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Wu K, Pan HH, Lin CH. Robotic exoskeletons and total knee arthroplasty: The future of knee rehabilitation and replacement - A meta-analysis. Medicine (Baltimore) 2024; 103:e37876. [PMID: 38669435 PMCID: PMC11049723 DOI: 10.1097/md.0000000000037876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVE Exoskeletons can play a crucial role in post-TKA rehabilitation by accelerating recovery, improving mobility, and reducing further injury risk. This meta-analysis evaluated the effectiveness of exoskeletons in post-total knee replacement (TKR) rehabilitation. DESIGN Comprehensive searches were conducted on PubMed, OVID Medline, Cochrane Collaboration Library, and Embase (period: database inception to March 2023). Randomized controlled trials enrolling patients who underwent TKR and studies examining the effect of robot-assisted rehabilitation on physical function and pain outcomes were eligible for inclusion. Eight studies (302 patients) were thus included. RESULTS Exoskeletons significantly improved active range of motion (ROM) (SMD: 10.98, 95% confidence interval (CI): 7.81-14.16, P < .001), passive ROM (SMD: 4.11, 95% CI: 1.02-7.20, P = .009), Hospital for Special Surgery scores (SMD: 7.78, 95% CI: 5.87-9.68, P < .00001), and hospital stay length (SMD: -3.19, 95% CI: -4 to -2.38, P < .00001) compared with conventional rehabilitation. Active and passive ROM improvements suggest that exoskeletons aid knee function restoration and mobility post-TKR, whereas Hospital for Special Surgery score improvements support exoskeleton use in TKR rehabilitation. A shorter hospital stay was an important finding which could potentially reduce healthcare costs and improve outcomes. CONCLUSION Despite the inclusion of a limited number of studies, our findings suggest that exoskeletons can enhance post-TKR rehabilitation outcomes and improve quality of life. Robot-assisted rehabilitation may be effective following TKR. Further research should confirm these findings.
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Affiliation(s)
- Karl Wu
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
- Department of Materials and Textiles, Oriental Institute of Technology, New Taipei City, Taiwan, ROC
- Department of Physical Education and Sport Sciences, National Taiwan Normal University, Taipei, Taiwan, ROC
| | - Hsiang Hung Pan
- Department of Education, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Chun Hung Lin
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
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2
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Cai L, Liu Y, Wei Z, Liang H, Liu Y, Cui M. Robot-assisted rehabilitation training improves knee function and daily activity ability in older adults following total knee arthroplasty. Res Nurs Health 2023; 46:203-209. [PMID: 36504201 DOI: 10.1002/nur.22290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/25/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022]
Abstract
To evaluate the effects of robot-assisted rehabilitation training on knee function and the daily activity ability of older adults following total knee arthroplasty (TKA). Eighty-eight patients who underwent TKA were randomly assigned to a robot-assisted rehabilitation or traditional therapy group. The patients in the control group were treated with traditional manual rehabilitation therapy, while the patients in the experimental group were subjected to the robot-assisted rehabilitation program. Range of motion of the knee joint, Hospital for Special Surgery Knee Rating Score, and the modified Barthel Index were assessed on the first or second day after TKA (preintervention) and the discharge day (postintervention). Additionally, the length of hospital stay and related hospitalization expenses of the two groups were collected on the discharge day. Improvements in the active range of motion (p < 0.001), passive range of motion (p = 0.001), Hospital for Special Surgery Knee Rating Score (p < 0.001), and modified Barthel Index score (p = 0.004) were significantly better in the robot-assisted rehabilitation group than in the traditional therapy group. Interestingly, the length of hospital stay in the experimental group (9 days) was shorter than that in the control group (13 days), and the total cost of hospitalization was lower (p = 0.002). The robot-assisted rehabilitation training program is an effective intervention that significantly improves the daily activity ability and knee function of older adults following TKA.
