Rehabilitation and Pain Management Modalities in Total Knee Arthroplasty

Despite the excellent results of total knee arthroplasty (TKA), providing adequate postoperative rehabilitation and pain control poses challenges for providers. Generally, the protocols for postoperative management vary between institutions, which may lead to differences in modalities and techniques used, affecting long-term outcomes and success. Given that there are no standardized rehabilitative guidelines in place, there exists a necessity to review and understand evidence-based rehabilitation methods to eventually construct the most efficacious protocols. However, it is important to note that there may also be a role for patient-specific customization of rehabilitation. In this issue, there are proposed guidelines, and we specifically address nonpharmacological modalities to reduce pain and improve muscle strength in the postoperative rehabilitation.

Furthermore, pain management following TKA is another area of concern. Here, we specifically discuss a newer agent, liposomal bupivacaine, which is a long-acting local anesthetic agent. Bupivacaine is incorporated into liposomes, which allows for the slow release of the anesthetic and a longer duration of action. This agent is administered intraoperatively, before wound closure, and the benefits may include lower pain scores, decreased in-hospital opioids usage, reduced lengths of stay, improved discharge status, and potentially quicker rehabilitation.

The six articles in this special section will highlight several rehabilitative and pain modalities for patients who undergo TKA. Many of the developments described in this issue are in their early stages of clinical investigation. However, we hope that this stimulates and provides an impetus for further work in the field.