The effect of early progressive isotonic exercise therapy on balance control of patients with total knee replacement

Knee osteoarthritis (OA) is believed to be an important risk factor for falling. Total knee replacement (TKR) is a commonly used choice when other methods are not satisfactory. Proprioception impairment, risk of falling and balance disorder are within the main complications of this method. While multiple protocols have been suggested for TKR, efficacy of early isotonic exercise therapy aimed at improving body balance after TKR has not been thoroughly investigated. In this quasi-experimental study, ten female patients with severe OA, sampled by nonrandomized convenient method were randomly assigned into either “routine”or “early isotonic exercise” groups. The subjects were undergone TKR surgery. The rehabilitation process (being the same for both groups until the second week) was initiated the day after surgery and lasted for 6 weeks. From the second week, the experimental group received progressive, isotonic exercises, in addition to the routine rehabilitation protocol. Static balance was assessed prior to surgery and after the rehabilitation process in both groups by Sharpened Romberg tests. In both groups, static balance was significantly enhanced after surgery and rehabilitation (P<0.000). Prior to surgery the groups were indifferent according to their static balance scores (P=0.423) but, after surgery and rehabilitation, the patients receiving early isotonic exercise in addition to routine physical therapy, were significantly in better balance condition comparing the control group (P=0.000). Routine physical therapy with and without early isotonic exercise therapy enhances static balance but, the balance improvement was more pronounced with this type of exercise. Early administration of isotonic exercise therapy in addition to the routine physical therapy program may enhance balance and prevent fall in patients with TKR.