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Affiliation(s)
- Libai Cai
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yanjin Liu
- Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zexu Wei
- School of Nursing, Zhengzhou University, Zhengzhou, China
| | - Hao Liang
- School of Nursing, Zhengzhou University, Zhengzhou, China
| | - Yangyang Liu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Miaoran Cui
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
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Konnyu KJ, Thoma LM, Cao W, Aaron RK, Panagiotou OA, Bhuma MR, Adam GP, Balk EM, Pinto D. Rehabilitation for Total Knee Arthroplasty: A Systematic Review. Am J Phys Med Rehabil 2023; 102:19-33. [PMID: 35302953 PMCID: PMC9464796 DOI: 10.1097/phm.0000000000002008] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
ABSTRACT We sought to determine the comparative benefit and harm of rehabilitation interventions for patients who have undergone elective, unilateral total knee arthroplasty for the treatment of primary osteoarthritis. We searched PubMed, Embase, The Cochrane Register of Clinical Trials, CINAHL, PsycINFO, Scopus, and ClinicalTrials.gov from January 1, 2005, through May 3, 2021. We included randomized controlled trials and adequately adjusted nonrandomized comparative studies of rehabilitation programs reporting performance-based, patient-reported, or healthcare utilization outcomes. Three researchers extracted study data and assessed risk of bias, verified by an independent researcher. The team assessed strength of evidence. Evidence from 53 studies randomized controlled trials suggests that various rehabilitation programs after total knee arthroplasty may lead to comparable improvements in pain, range of motion, and activities of daily living. Rehabilitation in the acute phase may lead to increased strength but result in similar strength when delivered in the postacute phase. No studies reported evidence of risk of harms due to rehabilitation delivered in the acute period after total knee arthroplasty; risk of harms among various postacute rehabilitation programs seems comparable. All findings were of low strength of evidence. Evaluation of rehabilitation after total knee arthroplasty needs a systematic overhaul to sufficiently guide future practice or research including the use of standardized intervention components and core outcomes.
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Affiliation(s)
- Kristin J. Konnyu
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Louise M. Thoma
- Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Wangnan Cao
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Roy K. Aaron
- Department of Orthopaedic Surgery, Warren Albert Medical School of Brown University, Providence, Rhode Island; Orthopedic Program in Clinical/Translational Research, Warren Albert Medical School of Brown University, Providence, Rhode Island; Miriam Hospital Total Joint Replacement Center, Providence, Rhode Island
| | - Orestis A. Panagiotou
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Monika Reddy Bhuma
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Gaelen P. Adam
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Ethan M. Balk
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Dan Pinto
- Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin
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Yoo JI, Oh MK, Lee SU, Lee CH. Robot-assisted rehabilitation for total knee or hip replacement surgery patients: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e30852. [PMID: 36221411 PMCID: PMC9543030 DOI: 10.1097/md.0000000000030852] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND This study was performed to update the current evidence and evaluate the effects of robot-assisted rehabilitation (RAR) in comparison with conventional rehabilitation (CR) in patients following total knee (TKR) or hip replacements (THR). METHODS PubMed Central, OVID Medline, Cochrane Collaboration Library, and EMBASE for a comprehensive search for all relevant studies, from database inception to July 2022. The following inclusion criteria were used to determine eligibility for studies: randomized and matched controlled trials recruiting men and women who underwent TKR and THR; and studies examining the effect of RAR on outcome measures of physical function and pain. RESULTS A total of 9 studies (230 patients) were included in this review and 4 were included in the meta-analysis. The meta-analysis of 2 studies showed that Hybrid Assistive Limb (HAL) training for 5 days, significantly improved pain measured on a visual analogue scale, compared to CR in patients following TKR (SMD = 1.05, 95% confidence interval [Cl] 0.39-1.71). Heterogeneity for I2 value was lower than moderate (tau^2 = 0.0121; I2 = 5%; P = .30). There were 2 studies that assessed self-selected walking speed. The meta-analysis of these studies showed that HAL training was significantly superior to CR in patients following TKR (SMD = 48.70, 95% Cl -50.53 to 147.94) at 2 months. A high heterogeneity was detected (P < .01; I2 = 97%). CONCLUSION The result of this systematic review and meta-analysis suggest that RAR may be an effective treatment in TKR and THR patients. However, high-quality studies are needed to verify the long-term effect on their recovery.
