Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
Department of Physiotherapy, Tan Tock Seng Hospital, Singapore, Singapore.
J Orthop Surg Res. 2024 May 10;19(1):288. doi: 10.1186/s13018-024-04776-y.
The Enhanced Recovery After Surgery (ERAS) Society recommends that after total knee arthroplasty (TKA), patients should be mobilized early. However, there is no consensus on how early physical therapy should be commenced. We aim to investigate whether ultra-early physical therapy (< 12 h postoperatively) leads to better outcomes.
This is a retrospective cohort study of 569 patients who underwent primary TKA from August 2017 to December 2019 at our institution. We compared patients who had undergone physical therapy either within 24 h or 24-48 h after TKA. Further subgroup analysis was performed on the < 24 h group, comparing those who had undergone PT within 12 h and within 12-24 h. The outcomes analyzed include the Oxford Knee Scoring System score, Knee Society Scores, range of motion (ROM), length of stay (LOS) and ambulatory distance on discharge. A student's t test, chi-squared test or Fisher's exact test was used where appropriate, to determine statistical significance of our findings.
LOS in the < 24 h group was shorter compared to the 24-48 h group (4.87 vs. 5.34 days, p = 0.002). Subgroup analysis showed that LOS was shorter in the ultra-early PT (< 12 h) group compared to the early PT (12-24 h) group (4.75 vs. 4.96 days, p = 0.009). At 3 months postoperatively, there was no significant difference in ROM, ambulatory distance or functional scores between the < 24 h group and 24-48 h group, or on subgroup analysis of the < 24 h group.
Patients who underwent physical therapy within 24 h had a shorter length of stay compared to the 24-48 h group. On subgroup analysis, ultra-early (< 12 h) physical therapy correlated with a shorter length of stay compared to the 12-24 h group (4.75 vs. 4.96 days, p = 0.009) - however, the difference is small and unlikely to be clinically significant. Ultra-early (< 12 h) physical therapy does not confer additional benefit in terms of functional scores, ROM or ambulatory distance. These findings reinforce the importance of early physical therapy after TKA in facilitating earlier patient discharge.
术后加速康复（ERAS）学会建议全膝关节置换术（TKA）后患者应尽早活动。然而，对于何时开始物理治疗还没有共识。我们旨在研究超早期物理治疗（术后<12 小时）是否会带来更好的结果。
这是一项回顾性队列研究，纳入了 2017 年 8 月至 2019 年 12 月在我院行初次 TKA 的 569 例患者。我们比较了术后 24 小时内和 24-48 小时内开始物理治疗的患者。进一步对术后<24 小时的患者进行亚组分析，比较了术后 12 小时内和 12-24 小时内开始物理治疗的患者。分析的结果包括牛津膝关节评分系统评分、膝关节学会评分、关节活动度（ROM）、住院时间（LOS）和出院时的步行距离。使用学生 t 检验、卡方检验或 Fisher 确切概率法来确定我们研究结果的统计学意义。
术后<24 小时组的 LOS 明显短于 24-48 小时组（4.87 天 vs. 5.34 天，p=0.002）。亚组分析显示，超早期物理治疗（<12 小时）组的 LOS 明显短于早期物理治疗（12-24 小时）组（4.75 天 vs. 4.96 天，p=0.009）。术后 3 个月，<24 小时组与 24-48 小时组之间的 ROM、步行距离或功能评分均无显著差异，术后<24 小时组的亚组分析也无显著差异。
与 24-48 小时组相比，术后 24 小时内开始物理治疗的患者住院时间更短。亚组分析显示，与 12-24 小时组相比，超早期（<12 小时）物理治疗与更短的 LOS 相关（4.75 天 vs. 4.96 天，p=0.009），但差异较小，可能无临床意义。超早期（<12 小时）物理治疗并不能在功能评分、ROM 或步行距离方面带来额外获益。这些发现强调了 TKA 后早期进行物理治疗对于促进患者早日出院的重要性。
