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PNA RESEARCH CASE LIBRARYRheumatology / Orthopaedic Rehabilitation · 2023

Physiotherapy Intervention for Grade 4 Rheumatoid Arthritis Managed With Total Knee Replacement: A Case Report

Shraddha S. Kochar, Mitushi Deshmukh, Pranali S. Fokmare

Cureus · 2023 · DOI: 10.7759/cureus.46658

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THE CASE IN PLAIN ENGLISH

What happened?

A 30-year-old woman with severe rheumatoid arthritis and deformities affecting multiple joints underwent left total knee replacement for advanced knee involvement. The case describes a 15-day physiotherapy programme addressing post-operative pain, restricted knee motion, muscle weakness and function in the context of systemic inflammatory disease.

Clinical findings

  • Severe rheumatoid arthritis with bilateral knee involvement and deformities in the hands and legs.
  • After left total knee replacement, the patient had pain, restricted knee range of motion and reduced lower-limb strength.
  • The report also considered positioning and mobility needs in other joints affected by rheumatoid arthritis.

Rehabilitation described in the report

  • A 15-day programme included continuous passive motion, passive and active-assisted movement, quadriceps/hamstring/gluteal isometrics, straight-leg raises and progressive strengthening.
  • Parallel-bar ambulation and stair practice were included, alongside positioning and gentle mobility care for other affected joints.

Reported outcomes

  • Knee flexion increased from 10–25° to 25–80° over 15 days as reported in the article's table.
  • The authors reported reduced pain, improved range of motion and increased muscle strength; several lower-limb MMT grades also improved.

Clinical lessons to consider

  • Post-operative knee rehabilitation should account for the wider effects of rheumatoid arthritis and the status of other involved joints.
  • Combine mobility, strengthening and functional gait goals while respecting surgical precautions and symptom response.
  • Document baseline and follow-up measures rather than relying on general impressions.

Limitations — what this case cannot tell us

  • Single case with a short 15-day follow-up; long-term outcomes are not established.
  • The report does not compare this programme with other post-TKR rehabilitation approaches.

Original source

Shraddha S. Kochar, Mitushi Deshmukh, Pranali S. Fokmare. “Physiotherapy Intervention for Grade 4 Rheumatoid Arthritis Managed With Total Knee Replacement: A Case Report.” Cureus, 2023. DOI: 10.7759/cureus.46658

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This page is an independently written educational summary, not a reproduction of the full paper. Check the original article for complete methods, outcome tables, references and licensing.