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Affiliation(s)
- Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Korea
| | - Min-Kyun Oh
- Department of Rehabilitation Medicine, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Chang Han Lee
- Department of Rehabilitation Medicine, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Korea
- Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Korea
- *Correspondence: Chang Han Lee, Department of Rehabilitation Medicine, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, and Institute of Health Science, Gyeongsang National University College of Medicine, Jinju 52727, Korea (e-mail: )
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Wood DS, Jensen K, Crane A, Lee H, Dennis H, Gladwell J, Shurtz A, Fullwood DT, Seeley MK, Mitchell UH, Christensen WF, Bowden AE. Accurate Prediction of Knee Angles during Open-Chain Rehabilitation Exercises Using a Wearable Array of Nanocomposite Stretch Sensors. SENSORS 2022; 22:s22072499. [PMID: 35408112 PMCID: PMC9003122 DOI: 10.3390/s22072499] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/20/2022] [Accepted: 03/21/2022] [Indexed: 01/14/2023]
Abstract
In this work, a knee sleeve is presented for application in physical therapy applications relating to knee rehabilitation. The device is instrumented with sixteen piezoresistive sensors to measure knee angles during exercise, and can support at-home rehabilitation methods. The development of the device is presented. Testing was performed on eighteen subjects, and knee angles were predicted using a machine learning regressor. Subject-specific and device-specific models are analyzed and presented. Subject-specific models average root mean square errors of 7.6 and 1.8 degrees for flexion/extension and internal/external rotation, respectively. Device-specific models average root mean square errors of 12.6 and 3.5 degrees for flexion/extension and internal/external rotation, respectively. The device presented in this work proved to be a repeatable, reusable, low-cost device that can adequately model the knee's flexion/extension and internal/external rotation angles for rehabilitation purposes.
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Affiliation(s)
- David S. Wood
- Department of Mechanical Engineering, Brigham Young University, Provo, UT 84602, USA; (D.S.W.); (K.J.); (A.C.); (D.T.F.)
| | - Kurt Jensen
- Department of Mechanical Engineering, Brigham Young University, Provo, UT 84602, USA; (D.S.W.); (K.J.); (A.C.); (D.T.F.)
| | - Allison Crane
- Department of Mechanical Engineering, Brigham Young University, Provo, UT 84602, USA; (D.S.W.); (K.J.); (A.C.); (D.T.F.)
| | - Hyunwook Lee
- Department of Exercise Science, Brigham Young University, Provo, UT 84602, USA; (H.L.); (H.D.); (M.K.S.); (U.H.M.)
| | - Hayden Dennis
- Department of Exercise Science, Brigham Young University, Provo, UT 84602, USA; (H.L.); (H.D.); (M.K.S.); (U.H.M.)
| | - Joshua Gladwell
- Department of Statistics, Brigham Young University, Provo, UT 84602, USA; (J.G.); (A.S.); (W.F.C.)
| | - Anne Shurtz
- Department of Statistics, Brigham Young University, Provo, UT 84602, USA; (J.G.); (A.S.); (W.F.C.)
| | - David T. Fullwood
- Department of Mechanical Engineering, Brigham Young University, Provo, UT 84602, USA; (D.S.W.); (K.J.); (A.C.); (D.T.F.)
| | - Matthew K. Seeley
- Department of Exercise Science, Brigham Young University, Provo, UT 84602, USA; (H.L.); (H.D.); (M.K.S.); (U.H.M.)
| | - Ulrike H. Mitchell
- Department of Exercise Science, Brigham Young University, Provo, UT 84602, USA; (H.L.); (H.D.); (M.K.S.); (U.H.M.)
| | - William F. Christensen
- Department of Statistics, Brigham Young University, Provo, UT 84602, USA; (J.G.); (A.S.); (W.F.C.)
| | - Anton E. Bowden
- Department of Mechanical Engineering, Brigham Young University, Provo, UT 84602, USA; (D.S.W.); (K.J.); (A.C.); (D.T.F.)
