Effects of Low-intensity Pulsed Ultrasound as an adjunct to usual Physiotherapy on Recovery of Physical Impairments, Functional Performance and Quality of Life in Patients with Total Knee Arthroplasty

Patients will undergo TKA surgery and during the surgical procedure, the designated surgeon will measure the thickness of tissues using patella caliper. After that, each patient will receive the following interventions: • Pulsed ultrasound with low-intensity - Duty cycle: 20% (1:4) - Frequency: 1 or 3 MHz (will be based on the thickness of patient’s tissues) - Intensity: 0.1 – 0.3 W/cm2 (will be based on the thickness of patient’s tissues) - Treatment time: 3-5 minutes (will be based on the size of the area treated) - An area to be treated: 0.5 cm away from the medial side of the patella - Duration of the treatment: 3 weeks (4-5 times/week for the first-week post-TKA, at an orthopedic ward and 2-3 times/week for a further 2 weeks, at physiotherapy department) - Transducer head and any other equipment related to the pulsed ultrasound treatment will be cleaned with the alcohol-based swab before and after the treatment - A researcher (physiotherapist) will deliver the intervention • TKA physiotherapy rehabilitation (4-5 times/week for the first-week post-TKA, at an orthopedic ward and 2-3 times/week for a further 11 weeks, at physiotherapy department). The rehabilitation guideline for TKA that will be used in this study is based on the general physiotherapy rehabilitation program for TKA in Universiti Kebangsaan Malaysia Medical Centre. A physiotherapist for in-patient and a physiotherapist for out-patient will administer the rehabilitation. The rehabilitation guideline is as below: Pre-operative • Chest physio • Exercise education: Quad sets, Gluteus Set, Ankle pump Inpatient • PRICE • Chest physio • Circulation exercises • Range of motion (ROM) exercises • Strengthening exercises • Mobility training • Gait re-education • Gentle patella mobilization as appropriate • Patient education Outpatient • Continue ice therapy as needed • ROM exercises • Strengthening exercises • Stretching exercises • Balance, proprioception and agility exercises • Gait re-education/functional training • Gentle patella mobilization as appropriate • Soft tissue mobilization as appropriate • Advice/Patient education • All participants will be instructed to do home exercise programme 2 times per day. The home exercise programme includes ankle pump exercise, strengthening exercises, and stretching exercises. • A telephone call will be made once a week to friendly remind them to do the home exercises programme and to monitor their progression and potential adverse effects related to exercise such as cramps and muscle soreness. • All participants will also be provided with exercises diary to record their home exercises programme that has been done. • Any amendments to the procedure and process of the pilot study will be applied to this study.