OBJECTIVE: To investigate the effects of early combined eccentric-concentric (ECC-CON) or concentric (CON) resistance training following total knee arthroplasty (TKA). METHODS: Patients who underwent a primary TKA were randomly assigned to an ECC-CON group (n=16) or a CON group (n=18). All patients received early, progressive resistance training with five sessions per week for 2 weeks starting 2 weeks after TKA. Isometric knee flexor and extensor strength of the surgical and non-surgical knees, instrumental gait analysis for spatiotemporal parameters, 6-Minute Walk Test (6MWT), Timed Up and Go Test (TUG), Timed Stair Climbing Test (SCT) were used to evaluate performance-based physical function. The Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and EuroQOL five dimensions (EQ-5D) questionnaire were used to evaluate self-reported physical function and self-reported quality of life. All patients underwent these evaluations before and 1 month after TKA. RESULTS: The ECC-CON group showed clinically meaningful improvements in extensor peak torque (PT) of the non-surgical knee, gait speed, and 6MWT from preoperative values. The CON group had an increase in H/Q ratio of the surgical knee and improvement in SCT-ascent postoperatively. Both groups showed significant improvements in WOMAC-Pain, function, and EQ-5D scores. Although extensor PT of the surgical knee did not reach the preoperative level in either group, the postoperative change was significantly less in the ECC-CON group than the CON group. CONCLUSION: Early combined ECC-CON resistance training minimizes the loss in quadriceps strength of the surgical knee and improves endurance and gait speed after TKA.
Arthroplasty ; Arthroplasty, Replacement, Knee* ; Gait ; Humans ; Knee ; Ontario ; Osteoarthritis ; Quality of Life ; Rehabilitation ; Resistance Training* ; Torque

BACKGROUND: Postoperative pain is a major concern after a total knee replacement (TKR). It hinders early intense physical therapy, the most influential factor for good postoperative knee rehabilitation. The purpose of this study was to compare intravenous patient-controlled analgesia (IV-PCA) using morphine and continuous ketorolac IV infusion with patient-controlled epidural analgesia (PCEA) using morphine and continuous bupivacaine infusion in terms of analgesic efficacy and postoperative knee rehabilitation after a unilateral TKR. METHODS: Eighteen patients undergoing a unilateral total knee replacement were randomly allocated to one of the two groups. In group IV-PCA (n = 9), 30 min before the end of surgery, patients received ketorolac 30 mg IV bolus followed by continuous infusion with ketorolac (5 mg/h) and IV-PCA with morphine (20microgram/kg, lockout 10 min). In group PCEA (n = 9), 30 min before the end of surgery, patients received 2 mg morphine bolus followed by continuous infusion with 0.1% bupivacaine (2 ml/h) and PCEA with morphine (1 mg, lockout 15 min). RESULTS: There were significant differences in visual analogue scale scores at the first 2-hours after the unilateral TKR, cumulative morphine consumption and number of postoperative days required to obtain 90o knee flexion. CONCLUSIONS: PCEA using a morphine-bupivacaine combination provided better pain relief and faci litated the continuous passive motion more than IV-PCA using a morphine-ketorolac combination. This results in possible faster postoperative knee rehabilitation.
Analgesia, Epidural ; Analgesia, Patient-Controlled* ; Arthroplasty, Replacement, Knee* ; Bupivacaine ; Humans ; Ketorolac ; Knee* ; Morphine ; Pain, Postoperative* ; Rehabilitation*

