Date of Award

2018

Document Type

Scholarly Project

Degree Name

Doctor of Physical Therapy (DPT)

Department

Physical Therapy

First Advisor

Peggy Mohr

Keywords

Arthroplasty, Replacement, Knee -- rehabilitation; Peroneal Neuropathies -- rehabilitation; Case Reports

Abstract

Introduction. With more than 600,000 knee replacements performed each year in the United States, functional exercise is necessary post-surgery. Patients who undergo knee replacements often attend physical therapy after surgery, which has been found to have significant effects on functional outcomes. In rare cases, patients experience a post-surgical complication of common peroneal nerve palsy (CPNP), and interventions must be adjusted based on the patient's specific needs.

Purpose. This is a case report describing the interventions for a patient with a right total knee arthroplasty ([R] TKA), multiple co-morbidities, and a post-surgical complication of CPNP.

Methods. A 78-year-old female had a (R) TKA after end-stage osteoarthritis (OA). She was referred to physical therapy for evaluation and treatment post-TKA surgery, with a goal of returning to her prior level of function. The plan of care included hip and knee musculature strengthening in weight-bearing (WB) and non-WB, balance training, functional mobility training specific to the patient's goals, and a home exercise program (HEP) to address functional limitations.

Results. Exercise intervention lasted 5 weeks, and the patient displayed improved clinical outcomes in (R) lower extremity (LE) strength and range of motion (ROM), decreased verbal pain rating, and improved functional measures. The Lower Extremity Functional Scale (LEFS) score was reduced from 98% impaired to 46%; however, the patient's further progress in therapy was limited by co-morbidities, specifically the OA in her left knee and her CPNP.

Conclusion. A combination of strength, balance, and functional training led to improved functional outcomes for this patient.

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