OBJECTIVE: To assess the effectiveness of our devised hybrid physiotherapy regime using an anti-gravity treadmill and a low-frequency electrical stimulation device, as measured in patients with hip osteoarthritis after total hip arthroplasty (THA). METHODS: The outcomes of the postoperative rehabilitation in 44 patients who underwent THA for hip osteoarthritis were retrospectively examined. The conventional group (n=22) underwent the postoperative rehabilitation according to our protocol, while the hybrid group (n=22) underwent the same training, along with training on an anti-gravity treadmill and training using a low-frequency therapeutic device. The outcome measures were recorded and reviewed with the Numerical Rating Scale for pain, which rates pain on an 11-point scale from 0 to 10, surgical side knee joint extension force, 10-m walking test, Timed Up and Go test, and the 6-minute walking distance (6MD). The outcome measurement was taken 2 weeks after conducting pre-operation and antigravity treadmill training and electrical muscle stimulation, and compared the respective results. RESULTS: At the timeframe of 2 weeks from the surgery after conducting a devised hybrid physiotherapy, the values of knee extension muscle strength and 6MD were not worse in the hybrid group than conventional group. In the evaluation at 2 weeks after surgery, the knee extension muscle strength and 6MD values significantly decreased compared with the preoperative values only in the conventional group. CONCLUSION: Lower limb muscular strength and endurance were maintained in the hybrid group, which suggested that hybrid physiotherapy could maintain physical functions early after THA operation.
Arthroplasty, Replacement, Hip ; Electric Stimulation ; Follow-Up Studies ; Humans ; Knee ; Knee Joint ; Lower Extremity ; Muscle Strength ; Osteoarthritis, Hip ; Outcome Assessment (Health Care) ; Rehabilitation ; Retrospective Studies ; Walking

OBJECTIVE: To investigate functional outcomes after the application of a critical pathway for inpatient rehabilitation of total knee arthroplasty (TKA).METHODS: A total of 184 patients (57 males and 127 females; average age, 71.5±5.9 years) who underwent unilateral or bilateral TKA were included. The critical pathway included early, intensive individualized rehabilitation exercises. Patients completed the following performance-based physical function tests: the stair climbing test (SCT), 6-minute walk test (6MWT), and Timed Up and Go test (TUG) as well as measurement of isometric knee flexor and extensor strength of the operated knee, gait speed, and range of knee flexion and extension. Self-reported physical function and pain were measured using the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and visual analog scale (VAS), respectively, and self-reported quality of life was measured using the EuroQoL 5 dimension (EQ-5D) questionnaire. These evaluations were performed preoperatively and at 1 month and 3 months postoperatively.RESULTS: Performance-based and self-reported physical function and quality of life measures improved nonlinearly over time. Specifically, the 6WMT, TUG, gait speed, WOMAC-pain, WOMAC-function, VAS, and EQ-5D scores showed a significant improvement at 1-month post-TKA, whereas SCT, peak torque of the knee extensors and flexors, and WOMAC-stiffness scores showed gradual, but substantial, improvements over 3 months. There were between-group differences (unilateral and bilateral TKA groups) in the time course of the SCT, 6MWT, TUG, VAS, WOAMC-stiffness, and WOMAC-function results.CONCLUSION: Patients who underwent critical pathway rehabilitation after TKA showed significant improvements in functional measurements during the first 3 months post-surgery.
Arthroplasty ; Arthroplasty, Replacement, Knee ; Critical Pathways ; Exercise ; Female ; Gait ; Humans ; Inpatients ; Knee ; Male ; Ontario ; Osteoarthritis ; Quality of Life ; Rehabilitation ; Torque ; Visual Analog Scale

