OBJECTIVE: The objective of this review is to provide a systematic and transparent overview of the effects of common physiotherapy techniques and exercises for the rehabilitation of patients following total knee arthroplasty. INTRODUCTION: Many protocols exist for the rehabilitation of patients after total knee arthroplasty, but there is a lack of systematic evidence on rehabilitation components, including precise exercise descriptions and their parameters. This review will fill in some of the gaps in reporting on scientific rehabilitation protocol components and the evaluation of their effectiveness. INCLUSION CRITERIA: We will include randomized controlled trials investigating active and passive physiotherapy techniques and exercises employed after primary total knee arthroplasty, and which report concrete parameters, such as dosage, duration, frequency, intensity, and function-related measurements. We will exclude other study types and randomized controlled trials reporting on techniques and exercises without precise descriptions. METHODS: This review will aim to find both published and unpublished studies. The key information sources to be searched are MEDLINE (PubMed), Embase (Ovid), CINAHL (EBSCO), PEDro, Cochrane CENTRAL, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform. Two independent reviewers will screen titles, abstracts, and full texts; assess the methodological quality; and extract the data. We will perform narrative synthesis, followed by meta-analyses for pooled studies, where possible. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022309185.
Osteoartróza ako najrozšírenejšie degeneratívne ochorenie kĺbov predstavuje významný medicínsky, spoločenský, ako aj ekonomický problém vo väčšine rozvinutých krajín sveta. Cieľ: Cieľom pilotnej klinickej štúdie bolo vyhodnotiť efekt komplexnej postoperačnej fyzioterapeutickej liečby na vybrané fyzioterapeutické parametre a kvalitu života pacientov po totálnej endoprotéze kolenného kĺbu. Súbor a metódy: Do sledovania sme zaradili 30 pacientov po implantácii totálnej endoprotézy kolenného kĺbu, ktorí absolvovali komplexnú fyzioterapeutickú liečbu zameranú na zvýšenie svalovej sily, zlepšenie rozsahu pohyblivosti, zníženie pooperačnej bolesti a opuchu stehna a na zlepšenie sebestačnosti pacientov. Pred fyzioterapeutickou intervenciou sme u každého pacienta realizovali nasledovné fyzioterapeutické vyšetrenia – svalový test, goniometrické vyšetrenie, subjektívne vyšetrenie bolesti, meranie obvodov dolnej končatiny, hodnotenie sebestačnosti prostredníctvom Barthelovho testu. Na porovnanie hodnôt sme použili štatistické testy, ktoré sa hodnotili na hladine významnosti α (p) = 0,05. Výsledky: Po absolvovaní fyzioterapeutických procesov došlo u pacientov po TEP kolenného kĺbu k štatisticky významnému zvýšeniu svalovej sily, ako jeho flexorov, tak aj extenzorov (p=0,001), zlepšeniu rozsahu pohyblivosti do flexie v kolennom kĺbe v porovnaní s jeho rozsahom pred liečbou (p=0,001), zníženiu bolesti kolenného kĺbu (p=0,001), zníženiu pooperačného opuchu (p<0,001). Po absolvovaní fyzioterapeutickej liečby sme zaznamenali štatisticky významné zlepšenie v sledovaných pohybových zložkách: obliekanie (p=0,008), použitie toalety (p=0,001), presun z postele na stoličku (p=0,008), chôdza po rovine (p=0,001), chôdza po schodoch (p=0,001). Absolvovaná fyzioterapia štatisticky významne znížila stupeň závislosti operovaných pacientov (p=0,001). Záver: Včasná pooperačná fyzioterapeutická liečba pozitívne ovplyvňuje celkový stav pacienta. Okrem toho zlepšuje svalovú silu, rozsah pohyblivosti operovaného kĺbu, eliminuje pooperačnú bolesť a redukuje opuch, čo v neposlednom rade vedie k zlepšeniu sebestačnosti pacientov.