The effectiveness of alternate flexion and extension splint(splint group) in restoring the range of motion(ROM) following total knee arthroplasty(TKA) was evaluated, comparing with the continuous passive motion(CPM) group. One hundred and twenty knees of 87 patients(21–80 years old:12 males & 75 females) who were followed for 2.7 years(ranging from 1.2 to 5.3 years) were involved in this study. The ROM of following groups were compared each other and the results were analyzed statistically with Wilcoxon rank sum test and the differences between each prosthesis were compared with Kruskal-Wallis test. 1) Splint(51 knees, 42.5%) v.s CPM group(69 knees, 57.5%) 2) RA(43 knees, 35.8%) v.s. OA(77 knees, 64.2%) 3) Various types of prosthesis(PSCK, PCA, Tricon-M, M/G, Oxford Knee, PFC) The results were as follws:1. The ROM of splint group(average 132.2°, ranging from 85–145°) was significantly greater than that of CPM group(average 110.5°, ranging from 50–140°)(p<0.01). 2. The ROM of osteoarthritic knees(average 122.2°) was slightly greater than that of rheumatoid knees(average 115.8°) without statistical significance(p) 0.05). 3. There was statistically significant difference between ROM of the various types of implant(p < 0.01). However this difference seemed due to different methods of rehabilitation rather than different types of prosthesis. From this result it is suggested that the alternate flexion and extension splint following TKA is a useful method in restoring ROM, comparing to gradual ROM exercise with CPM.
Arthroplasty, Replacement, Knee ; Humans ; Knee ; Male ; Methods ; Passive Cutaneous Anaphylaxis ; Prostheses and Implants ; Rehabilitation ; Splints

PURPOSE: To determine the priority for the instrumental development of Total knee replacement arthroplasty(TKA) by assessment of patient interviews after TKA in Korea. MATERIALS AND METHODS: We assessed the responses of 168 patients with primary TKA a minimum of one year after surgery. In order not to limit their choices by using a survey, interviewees responded to two open-ended questions, "What was the best result achieved after TKA?" and "What was the result you most wished for but was not achieved after TKA?" RESULTS: All the patients expressed satisfaction with TKA except for 12 patients (7.1%) and for the question of the best result after TKA, 118 patients (70.2%) pointed out that pain relief was the most satisfactory. For the question of the most wished for function still to be restored after TKA, 59 patients (35.1%) answered "No inconvenience and no need" and the greatest proportion among the others who had a wish, 61 patients (36.3%) pointed to discomfort related to the degree of knee flexion with the response "Not easy to stand from the ground and to have deep knee flexion". The average knee flexion degree was 120.7degrees in the group who had a wish related to knee flexion but 127.5degrees in the "No need" group, and the difference was significant (P=0.004). CONCLUSION: Although there was a 93% satisfaction rate after TKA, the remaining function most wished for after TKA was to stand up from the ground easily, which is related to knee flexion degree. Therefore, we propose that the improvement of knee flexion after TKA should be the priority for instrumental development in Korea.
Arthroplasty, Replacement, Knee ; Surveys and Questionnaires* ; Humans ; Knee ; Korea ; Patient Satisfaction* ; Rehabilitation*

Total knee arthroplasty is indicated for painful joints, with or without deformity, secondary to rheumatoid arthritis, osteoarthritis, traumatic arthritis, and certain other forms of nonseptic arthropathy. Many patients with arthritic knees have symetrical involvement and thus require a bilateral operation. Staged bilateral arthroplastis were performed with many drawbacks such as prolonged hospitalization, repeated anesthetic risks, and increased cost. Simultaneous bilateral arthroplasty under one anesthesia by two teams offers several advantages over staged procedure. We studied the results of 145 total knee arthroplasties, performed over a five-year period, to compare unilateral(group I;45 knees), staged bilateral(group II; 24 knees), and simultaneous bilateral arthroplasties(group III; 76 knees) by 2 team approach. Duration of mean follow-up was 1 year and 9 months. The results are as flollows; 1. The mean anesthetic times were 189 minutes, 312 minutes, and 218 minutes for the group I,II,III, respectively. 2. The mean blood loss was 1075ml for the group I, 1644ml for the group II, and 1902ml for the group III. 3. The hospitalization period was 74.1 days in two stage procedures, while it was 48.6 days in simultaneous bilateral procedures. 4. Knee scores by Knee Rating Scale of Hospital for Special Surgery were increased to 85.3 points, 80.7 points, and 85.4 points for group I,II,III, respectively. 5. There were no difference in complication among three groups. 6. Group III had advantages such as reduced anesthetic risk, reduced rehabilitation period, and decreased cost.
Anesthesia ; Arthritis ; Arthritis, Rheumatoid ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Congenital Abnormalities ; Follow-Up Studies ; Hospitalization ; Humans ; Joints ; Knee ; Osteoarthritis ; Rehabilitation

OBJECTIVETo investigate the principle and methods of preoperative and postoperative rehabilitation for simultaneous bilateral total knee arthroplasty.