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

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: Epidural analgesia (EPA) has been used for postoperative pain control in total knee replacement (TKR). However, many patients have suffered various side effects after epidural blockade. Peripheral nerve block (PNB) has been shown to provide effective pain relief after TKR. We compared the benefits of continuous femoral nerve block (FNB) combined with single-injection sciatic nerve block (SNB) with those of EPA for postoperative pain management after TKR. METHODS: Eighty participants undergoing unilateral TKR were randomized to receive either EPA (EPA group) or continuous FNB combined with SNB (PNB group). All patients received general anesthesia for TKR. Ropivacaine 2 mg/ml plus fentanyl 2 µg/ml was administered for EPA. Ropivacaine 2 mg/ml was administered through the femoral nerve catheter. The pain score, side effects (dizziness, sedation, nausea, vomiting, pruritus, hypotension and urinary retention), motor blockade, knee range of motion, and rehabilitation were measured postoperatively. The primary outcome measure was the number of patients experiencing side effects. RESULTS: The incidence of patients with side effects was 86.8% in the EPA group but only 35.1% in the PNB group (P < 0.001). There were no significant differences between the two groups in terms of pain score, motor blockade of the operative limb, knee range of motion, or rehabilitation. CONCLUSIONS: Continuous FNB combined with SNB can be an effective alternative to EPA for postoperative pain management in TKR.
Analgesia, Epidural* ; Anesthesia, General ; Arthroplasty, Replacement, Knee* ; Catheters ; Extremities ; Femoral Nerve* ; Fentanyl ; Humans ; Hypotension ; Incidence ; Knee ; Nausea ; Outcome Assessment (Health Care) ; Pain, Postoperative* ; Peripheral Nerves ; Pruritus ; Range of Motion, Articular ; Rehabilitation ; Sciatic Nerve* ; Vomiting

Inadequate pain management after total knee arthroplasty (TKA) impedes recovery, increases the risk of postoperative complications, and results in patient dissatisfaction. Although the preemptive use of multimodal measures is currently considered the principle of pain management after TKA, no gold standard pain management protocol has been established. Peripheral nerve blocks have been used as part of a contemporary multimodal approach to pain control after TKA. Femoral nerve block (FNB) has excellent postoperative analgesia and is now a commonly used analgesic modality for TKA pain control. However, FNB leads to quadriceps muscle weakness, which impairs early mobilization and increases the risk of postoperative falls. In this context, emerging evidence suggests that adductor canal block (ACB) facilitates postoperative rehabilitation compared with FNB because it primarily provides a sensory nerve block with sparing of quadriceps strength. However, whether ACB is more appropriate for contemporary pain management after TKA remains controversial. The objective of this study was to review and summarize recent studies regarding practical issues for ACB and comparisons of analgesic efficacy and functional recovery between ACB and FNB in patients who have undergone TKA.
Accidental Falls ; Analgesia ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Early Ambulation ; Femoral Nerve ; Humans ; Knee ; Nerve Block ; Pain Management ; Peripheral Nerves ; Postoperative Complications ; Quadriceps Muscle ; Rehabilitation

INTRODUCTIONThere are currently no guidelines supporting the use of routine chemoprophylaxis to prevent deep vein thrombosis (DVT) in arthroscopic surgery. Studies and meta-analysis show opposing views on its routine use in arthroscopy. This study aimed to examine the incidence of DVT in a prospective cohort of knee arthroscopy and knee arthroplasty patients, and to analyse the risk factors contributing to DVT.

METHODSAll patients scheduled to undergo knee arthroscopy or arthroplasty over a two-year period were included. A standardised regimen of postoperative mechanical prophylaxis and rehabilitation was applied to all patients. Only patients who were postoperatively symptomatic were referred for ultrasonography. DVT incidence was calculated, and univariate and multivariate analyses of the risk factors were performed.

RESULTSThe overall incidence of DVT was 0.5% among the 1,410 arthroscopy patients and 3.1% among the 802 arthroplasty patients. The incidence of proximal DVT among the arthroscopy and arthroplasty patients was 0.4% and 1.1%, respectively. Multivariate analysis showed that age was the only significant predictor of DVT incidence. Using the receiver operating characteristic method, the cut-off age for the arthroscopy and arthroplasty patients was 52 years, while that for the arthroscopy patients only was 40 years (increased risk of DVT: 5.46 and 6.44 times, respectively; negative predictive value: 99.7% and 99.8%, respectively).

CONCLUSIONDVT incidence among Asian arthroplasty and arthroscopy patients remains low, even without chemoprophylaxis. Since age was found to be a significant risk factor for DVT, DVT prophylaxis can be considered for patients in high-risk age groups.

Adult ; Arthroplasty ; Arthroplasty, Replacement, Knee ; adverse effects ; Asian Continental Ancestry Group ; Female ; Humans ; Incidence ; Knee Joint ; surgery ; Male ; Middle Aged ; Multivariate Analysis ; Prospective Studies ; Pulmonary Embolism ; prevention & control ; Rehabilitation ; Risk Factors ; Singapore ; Venous Thrombosis ; etiology

