Literature Review

Background: An increasing number of total knee arthroplasties (TKAs) are performed each year, making it a commonly seen post-operative diagnosis in an outpatient orthopedic setting. However, rehabilitation to restore optimal function continues to be a challenge, as research regarding the most effective interventions remains limited. The purpose of this case is to examine the efficacy of physical therapy interventions on range of motion (ROM) and functional outcomes following TKA, as well as demonstrate the need for further research in determining optimal exercise prescription. Case Description: Patient was a 65-year-old male who underwent a right TKA. He presented to therapy with associated post-operative range of motion limitations, decreased lower extremity strength, soft tissue restrictions, and impaired gait. Intervention: Interventions were primarily focused on regaining ROM and lower extremity strength, and included manual therapy, stretching, progressive resistive strengthening, and a home exercise program. Evidence Based Component: A literature review was performed to examine what types of interventions resulted in the most successful outcomes in regards to ROM, pain, quality of life, and reported function following TKA. Outcomes: The patient made gradual progress with physical therapy, but still demonstrated significant ROM deficits and functional mobility impairments after five weeks of formal therapy. Further physical therapy treatment was postponed at this point, as the patient elected to undergo manipulation under anesthesia. Discussion: Outpatient physical therapy is commonly prescribed to patients following TKA. However, regaining function and ROM postoperatively continues to be a challenge for both patients and physical therapists. Further research is needed to determine which therapeutic interventions result in the most successful outcomes in terms of reported function and ROM