Osteoarthritis (OA) is a very common chronic disease that frequently affects the knees of the elderly. The condition usually has a slow onset that results in pain, limited mobility, and stiffness due to swelling of the joint capsule, loss of joint space, and for some, joint deformity. Treatment guidelines generally recommend non-surgical options—like chiropractic care—as a front-line approach, but if conservative care does not produce a satisfactory result or if the condition has already progressed to end-stage knee OA, then a patient may be a candidate for total knee arthroplasty (TKA).
However, TKA does not always produce satisfactory long-term results with many patients continuing to report knee pain and disability. This is especially true if they have either restricted knee range of motion or poor knee alignment. If surgery becomes unavoidable, is there anything the patient can do beforehand to improve their chances for a successful outcome?
Taking into account published studies that support exercise as a means to approve post-surgical outcomes for patients who had undergone TKA, a 2021 study investigated if a knee rehabilitation exercise program could benefit patients awaiting TKA. The study included 60 older women who exercised for 30 minutes per session twice a day for three weeks. Compared with women in a control group who did not exercise, the participants in the exercise group reported better outcomes six weeks following TKA with respect to leg strength, sit-to-stand test performance, and subjective pain and function. Another study found that pre-TKA exercise rehabilitation not only improved sit-to-stand performance and knee range of motion, it also shortened hospital stays.
When the knee is out of normal alignment, the joint may be subjected to increased stress. In addition to treatment to restore proper motion to the knee, musculoskeletal disorders that affect one’s gait—such as ankle pronation—may place added stress on the knee and would also need to be addressed.
For the patient who must have a knee replacement, the data indicate that pre-surgical exercise rehabilitation and efforts to improve knee alignment are a great idea. However, in a perfect world, the goal is to avoid surgery. For knee OA, a doctor of chiropractic may adopt a multimodal approach that can include the following: joint manipulation and mobilization, acupuncture, soft-tissue therapies, modalities (such as low-level laser and interferential current), exercise (including yoga), mind-body interventions (such as mindful meditation and cognitive behavioral therapy), and lifestyle modifications (such as diet and smoking cessation). If necessary, your chiropractor will co-manage the condition with an allied healthcare provider.