BACKGROUND: Many factors contribute to suboptimal results after total knee arthroplasty (TKA) but little is known regarding the value of postsurgical rehabilitation after TKA. We examined the effects of an enhanced closed kinematic chain exercises program (AposTherapy) on gait patterns and clinical outcomes among patients with a lack of progress in their postsurgical rehabilitation. METHODS: Twenty-two patients were prospectively followed during the study. Gait spatiotemporal parameters were measured at the initial evaluation, after 15 minutes of therapy, and after 3 months of therapy. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the short form (SF) 36 health survey were completed by patients before treatment and after 3 months of treatment. RESULTS: The WOMAC and SF-36 scores improved significantly after 3 months of treatment. Gait velocity, single limb support, and step length of the operated leg improved significantly even after a single 15 minutes treatment. Normal gait velocity was observed in 36% of patients after 3 months of treatment. CONCLUSIONS: A physiotherapy program that included enhanced closed kinematic chain biomechanical therapy was beneficial for patients who experienced a suboptimal rehabilitation course after TKA.
Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee/*rehabilitation ; Biomechanical Phenomena ; Female ; Humans ; Male ; Middle Aged ; Physical Therapy Modalities/*instrumentation ; Pilot Projects ; Postoperative Complications/*therapy ; Prospective Studies ; Shoes ; Treatment Failure

UNLABELLEDOBJECTIVE To assess the effects of suction drainage versus nondrainage on the post-operative rehabilitation of patients receiving primary bilateral total knee arthroplasties (TKA).

METHODSA prospective study including 40 patients was conducted. These patients were diagnosed with osteoarthritis and underwent primary bilateral TKA between October 2007 and September 2009 with the same operation team. A suction drainage was placed by randomization in only one knee for each patient, while the other knee as self-control. Pain visual analogue scale score, extremity swelling, wound healing, range of motion and incidence of early post-operative complications between the drained and nondrained group were compared statistically.

RESULTSEach patient was followed up for 12 months. Placing drainage did not relieve the pain, extremity swelling, ecchymosis, or reduce the incidence of early complications (all P>0.05).

CONCLUSIONSSuction drainage in TKA does not exhibit substantial advantages in promoting post-operative rehabilitation after unsophisticated TKA, compared with nondrainage. On the other hand, it might complicate the surgical operation, and increase the incidence of post-operative hemorrhage and retrograde infection. Thus we do not recommend suction drainage in unsophisticated TKA.

Aged ; Arthroplasty, Replacement, Knee ; adverse effects ; rehabilitation ; Blood Loss, Surgical ; prevention & control ; Drainage ; methods ; Female ; Humans ; Male ; Middle Aged ; Range of Motion, Articular ; Visual Analog Scale ; Wound Healing

OBJECTIVETo explore the effect of electroacupuncture therapy for postoperative rehabilitation of total knee replacement of knee osteoarthritis.

METHODSSeventy cases of total knee replacement of knee osteoarthritis were randomly divided into an acupuncture-rehabilitation group and a rehabilitation group, thirty five cases in each group. In acupuncture-rehabilitation group, routine rehabilitation therapy combined with electroacupuncture therapy was applied. The acupoints selection was mainly based on pathological location; Xuehai (SP 10), Liangqiu (ST 34), Dubi (ST 35), Neixiyan (EX-LE 4) and Yanglingquan (GB 34), etc. were selected. In rehabilitation group, routine rehabilitation therapy was applied. The functions of affected knee in both groups were evaluated by artificial total knee replacement scale of the New York Hospital for Special Surgery (HSS), range of motion (ROM) of affected knee, Visual Analogue Scale (VAS) of pain and Manual Muscle Test (MMT) before, and 2, 6 and 12 weeks after surgery.

RESULTSHSS scores in acupuncture-rehabilitation group were markedly higher than those in rehabilitation group in 2, 6 and 12 weeks after surgery (P < 0.05, P < 0.01); VAS scores in acupuncture-rehabilitation group were markedly lower than those in rehabilitation group (P < 0.05, P < 0.01); ROM and MMT in acupuncture-rehabilitation group were little superior to those in rehabilitation group, however, there was no significant difference (all P > 0.05).

CONCLUSIONRehabilitation therapy combined with electroacupuncture can obviously restrain the pain during rehabilitation process for total knee replacement patients, improve the endurance capacity of rehabilitation training and motivation, and obviously promote the recovery of total knee joint function.

Adult ; Aged ; Arthroplasty, Replacement, Knee ; adverse effects ; rehabilitation ; Electroacupuncture ; Female ; Humans ; Knee ; physiopathology ; surgery ; Male ; Middle Aged ; Osteoarthritis, Knee ; physiopathology ; rehabilitation ; surgery ; therapy ; Pain, Postoperative ; etiology ; physiopathology ; therapy ; Range of Motion, Articular