- Correspondence:
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6
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Koo KI, Hwang CH. Five-day rehabilitation of patients undergoing total knee arthroplasty using an end-effector gait robot as a neuromodulation blending tool for deafferentation, weight offloading and stereotyped movement: Interim analysis. PLoS One 2020; 15:e0241117. [PMID: 33326434 PMCID: PMC7743990 DOI: 10.1371/journal.pone.0241117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 10/07/2020] [Indexed: 11/18/2022] Open
Abstract
Deafferentation and weight offloading can increase brain and spinal motor neuron excitability, respectively. End-effector gait robots (EEGRs) can blend these effects with stereotyped movement-induced neuroplasticity. The authors aimed to evaluate the usefulness of EEGRs as a postoperative neuro-muscular rehabilitation tool. This prospective randomized controlled trial included patients who had undergone unilateral total knee arthroplasty (TKA). Patients were randomly allocated into two groups: one using a 200-step rehabilitation program in an EEGR or the other using a walker on a floor (WF) three times a day for five weekdays. The two groups were compared by electrophysiological and biomechanical methods. Since there were no more enrollments due to funding issues, interim analysis was performed. Twelve patients were assigned to the EEGR group and eight patients were assigned to the WF group. Although the muscle volume of the quadriceps and hamstring did not differ between the two groups, the normalized peak torque of the operated knee flexors (11.28 ± 16.04 Nm/kg) was improved in the EEGR group compared to that of the operated knee flexors in the WF group (4.25 ± 14.26 Nm/kg) (p = 0.04). The normalized compound motor action potentials of the vastus medialis (VM) and biceps femoris (BF) were improved in the EEGR group (p < 0.05). However, the normalized real-time peak amplitude and total, mean area under the curve of VM were decreased during rehabilitation in the EEGR group (p < 0.05). No significant differences were found between operated and non-operated knees in the EEGR group. Five-day EEGR-assisted rehabilitation induced strengthening in the knee flexors and the muscular reactivation of the BF and VM after TKA, while reducing the real-time use of the VM. This observation may suggest the feasibility of this technique: EEGR modulated the neuronal system of the patients rather than training their muscles. However, because the study was underpowered, all of the findings should be interpreted with the utmost caution.
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Affiliation(s)
- Kyo-In Koo
- Department of Biomedical Engineering, School of Electrical Engineering, University of Ulsan, Ulsan, Republic of Korea
| | - Chang Ho Hwang
- Department of Physical and Rehabilitation Medicine, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Republic of Korea
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Joo SY, Lee SY, Cho YS, Lee KJ, Seo CH. Effects of Robot-Assisted Gait Training in Patients with Burn Injury on Lower Extremity: A Single-Blind, Randomized Controlled Trial. J Clin Med 2020; 9:jcm9092813. [PMID: 32878085 PMCID: PMC7563213 DOI: 10.3390/jcm9092813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 08/29/2020] [Indexed: 12/20/2022] Open
Abstract
This study investigated the effects of robot-assisted gait training (RAGT) on gait function in burn patients. Briefly, 40 burn patients were randomly divided into an RAGT group or a conventional training (CON) group. SUBAR® (Cretem, Korea) is a wearable robot with a footplate that simulates normal gait cycles. The RAGT group underwent 30 min of robot-assisted training using SUBAR® with 30 min of conventional physiotherapy once a day, 5 days a week for 12 weeks. Patients in the CON group received 30 min of overground gait training and range-of-motion (ROM) exercises twice a day for 5 days a week for 12 weeks. The RAGT group and the CON group underwent 60 min of training per day. The intervention frequency and duration did not differ between the RAGT group and the CON group. The main outcomes were functional ambulatory category (FAC); 6-min walking test (6MWT); visual analogue scale (VAS) during gait movement; ROM; and isometric forces of bilateral hip, knee, and ankle muscles before and after 12 weeks of training. The results of the VAS, FAC, and 6MWT (8.06 ± 0.66, 1.76 ± 0.56, and 204.41 ± 85.60) before training in the RAGT group improved significantly (4.41 ± 1.18, 4.18 ± 0.39, and 298.53 ± 47.75) after training (p < 0.001, p < 0.001, and p < 0.001). The results of the VAS, FAC, and 6MWT (8.00 ± 1.21, 1.75 ± 0.58, and 220.94 ± 116.88) before training in the CON group improved significantly (5.00 ± 1.03, 3.81 ± 1.05, and 272.19 ± 110.14) after training (p < 0.001, p < 0.001, and p = 0.05). There were differences in the improvement of results of the VAS, FAC, and 6MWT between groups after training, but they were not statistically significant (p = 0.23, p = 0.14, and p = 0.05). The isometric strengths of the right hip extensor (p = 0.02), bilateral knee flexor (p = 0.04 in the right, and p = 0.001 in the left), bilateral knee extensor (p = 0.003 in the right, and p = 0.002 in the left), bilateral ankle dorsiflexor (p = 0.04 in the right, and p = 0.02 in the left), and bilateral ankle plantarflexor (p = 0.001 in the right, and p = 0.008 in the left) after training were significantly improved compared with those before training in the RAGT group. The ROMs of the right knee extension (p = 0.03) and bilateral ankle plantarflexion (p = 0.008 in the right, and p = 0.03 in the left) were significantly improved compared with measurements before training in the RAGT. There were no significant differences of the isometric strengths and ROMs of the bilateral hip, knee, and ankle muscles after training in the CON group. There were significant improvements in the isometric strengths of the left knee flexor (p = 0.01), left ankle dorsiflexor (p = 0.01), and left ankle plantarflexor (p = 0.003) between the two groups. The results suggested that RAGT is effective to facilitate early recovery of muscles strength after a burn injury. This is the first study to evaluate the effectiveness of RAGT in patients with burns compared with those receiving conventional training. The absence of complications in burn patients provides an opportunity to enlarge the application area of RAGT.
