Thursday, December 6, 2018

Can You Rehab a Total Knee in 3 Weeks?

If you have been practicing as a therapist or an orthopedic surgeon for any number of years, I would ask you what are you doing differently now than you did 5 or 10 years ago when it comes to your post-op total knee?  If your unable to think of anything then I would encourage you to open your mind and follow along with me for what I believe is a revolutionary approach to total knee rehab.  If your someone who is considering a total knee replacement you can’t afford to be uneducated when it comes to your care.  Keep reading!

What is the single most untapped resource as it relates to total knee rehab?  It’s the patient themselves.  I would suggest to you that there are some novel approaches to total knee rehab that invest heavily in the biopsychosocial model and put the patient in control.  Give the patient a physical tool and protocol to mimic bringing the therapist home with them.  Essentially, turn the patient into their own therapist.  By utilizing a tool which allows the patient to perform a joint mobilization with movement into knee flexion and knee extension the patient becomes much more effective in gaining range of motion.  By utilizing a protocol which focuses on making the nervous system feel safe, creating neural drive at end ranges of flexion and extension and imparting motor control at those end ranges the patient regains active control of the extremity post-operatively much faster.

The combination of this protocol and a physical tool produces a return to full ROM and (I) ambulation with a cane or no AD within 2-3 weeks.  Combine the use of a kinesiotape in a basketweave pattern for edema management and IASTM techniques using a Pacinian stroke and the patient moves quickly and smoothly through their ROM and their rehab. 
Typical case scenarios I have are as follows:  TKA pt utilizes joint mobilization tool and protocol daily beginning day 3 post op and receives 1 therapy visit per week to guide progress.  Pt undergoes basketweave taping to effected knee day 3 post op.  Pt follows specific protocol on their own and has weekly therapy visit for 3 weeks.  At the end of 3 week time frame, the average results are pt ROM 0-120 deg effected knee with active end range control of all ROM resulting in motor control to be (I) ambulators with cane or no AD.

What are the implications of this?  As a profession utilizing this new protocol and tool we can cut post-op rehab by half for the majority of patients receiving total knees.  Currently there are 700,000 total knees every year in the US.  The average rehab costs for each total knee is $2-3,000.  That’s a total of roughly 2.4 billion dollars per year.  By using this new tool and process and speeding up the post op recovery we could save the patient and insurers 1.2 billion dollars every year.
We can deliver a better product, a better service and better outcomes to the patient and do it for a fraction of the cost.  Think outside the box.  Use tools and techniques that are getting results.  We are using the GoKnee device and protocol with our total knees and can turn your rehab around in 4-6 visits.

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