Quiet Knee Rehabilitation Protocol After Primary Total Knee Arthroplasty Is Associated with Lower Opioid Exposure and No Added Risks: A Retrospective Cohort Study.
Academic Article
Overview
abstract
BACKGROUND: Conventional early rehabilitation after total knee arthroplasty (TKA) that emphasizes immediate, aggressive range of motion and ambulation may heighten early inflammation and pain. We implemented a supervised 10-day "quiet knee" protocol prioritizing edema control, limited passive range of motion, rest, and telerehabilitation oversight. METHODS: We retrospectively reviewed 15,646 primary TKAs (quiet knee, n = 841; conventional, n = 14,805) performed from February 1, 2020, to January 15, 2025. We included patients under a strict, quiet knee protocol with telerehabilitation oversight and compared them to a conventional therapy cohort. Primary outcomes were inpatient postoperative morphine milligram equivalents (MME) and 90-day post-discharge MMEs prescribed. Cohorts were compared for the primary outcomes using multivariable linear regression adjusting for age, sex, body mass index, and Charlson Comorbidity Index. RESULTS: The mean lengths of stay (LOS) was shorter in the quiet knee cohort (1.2 versus 1.8 days; P < 0.001). Unadjusted opioid exposure was lower with the quiet knee group: inpatient 52.5 versus 67.5 MME and 90-day post-discharge 265.5 versus 332.1 MME. In adjusted models, conventional rehabilitation used more opioids: +15 MME inpatient (P < 0.001) and +58 MME post-discharge (P = 0.001). Patient-reported outcomes improved similarly in both cohorts at two years (Knee Injury and Osteoarthritis Outcome Score for Joint Replacement 79.4 versus 80.2; visual analog scale 19.1 versus 13.2). Complications were low and similar in each group (manipulation under anesthesia: 1.9 versus 0.1%; venous thromboembolism: 0.1 versus 0.3%; two-year revision: 0.1 versus 0%; quiet knee versus conventional). CONCLUSIONS: Compared with conventional hands-on, aggressive post-TKA rehabilitation, the quiet knee protocol was associated with lower inpatient and 90-day post-discharge opioid exposure and shorter LOS, without detriment to pain, function, or major complications. This study can serve as a basis for designing a prospective trial to further investigate this alternative therapy protocol post-TKA.