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Affiliation(s)
- So Young Joo
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul 07247, Korea; (S.Y.J.); (Y.S.C.)
| | - Seung Yeol Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Soonchunhyang University Hospital, Bucheon 14584, Korea;
| | - Yoon Soo Cho
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul 07247, Korea; (S.Y.J.); (Y.S.C.)
| | - Kuem Ju Lee
- Department of Rehabilitation & Assistive Technology, Korea National Rehabilitation Research Institute, National Rehabilitation Center, Seoul 01022, Korea;
| | - Cheong Hoon Seo
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul 07247, Korea; (S.Y.J.); (Y.S.C.)
- Correspondence: ; Tel.: +82-2-2639-5738; Fax: +82-2-2635-7820
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Jette DU, Hunter SJ, Burkett L, Langham B, Logerstedt DS, Piuzzi NS, Poirier NM, Radach LJL, Ritter JE, Scalzitti DA, Stevens-Lapsley JE, Tompkins J, Zeni Jr J. Physical Therapist Management of Total Knee Arthroplasty. Phys Ther 2020; 100:1603-1631. [PMID: 32542403 PMCID: PMC7462050 DOI: 10.1093/ptj/pzaa099] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/24/2020] [Accepted: 05/14/2020] [Indexed: 12/11/2022]
Abstract
A clinical practice guideline on total knee arthroplasty was developed by an American Physical Therapy (APTA) volunteer guideline development group that consisted of physical therapists, an orthopedic surgeon, a nurse, and a consumer. The guideline was based on systematic reviews of current scientific and clinical information and accepted approaches to management of total knee arthroplasty.
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Affiliation(s)
- Diane U Jette
- FAPTA, MGH, Institute of Health Professions, Boston, Massachusetts
| | | | - Lynn Burkett
- ONC, National Association of Orthopaedic Nurses (NAON), Wyomissing, Pennsylvania
| | - Bud Langham
- Home Health and Hospice Services, Encompass Health, Birmingham, Alabama
| | - David S Logerstedt
- Department of Physical Therapy, University of the Sciences, Philadelphia, Pennsylvania
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Noreen M Poirier
- Department of Orthopedics and Rehabilitation, University of Wisconsin (UW) Health, Madison, Wisconsin
| | - Linda J L Radach
- Consumers United for Evidence Based Healthcare, Lake Forest Park, Washington
| | - Jennifer E Ritter
- Department of Rehabilitation Services/Physical Therapy, University of Pittsburgh Medical Center (UPMC) St Margaret Hospital/Catholic Relief Services, Pittsburgh, Pennsylvania
| | - David A Scalzitti
- OCS, School of Medicine and Health Sciences, George Washington University, Washington, DC
| | - Jennifer E Stevens-Lapsley
- Department of Physical Medicine and Rehabilitation, University of Colorado at Denver & Health Sciences Center, Denver, Colorado
| | - James Tompkins
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Scottsdale, Arizona
| | - Joseph Zeni Jr
- Department of Physical Therapy, University of Delaware, Newark, Delaware
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9
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Joo SY, Lee SY, Cho YS, Lee KJ, Kim SH, Seo CH. Effectiveness of robot-assisted gait training on patients with burns: a preliminary study. Comput Methods Biomech Biomed Engin 2020; 23:888-893. [DOI: 10.1080/10255842.2020.1769080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- So Young Joo
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Seung Yeol Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Soonchunhyang University Hospital, Bucheon, Korea
| | - Yoon Soo Cho
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Kuem Ju Lee
- Department of Rehabilitation & Assistive Technology, Korea National Rehabilitation Research Institute, National Rehabilitation Center, Seoul, Korea
| | - Sang-Hyun Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Soonchunhyang University Hospital, Bucheon, Korea
| | - Cheong Hoon Seo
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
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10
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Wang X, Hunter DJ, Vesentini G, Pozzobon D, Ferreira ML. Technology-assisted rehabilitation following total knee or hip replacement for people with osteoarthritis: a systematic review and meta-analysis. BMC Musculoskelet Disord 2019; 20:506. [PMID: 31679511 PMCID: PMC6825714 DOI: 10.1186/s12891-019-2900-x] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/16/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND To evaluate the effectiveness and safety of technology-assisted rehabilitation following total hip/knee replacement (THR/TKR). METHODS Six electronic databases were searched without language or time restrictions for relevant studies: MEDLINE, EMBASE, Cochrane Library, CINAHL, SPORTDiscus, Physiotherapy Evidence Database (PEDro); from inception to November 7th, 2018. Two reviewers independently applied inclusion criteria to select eligible randomised controlled trials (RCTs) that investigated the effectiveness of technology-based interventions, compared with usual care or no intervention for people undergoing