Introduction: The provision of early intensive exercise following total knee replacement arthroplasty (TKRA) is popular to enhance physical function pain reduction. Exclusively, aquatic exercise (AE) appears to have an advantage over land exercise (LE) due to its buoyancy and hydrostatic pressure characteristics thus relieves axial weight loading, decreases pain and swelling and physical function especially in early phase after TKRA. However, up to date, there has been few study to compare the clinical efficacy of AE versus LE with controlled study design. Thus the purpose of our study was to compare the clinical efficacy among AE, LE and control group of pain and physical function.
Methods: Between February 2008 and January 2020, total 107 TKRA patients were enrolled in this study. Subjects were divided into three groups, AE, LE and self-home exercise group (HE). We measured range of motion (ROM) of knee, isokinetic strength of knee joint. Total 2 weeks of aquatic and land exercise inpatient programs were provided after 1 week of TKRA to AE and LE group. Two times of 30 minutes for 10 days of intensive range of motion, knee strengthening exercise and balance training were provided to AE and LE group. For HE group, education of ROM, strengthening exercise were educated before discharge.
Results: 100 women and 7 men participated in this study. 36 patients were allocated to AE, 22 patients to LE and 49 patients to HE. Table 2 shows the difference between the range of motion of the knee joint and the pain score before and after surgery in each exercise group. The ROM of the surgical side was improved in all exercise groups, which showed statistically significant result. However, p-value were different for each group, AE was 0.002, LE was 0.046 and HE was 0.030, respectively. Table 3 is comparing the knee extensor strength of the knee joint. In the AE group, the peak torque at the left knee flexion was p-value of 0.024, showing muscle improvement before and after surgery. The difference in mean values between the three groups is not statistically significant.
Conclusion: All group showed significant improvement of pain and knee joint ROM after TKRA. AE after TKRA showed significant improvement in relieving pain compared to LE and HE group. With our results, the two-week rehabilitation treatment immediately after the surgical intervention showed no substantial improvement in muscle strength. However, it has been confirmed to be effective in controlling pain and increasing the knee joint ROM required for initial post-surgery rehabilitation. In conclusion, through this study, we statistically proved that the initial AE showed improvement in related symptoms (pain, joint angle limitation) after surgery. Therefore, AE is an appropriate rehabilitation method for initial rehabilitation, and it can be expected that a combination of continuous strength training will be a more effective rehabilitation method.
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