Physical functioning before knee arthroplasty is not associated with (standardized) preoperative physiotherapy, but is tied to physical functioning 1-year post-surgery: A prospective cohort study

Abstract

Background: and purpose This study investigates whether a (regionally) standardized physiotherapy approach, employing a stepped-care model, can more effectively enhance preoperative physical function in end-stage osteoarthritis (OA) patients undergoing total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA) and improve postoperative outcomes, addressing the current gap in understanding the impact of such interventions. Methods: This mono-center observational prospective cohort study followed 216 primary UKA or TKA patients for one-year post-surgery. Preoperative physiotherapy, recorded through self-reported questionnaires, included standardization and treatment frequency details. Physical functioning assessments encompassed quadriceps and hamstrings muscle strength, functional mobility (FM), and range of motion (ROM). Statistical analyses comprised multivariate and single linear regression for both UKA and TKA groups. Results: Standardized preoperative physiotherapy correlated with superior preoperative extension ROM in TKA patients (B = −3.557, 95 % CI [-.915; −.241]), while less than 10 treatments were associated with superior preoperative extension ROM for both groups (β = −.202, p = .030 and β = −.228, p = .045). No associations were found between location or treatment frequency and preoperative muscle strength or FM. For both groups, preoperative FM, ROM, and muscle strength positively correlated with postoperative levels, except for extension ROM for UKA patients (p = .178). Conclusion: While adherence to standardized preoperative physiotherapy at an affiliated practice did not significantly correlate with preoperative physical functioning levels, a strong relationship exists between preoperative and one-year postoperative physical functioning levels.