THR/TKR. Two reviewers independently extracted trial details (e.g. patients' profile, intervention, outcomes, attrition and adverse events). Study methodological quality was assessed using the PEDro scale. Quality of evidence was critically appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach. RESULTS We identified 21 eligible studies assessing telerehabilitation, game- or web-based therapy. There were 17 studies (N = 2188) in post-TKR rehabilitation and 4 studies (N = 783) in post-THR rehabilitation. Compared to usual care, technology-based intervention was more effective in reducing pain (mean difference (MD): - 0.25; 95% confidence interval (CI): - 0.48, - 0.02; moderate evidence) and improving function measured with the timed up-and-go test (MD: -7.03; 95% CI: - 11.18, - 2.88) in people undergoing TKR. No between-group differences were observed in rates of hospital readmissions or treatment-related adverse events (AEs) in those studies. CONCLUSION There is moderate-quality of evidence showed technology-assisted rehabilitation, in particular, telerehabilitation, results in a statistically significant improvement in pain; and low-quality of evidence for the improvement in functional mobility in people undergoing TKR. The effects were however too small to be clinically significant. For THR, there is very limited low-quality evidence shows no significant effects.
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MESH Headings
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/trends
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/trends
- Humans
- Osteoarthritis, Hip/rehabilitation
- Osteoarthritis, Hip/surgery
- Osteoarthritis, Knee/rehabilitation
- Osteoarthritis, Knee/surgery
- Randomized Controlled Trials as Topic/methods
- Telerehabilitation/methods
- Telerehabilitation/trends
- Walk Test/methods
- Walk Test/trends
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Affiliation(s)
- Xia Wang
- Level 10 Kolling Institute, Institute of Bone and Joint Research, Royal North Shore Hospital, University of Sydney, Reserve Road, St. Leonards, Sydney, NSW 2065 Australia
| | - David J. Hunter
- Level 10 Kolling Institute, Institute of Bone and Joint Research, Royal North Shore Hospital, University of Sydney, Reserve Road, St. Leonards, Sydney, NSW 2065 Australia
- Department of Gynaecology and Obstetrics, Botucatu Medical School, San Paulo State University, São Paulo, Brazil
| | - Giovana Vesentini
- Level 10 Kolling Institute, Institute of Bone and Joint Research, Royal North Shore Hospital, University of Sydney, Reserve Road, St. Leonards, Sydney, NSW 2065 Australia
- Department of Gynaecology and Obstetrics, Botucatu Medical School, San Paulo State University, São Paulo, Brazil
| | - Daniel Pozzobon
- Level 10 Kolling Institute, Institute of Bone and Joint Research, Royal North Shore Hospital, University of Sydney, Reserve Road, St. Leonards, Sydney, NSW 2065 Australia
| | - Manuela L. Ferreira
- Level 10 Kolling Institute, Institute of Bone and Joint Research, Royal North Shore Hospital, University of Sydney, Reserve Road, St. Leonards, Sydney, NSW 2065 Australia
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11
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Wu XB, Wang JQ, Sun X, Han W. Guidance for the Treatment of Femoral Neck Fracture with Precise Minimally Invasive Internal Fixation Based on the Orthopaedic Surgery Robot Positioning System. Orthop Surg 2019; 11:335-340. [PMID: 31062519 PMCID: PMC6595117 DOI: 10.1111/os.12451] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 03/19/2019] [Indexed: 01/01/2023] Open
Abstract
Femoral neck fractures are among the most common fractures in orthopaedics. There are many surgical methods for the treatment of femoral neck fracture. Percutaneous cannulated lag screw fixation for the treatment of femoral neck fractures is favored by orthopaedic doctors because of its characteristics of being minimally invasive, with less bleeding and firm fixation. However, traditional freehand screw placement is limited by many factors, and the screw malposition rate is very high, which directly leads to the reduction of its biomechanical stability, and even leads to the ischemic necrosis of the femoral head caused by damage to blood vessels. In addition, excessive attempts to drill holes can damage cancellous bone and affect the screw's holding force, which reduces the stability of internal fixation and increases the risk of failure. At the same time, too much radiation exposure to medical personnel and patients also causes great damage to the body. Robot‐assisted orthopaedic surgery combines the mechanical “eye” (an infrared ray tracking device) and the mechanical “hand” (six degrees of freedom mechanical arm), and through the process of preoperative planning, intraoperative assistance in screw placement, and postoperative confirmation, provides a more minimally invasive and precise treatment method for this kind of surgery, and significantly reduces radiation exposure. This guide uses the TiRobot system as an example to describe the robot surgery in detail, aiming at standardizing the application of robots in orthopaedic surgery.
