Chapter 11: Therapeutic Yoga after Knee Replacement 1 CC Hour
By: Jessica Rassmann, PT, DPT Learning objectives
Identify yoga poses that have been shown to activate knee musculature to ultimately positively improve occupational performance. Implement evidence-based therapeutic yoga poses shown to improve range of motion, strength, and balance after Total Knee Replacement musculature to ultimately positively improve occupational performance. Recognize the utilization of props in the various poses to address performance barriers. adversely impact health outcomes. Addressing implicit bias in healthcare is crucial for achieving equity in medical treatment. Strategies to combat these biases involve education and aware- ness programs for healthcare professionals. These programs help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased approach to patient care. Addi- tionally, implementing policies and procedures prioritizing equi- table treatment for all patients can play a pivotal role in reduc- ing healthcare disparities. Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system where everyone receives fair and equal treat- ment regardless of their background or characteristics.
After completing this course, the learner will be able to: Recognize the etiology, prevalence, and impacts of knee osteoarthritis and replacement surgeries on our society and individual occupational performance. Describe the foundations of yoga as used in a therapeutic setting. Apply current evidence-based literature regarding the use of yoga poses for knee osteoarthritis and replacement rehabilitation. Implicit bias in healthcare Implicit bias significantly affects how healthcare professionals perceive and make treatment decisions, ultimately resulting in disparities in health outcomes. These biases, often unconscious and unintentional, can shape behavior and produce differences in medical care along various lines, including race, ethnicity, gen- der identity, sexual orientation, age, and socioeconomic status. Healthcare disparities stemming from implicit bias can mani- fest in several ways. For example, a healthcare provider might unconsciously give less attention to a patient or make assump- tions about their medical needs based on race, gender, or age. The unconscious assumptions can lead to delayed or inadequate care, misdiagnoses, or inappropriate treatments, all of which can
INTRODUCTION
cording to the clinical practice guideline from the American Acad- emy of Orthopedic Surgeons, factors that increase the risk for de- veloping osteoarthritis of the knee such that surgical treatment is required include hereditary vulnerability, large body mass, certain occupations, past trauma affecting the joint or subchondral bone adjacent to the joint, and prior intra- articular damage such as meniscal tear or removal, and anterior cruciate ligament tear (Mc- Grory et al., 2016). A total knee arthroplasty is the surgical treat- ment option for patients who failed conservative management of osteoarthritis in more than one compartment of the knee. A TKA involves replacing the articular surfaces (femoral condyles and tibial plateau) of the knee joint with metal and polyethylene pros- thetic components. The main indications for a TKA include knee pain, radiological confirmation of osteoarthritis or osteonecrosis, inadequate response to conservative treatment, adverse impact of knee disease on the patient's quality of life, and the burden of suffering due to the knee disease (Lützner et al., 2018). Total knee replacements continue to be the best option for alleviating knee pain, restoring function, and correcting valgus or varus deformi- ties in patients with progressive and painful osteoarthritis. Total knee arthroplasty epidemiology Knee replacement surgery has become a routine procedure in many hospitals. According to the American Joint Replacement Registry (AJRR) Annual Report, over 995,000 total knee replace- ments were performed in the U.S. in 2019, which was a 92% in- crease since 2012. The mean age for individuals undergoing surgery was 67, and more than half of patients were female. Of the total patients, 88% achieved a meaningful improvement in patient- reported outcome measures one year after surgery. Par- tial knee replacements (medial or lateral unicompartmental, and patellofemoral arthroplasty) decreased 50% in prevalence since 2012 and accounted for just 4.2% of all knee arthroplasties in 2019 (AJRR, 2020).
The purpose of this course is to provide licensed practitioners with information on how therapeutic yoga can be used as a treat- ment intervention after total knee arthroplasty (TKA). It provides information on the prevalence of knee osteoarthritis and replace- ment surgery, examines the basic principles of yoga and its mus- culoskeletal benefits, and reviews conventional management of TKAs. Healthcare providers will learn specific yoga poses and modifications shown to improve range of motion, strength, and Knee osteoarthritis (OA) is a degenerative joint disease charac- terized by progressive loss of articular cartilage and subchondral bone remodeling. Knee osteoarthritis can be divided into two types, primary and secondary, depending on its cause. Primary knee osteoarthritis is the result of articular cartilage degeneration without any known reason, as with age or wear and tear. Second- ary knee osteoarthritis is the result of a known cause such as trau- ma, surgery, disease, infection, or deformity. Typical symptoms of knee OA include pain, muscle weakness, joint instability, brief morning stiffness, crepitus, and functional limitations (Hunter et al., 2019). Knee osteoarthritis epidemiology Knee osteoarthritis is highly prevalent in the U.S. and worldwide. As of 2020 it was estimated that about 654 million people world- wide were affected by knee OA. The global prevalence is roughly 16% in individuals over 15 years of age, and 23% in those over 40 years of age (Cui et al., 2020). The prevalence has been shown to increase with age and is higher among women. The incidence of knee OA is expected to continue to rise as a result of longer life expectancy and increasing BMI (Safiri et al., 2020). Total knee arthroplasty etiology balance for the TKA patient. Knee osteoarthritis etiology Treatment for knee osteoarthritis can be broken down into non- surgical and surgical management. Initial management commonly begins with conservative treatments and progresses to surgical options once conservative methods are no longer effective. Ac-
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