Total Knee Replacement and Rehabilitation: The Knee Owner's Manual.

Total Knee Replacement and Rehabilitation: The Knee Owner's Manual. Brugioni DJ, Falkel J. Alameda, CA 94501-0914, Hunter House Inc, 2004, paperback, 272 pp, illus, ISBN: 0-89793-439-3, $19.95.

The purpose of this book is to help patients receive the greatest benefit from total knee arthoplasty (TKA) and rehabilitation. The intended audience is the patient who is considering a TKA and the patient's family and friends. The authors' goals were to provide patients with detailed information on joint replacement rehabilitation and to provide answers to their questions and concerns.

The authors are clinicians as well as former patients who underwent orthopedic surgical procedures. Brugioni is an orthopedic surgeon who underwent a lumbar fusion, and Falkel is a physical therapist who underwent bilateral TKA.

Between them, the authors bring 45 years of clinical experience to the discussion of TKA.

The chapters are logically organized along the timeline of preoperative preparation to 1 year after the surgery. Each chapter's contents correspond to a particular postoperative time frame and contain information specific to that period. A short question-and-answer section ends each chapter, not as a review of the chapter's contents, but as answers to common questions the reader may have. Two appendixes are also included: appendix A provides a sobering and realistic view of potential complications of TKA, and appendix B is noteworthy as a complete index of the exercises presented in the text, grouped by exercise type, and listed according to the name of the exercise and its corresponding page number.

The work's early chapters discuss knee arthritis and its various treatment options, including lifestyle changes, medication, exercise, injections (visco-supplementation), arthroscopy, cartilage replacement, and osteotomy. Written for a general audience, the text clearly presents each treatment option in a way that is very informative and that is comprehensive enough to help the prospective patient make informed treatment decisions in conjunction with their health care provider. Although the authors do a good job at outlining various treatment options, surprisingly they make no mention of unicondular joint replacement or of mosaicplasty as options for younger patients with more focal defects.

The text is written in a consistent, "plain English" style and is easily understood by general readers. The overall tone is upbeat, instructive, and encouraging. Several times Falkel's own experiences with TKA are recalled, thus fostering a sense of empathy with the reader. The material is accurate and timely with one exception: this work was written before the recall of Vioxx and before renewed concerns over the safety of Celebrex. Both drugs are presented in the book as viable nonsurgical options for the treatment of arthritis.

Several chapters deserve special mention. The chapter on the day of surgery contains a detailed and thorough explanation on what the patient can expect regarding the operation itself and its in-hospital aftermath. The chapter on preparing yourself and your home before surgery contains an abundance of simple measures and practical advice designed to greatly enhance the postoperative course. Special features in this chapter include recommendations on improvising home exercise equipment, a full series of preoperative exercises, and simple home modifications designed to enhance patient safety and comfort. Later chapters incorporate exercises with weights, gait training, balance activities, stationary bikes, and rowing machines. The chapter on pool-based therapy is noteworthy for its presentation of comprehensive water therapy exercises designed to enhance joint range of motion, soft tissue pliability, and dynamic standing balance. Finally, a section describing futebol exercises presents a unique series of activities designed to enhance the patient's mobility and agility; physical therapists will find this innovative information useful in expanding their own repertoire of exercises.

This work lists more than 20 sources from textbooks and peer-reviewed journals, most of which are cited in the chapters on arthritis and assorted treatment options. The outcomes of various treatments are referenced, but there is no specific mention of validity or reliability studies. In accordance with the overall focus of this work, the depth of discussion varies according to the subject matter. The discussion of arthritis and non-TKA management are covered more superficially, yet adequately for the lay audience, whereas the most detail is reserved for TKA and its aftermath.

Throughout the text, exercise rationale is clearly and simply explained according to the intended functional outcome, thereby enhancing the patient's understanding of why a particular activity is important for achieving a specific goal. This work features an outstanding variety of exercises. Each exercise is presented in a captioned photograph that clearly depicts the intended motion. Activities are presented in accordance with the preoperative and postoperative timeline, and culminate in advanced balance training and return to modified sports activities.

This is a well-written and logically organized text that easily achieves its stated purpose. Prospective patients and their families will find a wealth of practical information on TKA in this reader-friendly reference.

Eugene Pavone, PT

Sports Physical Therapy of NY, PC

Spring Valley, UV

Mr Pavone specializes in orthopedic physical therapy in an outpatient setting.