Osteoarthritis, as the most common degenerative joint disease, is a significant medical, social and economic problem in the majority of developed countries. Objective: The objective of the pilot study was to evaluate the effect of the comprehensive post-operative physiotherapeutic treatments on the selected physiotherapeutic parameters as well as patients' quality of life after a total endoprosthesis of a knee joint. Patients and methods: Thirty patients after implantation of a total endoprosthesis of a knee joint were enrolled into the pilot study. The patients underwent comprehensive physiotherapeutic treatment to increase muscle strength, improve range of movement, reduce post-operative pain and swelling of thighs and to improve their self-sufficiency. Prior to the physiotherapeutic intervention, we carried out the following physiotherapeutic examination for each patient - muscle test, trigonometric examination, subjective pain assessment, measuring the circumference of the lower limbs, evaluation of the self-sufficiency through the Barthel Test. To compare the figures, we used statistical tests which were evaluated on the significance level α (p) = 0.05. Results: After completing the physiotherapeutic processes, we have observed among the patients who underwent a total knee replacement surgery, a significant increase in muscle strength as with the flexors as well as the extensors (p = 0.001), improvement in their range of movement in flexion in the knee joint, in comparison to its range before treatment (p = 0.001), reduction of knee pain (p = 0.001) and post-operative swelling (p <0.001), respectively. After undergoing the physiotherapeutic procedures, we recorded a statistically significant improvement in the monitored physical components: dressing (p = 0.008) and toilet use (p = 0.001), transfer from bed to chair (p = 0.008), walking on flat surface (p = 0.001), climbing stairs (p = 0.001). Passing the physiotherapy significantly reduced the degree of dependence of operated patients (p = 0.001). Conclusion: The early post-operative physiotherapy treatment positively affects patients' general condition. In addition, it improves muscle strength, range of motion of the operated joint, eliminates post-operative pain and reduces swelling that improves the self- -sufficiency of patients.
- MeSH
- lidé MeSH
- pooperační péče metody MeSH
- rehabilitace metody MeSH
- totální endoprotéza kolene * metody rehabilitace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
PURPOSE OF THE STUDY Our study compared early outcomes of total knee arthroplasty performed in conventional and enhanced perioperative care regimes, i.e. without the use of Redon drain, with intensified perioperative analgesia and more frequent and intensive rehabilitation regime in the latter. MATERIAL AND METHODS The prospective study included 194 patients (76 men and 118 women) implanted with primary knee endoprosthesis. The mean age was 68.8 (44.7 - 88.0 years). The patients were divided into two groups - the "enhanced" and "conventional" procedures. In the first group, Redon suction drain was not inserted at the end of the surgery, and the patients commenced passive knee mobility exercise of the operated knee immediately after being brought back from the operating theatre. The general anaesthesia was supplemented by a combined femoral nerve block and wound infiltration with local anaesthetics. The second group comprised the patients who underwent conventional surgery, i.e. with the use of drain, without femoral nerve block, with no wound infiltration with local anaesthetics, and without immediate post-operative mobilization of the joint. The evaluation was carried out using regular clinical tools (subjective evaluation, objective examination, questionnaire and Knee Society Score (KSS)). Standard statistical methods were applied to data processing. RESULTS The patients under the "conventional regime" showed a significantly sharper drop in haemoglobin and haematocrit levels, higher consumption of blood transfusion and analgesics during the first three days after the surgery. The patients under the "enhanced regime" showed a better range of joint motion at hospital discharge, flexion in particular (p = 0.001). During the hospital stay no frequent swelling, secretion or wound reddening was reported in any of the monitored groups. In the "conventional" group, however, haematomas were more frequently present. The postoperative checks did not reveal any differences in satisfaction of the patients with the surgery. At the first follow-up examination at the outpatient department the "conventional" group patients more often reported knee pain and a feeling of a swollen knee. Nonetheless, their statements did not correspond with the VAS score. In the period between the 6th and 12th months following the surgery, the differences in the range of motion disappeared. The KSS showed a noticeable improvement in both the groups as against the preoperative values. In the "enhanced" group patients, the score increased dramatically at the beginning, whereas in the "conventional" group, the score was growing slowly and gradually until the last follow-up check after the surgery. The "conventional" group patients more frequently reported infectious complications (surface and deep wound infections: 4 vs. 2 patients) requiring a revision surgery (p = 0.024). DISCUSSION Recently, attention has been drawn to the rapid recovery approach, which eliminated postoperative immobilization and enabled the patient to start exercising already on the day of the surgery, with some patients even walking independently. The individual enhanced recovery regimes differ in details but mostly result in achieving the aim much sooner when compared to the conventional approaches. The patients under the enhanced recovery regimes can accomplish better functional outcomes in the first few months after the surgery than the patients undergoing the surgery under the conventional regime. The routine use of Redon drains in TKA is obviously unnecessary; it tends to be associated with a higher blood loss and a higher risk of prosthetic joint infection. CONCLUSIONS The TKA implant without suction drains combined with intensified perioperative analgesia and intensive postoperative rehabilitation is a safe way to earlier recovery of the function of the operated knee, or, by extension, the lower limb. The described approach is not associated with a higher risk of perioperative complications (bleeding, healing disorders or early infections). Patients also benefit from lower blood losses. Based on the results of our study, we recommend performing the TKA surgeries routinely without drains, with perioperative analgesia and immediate postoperative joint mobilization. Key words: total knee arthroplasty; perioperative care; rapid recovery; drainage; active movement; postoperative outcomes; pain; infection.
