Physical therapists may use varied treatment protocols for the acute care of patients with total hip or knee replacements. The purpose of this study was to develop, via consensus, a standardized treatment program for patients receiving total hip or knee replacement for primary osteoarthritis. Eighteen clinicians nationwide participated in a 3-round consensus process. In Round 1, over 80% of the panel identified exercise, transfers, ambulation, and discharge criteria as the important treatment categories. In Round 2, they reviewed the preliminary physical therapy treatment program and recommended additional exercise regimes. In Round 3, 76% of the panel accepted the final total hip replacement program, while 70% of the panel accepted the total knee replacement program. Using the consensus development process, physical therapists may begin to define their treatment programs, which is fundamental to establishing a baseline standard of care.

J Orthop Sports Phys Ther. 1996;23(1):3-11.

Key Words: consensus, treatment, hip and knee joint replacement

The purpose of this study was to investigate the time course of spontaneous recovery (no supervised training) of muscle torques in the first 3 months postarthroscopic partial meniscectomy. This information will then be used to plan a clinical trial investigating the effects of rehabilitation following arthroscopic meniscectomy. Knee extensor and flexor strength were evaluated at 4 different velocities (60, 120, 180, and 240°/sec) preoperatively and every 2 weeks from weeks 2-12 postsurgery. Eight subjects were evaluated on a Cybex II+ and 14 subjects were evaluated on a Cybex II isokinetic device. A repeated measures analysis of variance was used to determine possible side (involved and uninvolved, speed (60, 120, 180, and 240°/sec), or time (preoperative, 2, 4, 6, 8, 10, and 12 weeks postoperatively) effects as well as possible interactions between these factors. Prior to partial meniscectomy, the involved quadriceps was significantly weaker than the uninvolved quadriceps only at 60°/sec (15%). A further decrease in torque was noted at 2 (25-40% deficit depending on the velocity) and 4 weeks postsurgery at all speeds (17-25%). The quadriceps recovered to preoperative values by 4-6 weeks postsurgery and stabilized at this level until the end of the study, at which time the quadriceps remained weaker than the contralateral side at 60°/sec (14%) and 120°/sec (12%). Prior to surgery, the involved hamstrings were comparable with the uninvolved hamstrings. Although significant differences between sides were found at week 2 postsurgery at 60 (23%) and 120°/sec (17%), the hamstrings were fully recovered by 4 weeks postoperatively. In conclusion, although the quadriceps may recover to preoperative levels by 4-6 weeks following partial meniscectomy, further recovery does not appear to be possible without training as the quadriceps remains weaker than the contralateral side up to 12 weeks postsurgery.

J Orthop Sports Phys Ther. 1996;23(1):18-26.

Key Words: arthroscopic meniscectomy, recovery, rehabilitation

James Cyriax's approach to diagnosis and treatment of soft tissue disorders is frequently used by orthopaedic and sport physical therapists. The reliability of using Cyriax's system to determine diagnostic categories, however, has not been established. The purpose of this study was to examine the intertherapist reliability of assessments made using Cyriax's shoulder evaluation. Twenty-one cases of painful shoulder were evaluated independently by 2 experienced physical therapists. Therapists used a checklist to indicate their assessment of each case by selecting a specific shoulder lesion or by indicating that the case did not fit the Cyriax model. Cohen's kappa statistic was used to measure intertherapist agreement. Therapists classified 19 of the 21 cases into the same diagnostic category for a percent agreement of 90.5%. The kappa value was .875, indicating "almost perfect" agreement. Both therapists classified the same 4 cases of painful shoulder as not fitting the Cyriax model of soft tissue examination. The results of this study show that the Cyriax evaluation can be a highly reliable schema for assessing patients with shoulder pain.

J Orthop Sports Phys Ther. 1996;23(1):34-38.

Key Words: Cyriax, shoulder, evaluation, diagnosis

Slipped capital femoral epiphysis (SCFE) is a condition of the adolescent hip in which the femoral head displaces relative to the femoral neck. This disorder is characterized by a synovitis of the hip joint or a mechanical limitation of motion with pain referred to the thigh or knee. The case described in this report is typical of an adolescent with SCFE. A brief review of epidemiology, etiology, clinical presentation, and treatment is presented to facilitate the physical therapist's knowledge of this condition and its proper management. Delay in diagnosis and treatment of SCFE may result in progression of the slip and chronic disability from osteoarthritis. It is imperative, therefore, that a patient suspected of having this condition be promptly referred to an orthopaedic surgeon for radiographic evaluation.

J Orthop Sports Phys Ther. 1996;23(1):51-55.

Key Words: slipped capital femoral epiphysis, pain, hip