[Rehabilitation following total knee replacement. Conservative orthopedics and sport science].
Total knee replacement (TKR) is a highly standardized procedure. However; many patients are not satisfied with the functional results. Surgery focuses initially on restoration of joint function. Based on the ICF classification (WHO) rehabilitation adds individual and social perspectives. The focus is not limited to body functions but includes abilities and participation. After surgery the patient suffers from pain, swelling, restricted blood circulation and a dramatic impairment of motor function. To prepare patients for activities of daily living it is important to analyze and understand the demands after TKR. Key qualities are the range of motion of the knee joint, functional joint stability, postural stability and muscle coordination. The paper describes a comprehensive rehabilitation protocol which is mainly based on the concept of functional training which consists of purposeful training preparing patients for activities of daily living and participation. It attempts to focus on multijoint movement as much as possible using closed chain muscle action (leg press, indoor cycling, gait training) and on sensorimotor training. A second focus is on postural stability (balance training). For clinical evaluation standardized scores are widely used (e.g. knee society score, HSS score). These scores were adapted for evaluation of the rehabilitation process (e.g. Staffelstein score, EVA-Reha score). However; these are not specific enough to analyze the effects of sensorimotor training and balance training. More detailed assessments should be used to evaluate the benefits of functional based rehabilitation concepts.