Chapter 11: Therapeutic Yoga after Knee Replacement 1 CCH
By: Jessica Rassmann, PT, DPT Learning objectives
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.
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.
INTRODUCTION
The purpose of this course is to provide licensed practitioners with information on how therapeutic yoga can be used as a treatment intervention after total knee arthroplasty (TKA). It provides information on the prevalence of knee osteoarthritis and replacement surgery, examines the basic principles of yoga and its musculoskeletal benefits, and reviews conventional management of TKAs. Healthcare providers will learn specific yoga poses and modifications shown to improve range of motion, strength, and balance for the TKA patient. Knee osteoarthritis etiology Knee osteoarthritis (OA) is a degenerative joint disease characterized 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. Secondary knee osteoarthritis is the result of a known cause such as trauma, 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 worldwide 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 Treatment for knee osteoarthritis can be broken down into nonsurgical and surgical management. Initial management commonly begins with conservative treatments and progresses to surgical options once conservative methods are no longer effective. According to the clinical practice guideline from the American Academy of Orthopedic Surgeons, factors that increase the risk for developing 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 (McGrory et al., 2016). A total knee arthroplasty is the surgical treatment 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 prosthetic
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 deformities 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 replacements were performed in the U.S. in 2019, which was a 92% increase 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. Partial knee replacements (medial or lateral unicompartmental, and patellofemoral arthroplasty) decreased 50% in prevalence since 2012 and accounted for just 4.2% of all Postoperative rehabilitation contributes significantly to patient outcomes following a total knee replacement. Currently there is no universally accepted rehabilitation protocol for patients following a TKA, and rehabilitation standards are often surgeon specific. Protocols vary from surgeon to surgeon, but the majority aim to improve quadriceps strength, knee range of motion (ROM), gait, balance, and functional performance. Data collected from patients participating in physical therapy (PT) rehabilitation after TKA revealed the following open chain exercises were consistently performed by most: straight leg raises, quadriceps sets, and short arc quadriceps. Those exercises were commonly progressed to the following closed chain exercises: squats, wall slides, and step-ups. Considerable variation existed in the remainder of exercises documented in the PT records, and in the timing of the initiation of either open or closed chain exercises (Oatis et al., 2019). A 2020 clinical practice guideline (CPG) on the management of total knee arthroplasty was developed by the American Physical Therapy Association (APTA) based on a systematic review of published studies. The CPG recommended that: ○ "Physical therapy management should start within 24 hours of surgery for patients who have undergone TKA. ○ Physical therapists should engage and teach patients to implement passive, active assistive, and active ROM exercises for the involved knee to enhance patients’ potential to reach full functional mobility. knee arthroplasties in 2019 (AJRR, 2020). Total knee arthroplasty rehabilitation
Page 202
EliteLearning.com/ Physical-Therapy
Powered by FlippingBook