Prehabilitation and rehabilitation for total knee replacement surgery: physiotherapy interventions in personalized medicine and charting a course towards optimal outcomes

Physiotherapy is a critical component in the multidisciplinary team approach to supporting patients to achieve optimal outcomes after the onset of knee osteoarthritis and progression to total knee replacement (TKR) surgery. Physiotherapists possess a wide range of scientifically-informed and evidence-based intervention techniques that can be combined to differing degrees and integrated in differing contexts for the multi-modal, personalized and holistic rehabilitation of patients after TKR surgery. The purpose of this paper is to offer the reader advice and instruction on specific considerations in physiotherapy practice for people preparing for and recovering from TKR surgery. Emphasis is placed on a clinically-reasoned and rational approach with a solid foundation in science and pragmatic clinical practice. Specific comments and recommendations are made regarding defining optimal outcomes after TKR surgery, framing optimal outcomes relative to models of clinical reasoning, the association between impairments (e.g. quadriceps muscle weakness) and physical activity limitations (e.g. inability to walk), physiotherapy intervention techniques in personalized medicine, physiotherapy intervention techniques in prehabilitation and rehabilitation, physiotherapy effectiveness after TKR surgery, and physiotherapy rehabilitation session design and progression. The ideal approach to physiotherapy practice for people preparing for and recovering from TKR surgery is also considered, along with the contribution of outpatient physiotherapy to post-surgery patient satisfaction. Collaboration between the general practitioner, surgeon, physiotherapist, other allied health professionals and the patient is necessary to best influence the probability for optimal outcomes after TKR surgery.