METHODSFrom January 2005 to June 2008, 72 patients (144 knees) were reviewed in the study, including 33 males and 39 females, ranging in age from 46 to 78 years, with an average age of 69 years. There were 54 patients with osteoarthritis, 17 patients with RA, and 1 patient with traumatic osteoarthritis, including 10 cases (15 knees) of fixed varus deformity more than 30 degree and 6 cases (8 knees) of fixed vagus deformity more than 15 degree. Rehabilitation protocol was made for preoperative, early postoperative and late postoperative stages. Patients were encouraged to initiate the exercises at the early postoperative stage on the premise of multimodal analgesia. Knee function and pain were evaluated using WOMAC and VAS pain scores. Lower limb embolism was determined by ultrasonic scan and pulmonary embolism was diagnosed by clinical manifestation and D-dimer level.

RESULTSSixty-nine patiets (138 knees) were followed up at 2 d preoperatively and the second day, 1, 2, 8 and 24 weeks postoperatively. The average postoperative WOMAC and VAS score were significantly lower than preoperative levels,while the postoperative knee ROM and 6 min walking distance were evidently higher than the preoperative ones, respectively. One hundred and twenty-eight knees achieved full extension and flexion more than 90 degree at 2 weeks postoperatively, and 135 knees reached 110 degree in flexion. Unilateral lower limb embolism was found in 2 cases (2 knees) and bilateral ones were found in 1 case (2 knees). No pulmonary embolism was confirmed.

CONCLUSIONRehabilitation protocols should be made for preoperative, early postoperative and late postoperative stages of simultaneous bilateral knee arthroplasty. Patients should be encouraged to exercise at the early postoperative stage on the premise of multimodal analgesia, in order to improve knee function and reduce edema.

Aged ; Arthroplasty, Replacement, Knee ; rehabilitation ; Female ; Humans ; Male ; Middle Aged ; Range of Motion, Articular ; Recovery of Function

Arthroplasty, Replacement, Knee ; adverse effects ; rehabilitation ; Humans ; Postoperative Complications ; prevention & control ; Recovery of Function

OBJECTIVETo study the methods and effects of rehabilitation exercises after single total knee replacement (TKR).

METHODSFrom May 2007 to May 2009, 38 patients with knee joint diseases were treated with artificial total knee replacement, and the postoperative rehabilitation training was conducted. Among the patients, 20 were males and 18 were females, ranging in age from 50 to 82 years, with an average of 65 years. Course of diseases ranged from 4 to 35 years. Thirty patients were traumatic arthritis, 5 patients were osteoarthritis, and 3 patients were rheumatoid arthritis. Clinical symptoms were knee joint pain and dysfunction; some patients had morning stiffness and bone hypertrophy, a few of them accompanied with knee varus or valgus, quadriceps atrophy. X-ray films showed narrow joint space, osteophyte, cystic changes, and subchondral bone sclerosis.

RESULTSAll the patients were followed up ranging from 6 to 12 months. According to HSS knee score system, the mean scores were 40.22 +/- 7.39 points before operation, and 87.47 +/- 6.60 points after rehabilitation. The difference was statistically significant (t = 31.56, P < 0.01).

CONCLUSIONRehabilitation training after single total knee replacement is the key to ensure the effects of the operation. The rehabilitation training in our hospital has satisfactory results, and is worth to popularize.

Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee ; Female ; Humans ; Joint Diseases ; rehabilitation ; surgery ; Knee Joint ; surgery ; Male ; Middle Aged

OBJECTIVETo investigate the influence of gender on osteoarthritic knee rehabilitation outcome of osteoarthritis patient undergoing total knee arthroplasty (TKA).

METHODSWe prospectively studied thirty male and thirty female knee primary osteoarthritis patients receiving unilateral TKA with posterior stable-fixed plateau prosthesis at our hospital from March 2003 to March 2008. The age and body mass index of male and female patients were matched. The surgical and rehabilitation clinical factors were compared between two groups.

