Stratification of Outpatient Physical Therapy Following Total Knee Arthroplasty: Knee Arthroplasty Physical Therapy Pathways (KAPPA) Non-Randomized Controlled Trial

Larissa Sattler, Adam Walker, Adrian Kan, Wayne Hing, Christopher Vertullo

Research output: Contribution to journalArticleResearchpeer-review


BACKGROUND: Outpatient physical therapy following total knee arthroplasty (TKA) is often considered crucial for an effective recovery. However, recent evidence suggests that a self-directed pathway may yield similar benefits to supervised care. Despite this, there appear to be no established criteria to determine who can successfully self-direct their rehabilitation versus those who would benefit from outpatient physical therapy. This study aimed to determine if early postoperative criteria can stratify TKA patients into a self-directed or supervised physical therapy pathway without compromising outcomes.

METHODS: Overall, sixty TKA patients were initially allocated to a self-directed, unsupervised protocol for their postoperative rehabilitation. Baseline demographics, along with functional and self-reported outcomes, were assessed preoperatively and at two weeks, six weeks, and four months following surgery. Patients were referred to supervised outpatient physical therapy if they met any of the following KAPPA criteria: 1) knee flexion range of motion (ROM) <90 degrees; 2) knee extension ROM lacking > 10 degrees; or 3) dissatisfaction with the progress of their rehabilitation.

RESULTS: At two weeks post-TKA, 28 participants met the KAPPA criteria for supervised physical therapy for reasons of knee flexion < 90 degrees (61%), a lack of knee extension > 10 degrees (36%), or not being satisfied with the progress of their recovery (3%). The remaining 32 participants continued with a self-directed rehabilitation pathway. All outcomes assessed favored the self-directed group at two weeks, however, after an average of four supervised physical therapy sessions at four months there were no longer any differences between the two groups.

CONCLUSIONS: Over half of the included participants in this study could successfully self-direct their rehabilitation following TKA without supervised physical therapy while also maintaining excellent clinical and self-reported outcomes. For those who met the KAPPA criteria at two weeks post-TKA, four supervised physical therapy sessions appeared to be beneficial when outcomes were reassessed at four months.

Original languageEnglish
Pages (from-to)1-19
Number of pages19
JournalJournal of Arthroplasty
Publication statusAccepted/In press - 6 Feb 2024


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