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Affiliation(s)
- Xin-Bao Wu
- Trauma Orthopaedic, Beijing Jishuitan Hospital, Fourth Clinical Hospital of Peking University, Beijing, China
| | - Jun-Qiang Wang
- Trauma Orthopaedic, Beijing Jishuitan Hospital, Fourth Clinical Hospital of Peking University, Beijing, China
| | - Xu Sun
- Trauma Orthopaedic, Beijing Jishuitan Hospital, Fourth Clinical Hospital of Peking University, Beijing, China
| | - Wei Han
- Trauma Orthopaedic, Beijing Jishuitan Hospital, Fourth Clinical Hospital of Peking University, Beijing, China
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12
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Wu XB, Wang JQ, Sun X, Zhao CP. Guidance for Treatment of Pelvic Acetabular Injuries with Precise Minimally Invasive Internal Fixation Based on the Orthopaedic Surgery Robot Positioning System. Orthop Surg 2019; 11:341-347. [PMID: 31062515 PMCID: PMC6595112 DOI: 10.1111/os.12452] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 03/19/2019] [Indexed: 11/30/2022] Open
Abstract
Pelvic acetabular fracture is a common kind of fracture, mostly caused by high energy injuries. It is associated with high mortality and disability rates. The aim of surgical treatment of pelvic acetabular fractures is to restore the symmetry and stability of the pelvic ring structure and the anatomical structure of acetabular. Open reduction internal fixation is often used for the treatment of such fractures, but open surgery is in cases of serious injury, more bleeding, and high risk of infection. With the development of minimally invasive technology and the concept of the bone channel structure, the percutaneous lag screw technique for the treatment of pelvic and acetabular fractures has been applied in clinical practice and has proven to be effective. However, the anatomical structure of the pelvis and acetabulum is complex, and there are many important nerves and vessels adjacent to it. Traditional fluoroscopy screw placement is prone to screw malposition, and even minor angle changes may lead to screw perforation and damage of nerve vessels. The problem of radiation exposure is also noteworthy. Robotic-assisted surgery can be used to carry out screw position planning through preoperative imaging, intraoperative real-time tracking, and mechanical arm assistance to ensure that the screw placement position is consistent with the planning. In this way, robotic-assisted surgery can be used to accurately insert lag screws, and can reduce surgical risk and radiation exposure. This guide uses the TiRobot system as an example to describe the application of robot surgery in detail, aiming at standardizing the application of robots in orthopaedic surgery.