RESULTSThere was no significant difference in postoperative hospitalization time, surgical tourniquet time, and wound drainage volume between two groups (P>0.05). The extension/flexion degrees of knee joint before operation, 1-week, 2-week and 1-year after operation for male patients were 6.0 +/- 3.3 degrees/114.0 +/- 10.0 degrees, 2.0 +/- 1.6 degrees/93.0 +/- 7.4 degrees, 0.6 +/- 0.6 degrees/104.0 +/- 9.9 degrees and 0.3 +/- 0.5 degrees/125.0 +/- 8.8 degrees, for female patients were 7.0 +/- 3.4 degrees/112.0 +/- 14.0 degrees, 2.0 +/- 1.3 degrees/89.0 +/- 10.9 degrees, 0.9 +/- 0.8 degrees/101.0 +/- 11.8 degrees, 0.4 +/- 0.5 degrees/124.0 +/- 7.1 degrees. The range of motion before operation, 1-week, 2-week, and 1-year after operation for male patients was 108.0 +/- 9.5 degrees, 91.0 +/- 7.1 degrees, 103.0 +/- 9.9 degrees, and 125.0 +/- 8.9 degrees, for female patients was 105.0 +/- 14.1 degrees, 87.0 +/- 11.4 degrees, 100.0 +/- 11.9 degrees, and 124.0 +/- 7.0 degrees. The preoperative and 1-year postoperative HSS scores were 55.8 +/- 13.3 and 89.6 +/- 6.7 for males and 54.5 +/- 13.8 and 89.2 +/- 4.1 for females. No significant statistical difference was observed between two gender groups in regards to degree of extension and flexion, range of motion and HSS score (P>0.05).

CONCLUSIONSGender does not influence postoperative knee function of osteoarthritis patients. TKA significantly improves knee joint function and relieve osteoarthritis-related pain.

Aged ; Arthroplasty, Replacement, Knee ; rehabilitation ; Body Mass Index ; Female ; Humans ; Knee Prosthesis ; Male ; Osteoarthritis, Knee ; rehabilitation ; surgery ; Postoperative Period ; Prospective Studies ; Sex Factors ; Treatment Outcome

BACKGROUND: This study evaluated outcomes following total knee arthroplasty for severely stiff knees in Asians. METHODS: Registry data of patients undergoing primary total knee arthroplasty between 2004 and 2013 were collected and retrospectively reviewed. Sociodemographic and anthropometric data together with the Oxford Knee Score and the Knee Society Score (Knee Society Knee Score and the Knee Society Function Score) were collected both preoperatively and postoperatively for up to 2 years. Case subjects consisted of patients with a preoperative flexion range of ≤ 20°. Control subjects consisted of patients with a preoperative flexion range of > 90°. Patients were matched for age, sex, and all preoperative scores in a 2:1 fashion. Two-year outcomes and 5-year revision rates were then compared between cases and controls. RESULTS: There were 28 cases and 56 controls. Cases had a significantly lower body mass index than the controls (p = 0.003) and had a longer hospital stay (p < 0.0001). At 2 years, cases had a significantly lower flexion range (p < 0.001) and a lower Knee Society Function Score (p = 0.020) than the controls. Cases had a significantly greater improvement in the flexion range (p < 0.001) postoperatively than controls. The mean change in functional outcomes at 2 years was comparable between the two groups. Seventy-one percent of the cases and 88% of controls were satisfied. There was a significant difference in the 5-year revision rate (10% vs 0%, p = 0.013). More cases were discharged to a rehabilitation facility compared to controls (p = 0.011). There were no differences in inpatient complication rates. CONCLUSIONS: Functional outcomes and patient satisfaction were acceptable following total knee arthroplasty in Asian patients with severe knee stiffness.
Ankylosis ; Arthroplasty ; Arthroplasty, Replacement, Knee* ; Asian Continental Ancestry Group* ; Body Mass Index ; Humans ; Inpatients ; Knee* ; Length of Stay ; Patient Satisfaction* ; Rehabilitation ; Retrospective Studies