The role of pain for early rehabilitation in fast track total knee arthroplasty

Purpose. To investigate the relationship between early functional mobility and pain intensity in a fast track program after total knee arthroplasty (TKA). Methods. One hundred consecutive patients operated with TKA in an orthopaedic unit at a University hospital were prospectively studied. Measurements of independence in transfer and ambulation (Cumulated Ambulation Score), pain intensity (Verbal Analog Scale (VAS)), range of knee motion, functional mobility ('Timed Up & Go' (TUG) test), and walking distance were recorded daily from the first postoperative day until discharge. Results. On the first postoperative day, 90% of the patients were able to walk independently with median pain intensity of <= 5 on VAS. Of these, 78% walked > 70 m. All patients walked independently on postoperative Day 2 with pain intensity of <= 4. On the day of discharge, all patients walked with crutches with pain intensity of <= 3, walking distance > 70 m, median range of motion 10-80 degrees, and median test time of the 'TUG' 19.2 s. The length of hospital stay was median 3 days. Conclusion. Pain has a limited influence on the functional recovery beyond the first postoperative day after TKA, thereby allowing early physiotherapy.