# Physical therapy interventions in pain management after knee arthroplasty - Savonia AMK

> BIP Week students’ article on the topic pain management after knee arthroplasty.

## Background: Evidence-Based Physical Therapy (EBP)
Evidence-Based Physical Therapy (EBP) uses the best research evidence with clinical expertise and user’s preferences to produce the most appropriate and effective care. In week 43 of 2024, a Blended Intensive Program (BIP) was held at Charles University in the Czech Republic regarding EBP. The program featured the president of The European Network of Physiotherapy in Higher Education (ENPHE) and focused on the foundations of EBP and challenges across various physical therapy fields.

More than 43 physiotherapy students and 8 teachers from five universities participated:
* Savonia University of Applied Sciences, Finland
* Universidade da Coruña, Spain
* Charles University, Prague
* Universidad Europea de Madrid, Spain
* CEERRF, France

Students collaborated on articles covering themes such as sports, prevention, injuries, neurological diseases, respiratory diseases, cardiovascular diseases, and care for children and older adults. As part of the learning task, students practiced conducting a mini-review and using the PEDro scale to assess study quality.

## Knee Arthroplasty and Pain Management
Knee arthroplasty is a widely performed procedure aimed at reducing chronic pain, improving range of motion (ROM), and restoring knee function in patients with severe knee joint damage. Managing postoperative pain remains a complex issue that impacts both recovery duration and patient outcomes.

This review evaluates the effectiveness of five physical therapy interventions for reducing postoperative pain:
* Manual Lymphatic Drainage (MLD)
* Continuous Passive Motion (CPM)
* Maximal Strength Training
* Pulsed Electromagnetic Fields (PEMFs)
* Compression Therapy

## Methodology
The PICO question addressed was: *Which of the chosen physical therapy interventions are more effective in reducing the level of pain in patients after knee arthroplasty?*

A systematic review was developed using the Pedro, PubMed, and EBSCO databases. Search terms included: “Pain Management,” “Rehabilitation,” and “Arthroplasty, Replacement, Knee.”

### Eligibility Criteria
* **Study Design:** Randomized controlled trials (RCTs).
* **Publication Period:** Last 15 years.
* **Inclusion Criteria:** Studies focusing on physical therapy interventions aimed at controlling and reducing pain after knee arthroplasty.
* **Exclusion Criteria:** Studies with poor methodology or incomplete follow-up data.

## Results and Discussion
The methodological quality of the reviewed studies varied. Two studies scored 8/10 (high quality), two scored 6/10 (good), and one study indicated a need for caution due to interventions not specifically targeting pain management.

The review reveals that Pulsed Electromagnetic Fields (PEMFs) are the most effective intervention for reducing pain, suggesting they may be a valuable accessory to standardized rehabilitation. Other interventions—Manual Lymphatic Drainage, Continuous Passive Motion, Maximal Strength Training, and Compression Therapy—provide varied benefits, often focusing more on mobility or swelling reduction than direct pain relief.

The findings highlight the need for individualized rehabilitation protocols that combine interventions based on specific patient needs. Future research should focus on multi-modal approaches to achieve greater pain relief and improved functional recovery.

## Authors
* **Cesare Vetrano**, physiotherapy student, Universidad Europea de Madrid, Spain.
* **Roberto Blanco Garrido**, physiotherapy student, Universidad Europea de Madrid, Spain.
* **Júlia Rumanová**, physiotherapy student, Charles University, Czech Republic.
* **Sonja Lydman**, physiotherapy student, Savonia University of Applied Sciences, Kuopio, Finland.
* **Abril López Chas**, physiotherapy student, University of A Coruña, A Coruña, Spain.
* **Dagmar Pavlu**, Physiotherapist, Assoc. Prof. Charles University, Czech Republic.
* **Ivana Vláčilová**, Physiotherapist, PhD., Charles University, Czech Republic.
* **Marja Äijö**, PT, PhD Principal Lecturer of gerontology and rehabilitation, Savonia University of Applied Sciences, Kuopio, Finland.
* **Veronica Robles García**, PhD. PT. OT. Lecturer, University of A Coruña, A Coruña, Spain.
* **Beatriz Martínez Toledo**, PT. Lecturer at University of A Coruña, A Coruña, Spain.
* **Montserrat Fernández Pereira**, PT, Lecturer at University of A Coruña, A Coruña, Spain.
* **Lorena Canosa Carro**, PT, MSc, PhD. Lecturer at Universidad Europea de Madrid, Spain.
* **Adrien Pallot**, PT, MSc, Lecturer at CEERRF, France.

## References
1. Gil-González, S., Barja-Rodríguez, R.A., López-Pujol, A. et al. (2022). Continuous passive motion not affect the knee motion and the surgical wound aspect after total knee arthroplasty. *J Orthop Surg Res* 17, 25. https://doi.org/10.1186/s13018-022-02916-w
2. Christensen, L. M. R., Arnesen, C. E., Möller, S., & Hyldig, N. (2021). The effect of compression therapy on post-surgical swelling and pain after total knee arthroplasty. *International journal of orthopaedic and trauma nursing*, 41, 100815. https://doi.org/10.1016/j.ijotn.2020.100815
3. Winther, S. B., Foss, O. A., Klaksvik, J., & Husby, V. S. (2020). Pain and load progression following an early maximal strength training program in total hip- and knee arthroplasty patients. *Journal of Orthopaedic Surgery*, 28(2), 230949902091639. https://doi.org/10.1177/2309499020916392
4. D’Ambrosi, R., Ursino, C., Setti, S., Scelsi, M., & Ursino, N. (2022). Pulsed electromagnetic fields improve pain management and clinical outcomes after medial unicompartmental knee arthroplasty: A prospective randomised controlled trial. *Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine*, 7(5), 105–112. https://doi.org/10.1016/j.jisako.2022.05.002
5. Ebert, J. R., Joss, B., Jardine, B., & Wood, D. J. (2013). Randomized trial investigating the efficacy of manual lymphatic drainage to improve early outcome after total knee arthroplasty. *Archives of Physical Medicine and Rehabilitation*, 94(11), 2103–2111. https://doi.org/10.1016/j.apmr.2013.06.009