Rehabilitation for revision total knee replacement: Survey of current service provision and systematic review

Abstract Background Approximately 6,000 revision total knee replacements are performed annually in the National Health Service. Revision total knee replacement is a major operation with a long recovery period and many patients report suboptimal outcomes. Rehabilitation has the potential to improve outcomes after revision total knee replacement. The aim of this study was to understand current provision of rehabilitation for revision total knee replacement in England and evaluate the existing evidence. Methods A national survey of education and rehabilitation provision for patients receiving revision total knee replacement was completed by physiotherapy staff at 22 hospitals across England. A systematic review was undertaken to identify studies evaluating rehabilitation programmes for revision joint replacement. Searches were conducted in MEDLINE, EMBASE, PsycINFO, CINAHL, and Cochrane databases from inception to 15th June 2022. Studies were included if they evaluated post-operative rehabilitation interventions for adults undergoing revision joint replacement for any indication. Screening, data extraction and assessment of methodological quality were undertaken by two reviewers. Results Survey: Pre-operative education was provided in most hospitals, which predominately involved a single session delivered by a multidisciplinary team. Inpatient physiotherapy commonly commenced on post-operative day 1 and was provided twice daily, with most hospitals also providing occupational therapy. Rehabilitation was often provided in the first four weeks after hospital discharge, either in an outpatient, community or home setting. In most hospitals, the education and rehabilitation provided to patients receiving revision total knee replacement was the same as that provided to patients undergoing primary total knee replacement. Systematic review: Of the 1,445 articles identified in the searches, three retrospective cohort studies based on hospital records review were eligible for inclusion. The studies evaluated intensive rehabilitation programmes delivered in an inpatient hospital setting, consisting of 2-3 hours of daily supervised group or individual physiotherapy, with additional occupational therapy in one study. All three studies reported improvement in functional outcomes for patients undergoing rehabilitation after revision total knee replacement. Conclusion This study identified the need for future research to develop and evaluate tailored rehabilitation to optimise patient outcomes following revision total knee replacement.