- MeSH
- anestetika lokální aplikace a dávkování MeSH
- celková anestezie metody MeSH
- dospělí MeSH
- kolenní kloub patofyziologie MeSH
- krevní transfuze MeSH
- lidé středního věku MeSH
- lidé MeSH
- management bolesti metody MeSH
- nervová blokáda metody MeSH
- nervus femoralis MeSH
- odsávání škodlivé účinky metody MeSH
- pooperační péče metody MeSH
- prospektivní studie MeSH
- rozsah kloubních pohybů MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- strečink metody MeSH
- totální endoprotéza kolene metody rehabilitace MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky kontrolované MeSH
Úvod: Terapie motodlahou (CPM) je metodou volby zvláště po implantování totální endoprotézy u kolenního nebo kyčelního kloubu. Jde o aplikaci kontinuálního pasivního pohybu na postiženou končetinu. Cíl studie: Ověření vlivu rychlosti motodlahy na terapeutický efekt. Zejména na rozsah pohybu v kloubu a subjektivní vnímání klidové bolesti. Metody: Terapie byla provedena u 50 náhodně vybraných pacientů po artroplastice kolenního kloubu formou endoprotézy. Pacienti absolvovali 10 terapií, 5x týdně, 20 minut dle předpisu lékaře. 26 pacientů absolvovalo terapii na motodlaze od firmy BTL, 24 pacientů na motodlaze od konkurenční firmy. K určení rozsahu pohybu byla použita metoda SFTR. K určení analgetického efektu byla použita kombinace Visual Analog Scale (VAS) a Verbal Numerical Rating Scale (VNRS). Výsledky: Zvýšení rozsahu pohybu a snížení bolesti bylo signifikantní u obou skupin pacientů. Většího rozsahu pohybu (v průměru o 20 %) a snížení bolesti (v průměru o 15 %) dosahovali pacienti s motodlahou BTL, 2 pacienti byli ze studie vyřazeni. Závěr: Prokázali jsme pozitivní vliv vyšší rychlosti motodlahy na zvýšení rozsahu pohybu v kolenním kloubu a na snížení bolesti.
Background: Continuous passive motion (CPM) therapy is the method of choice especially after implantation of total knee or hip joint replacement. It is the application of continuous passive motion on the affected limb. Objective: Verification of the CPM device velocity for therapeutic effect. Particular range of motion and subjective perception of pain (at rest). Methods: The therapy was performed with 50 randomly selected patients following arthroplasty of the knee joint in the form of prosthesis. Patients had 10 therapies, 5 times per week, 20 minutes according to the doctor's prescription. 26 patients completed therapy on BTL device, 24 on competitive device. To determine the range of motion we used SFTR method. We used the combination of the Visual Analog Scale (VAS) and the Verbal Numerical Rating Scale (VNRS) to determine the analgesic effect. Results: Increased range of motion and pain reduction was significant in both groups. A greater range of motion (on average 20%) and pain reduction (average 15%) patients reached with BTL device, 2 patients were excluded from the study. Conclusion: We have demonstrated the positive impact of CPM speed to increase range of motion in the knee joint and reduce pain.
- MeSH
- artralgie prevence a kontrola rehabilitace MeSH
- fyzioterapie (techniky) MeSH
- lidé středního věku MeSH
- lidé MeSH
- pasivní pohybová terapie CPM * metody přístrojové vybavení MeSH
- pilotní projekty MeSH
- rozsah kloubních pohybů MeSH
- senioři MeSH
- terapie cvičením metody MeSH
- totální endoprotéza kolene * rehabilitace MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