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Affiliation(s)
- Xin-Bao Wu
- Trauma Orthopaedic, Beijing Jishuitan Hospital, Fourth Clinical Hospital of Peking University, Beijing, China
| | - Jun-Qiang Wang
- Trauma Orthopaedic, Beijing Jishuitan Hospital, Fourth Clinical Hospital of Peking University, Beijing, China
| | - Xu Sun
- Trauma Orthopaedic, Beijing Jishuitan Hospital, Fourth Clinical Hospital of Peking University, Beijing, China
| | - Chun-Peng Zhao
- Trauma Orthopaedic, Beijing Jishuitan Hospital, Fourth Clinical Hospital of Peking University, Beijing, China
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13
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Chew E, Turner DA. Can a Robot Bring Your Life Back? A Systematic Review for Robotics in Rehabilitation. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1170:1-35. [PMID: 32067201 DOI: 10.1007/978-3-030-24230-5_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
Stroke is a leading cause of disability in the world and the use of robots in rehabilitation has become increasingly common. The Fourth Industrial Revolutions has created a novel and wide range of options for the involvement of computer-guided and artificially intelligent machines to be used in rehabilitation. In this chapter we critically review some of the literature on the use of robots in rehabilitation, and emphasize the diversity of approaches in this burgeoning field. We argue that there is a need to consolidate interdisciplinary evidence on robotics and rehabilitation in a systematic way, as the alternative is to have a literature that continues to grow, following the interests of various specialists, but without offering a synoptic assessment of what is available to medical specialists and patients. A literature review using Scopus and Web of Science, coupled with the Briggs Institute's Critical Appraisal Tool: Checklist for Case Reports was conducted. The two databases were systematically searched using inter-disciplinary keywords in Feb 2019. An initial search of the databases produced 9894 articles. After rigorous reviews, 35 articles were screened and selected for further interpretation. We examined the current studies on the efficiency and effectiveness of the robot interventions and produced a taxonomy of the review. An original finding of the current robotics in rehabilitation landscaping are critical presented with recommendations and concluding remarks concerning interdisciplinary impact.
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Affiliation(s)
- Esyin Chew
- EUREKA Robotics Lab, Cardiff School of Technologies, Cardiff Metropolitan University, Cardiff, UK.
| | - David A Turner
- Institute for International and Comparative Education, Beijing Normal University, Beijing, China
- South Wales University, Wales, UK
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14
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Henderson KG, Wallis JA, Snowdon DA. Active physiotherapy interventions following total knee arthroplasty in the hospital and inpatient rehabilitation settings: a systematic review and meta-analysis. Physiotherapy 2018; 104:25-35. [DOI: 10.1016/j.physio.2017.01.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 01/19/2017] [Indexed: 10/20/2022]
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15
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Technology-Based Feedback and Its Efficacy in Improving Gait Parameters in Patients with Abnormal Gait: A Systematic Review. SENSORS 2018; 18:s18010142. [PMID: 29316645 PMCID: PMC5795813 DOI: 10.3390/s18010142] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/14/2017] [Accepted: 01/02/2018] [Indexed: 11/16/2022]
Abstract
This systematic review synthesized and analyzed clinical findings related to the effectiveness of innovative technological feedback for tackling functional gait recovery. An electronic search of PUBMED, PEDro, WOS, CINAHL, and DIALNET was conducted from January 2011 to December 2016. The main inclusion criteria were: patients with modified or abnormal gait; application of technology-based feedback to deal with functional recovery of gait; any comparison between different kinds of feedback applied by means of technology, or any comparison between technological and non-technological feedback; and randomized controlled trials. Twenty papers were included. The populations were neurological patients (75%), orthopedic and healthy subjects. All participants were adults, bar one. Four studies used exoskeletons, 6 load platforms and 5 pressure sensors. The breakdown of the type of feedback used was as follows: 60% visual, 40% acoustic and 15% haptic. 55% used terminal feedback versus 65% simultaneous feedback. Prescriptive feedback was used in 60% of cases, while 50% used descriptive feedback. 62.5% and 58.33% of the trials showed a significant effect in improving step length and speed, respectively. Efficacy in improving other gait parameters such as balance or range of movement is observed in more than 75% of the studies with significant outcomes. CONCLUSION Treatments based on feedback using innovative technology in patients with abnormal gait are mostly effective in improving gait parameters and therefore useful for the functional recovery of patients. The most frequently highlighted types of feedback were immediate visual feedback followed by terminal and immediate acoustic feedback.
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16
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Chan ACM, Ouyang XH, Jehu DAM, Chung RCK, Pang MYC. Recovery of balance function among individuals with total knee arthroplasty: Comparison of responsiveness among four balance tests. Gait Posture 2018; 59:267-271. [PMID: 29121594 DOI: 10.1016/j.gaitpost.2017.10.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 07/04/2017] [Accepted: 10/16/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND AIM Balance deficits are common after total knee arthroplasty (TKA); however the responsiveness of commonly used balance measurement tools has not been well defined. The objective of this prospective study was to compare the internal and external responsiveness of four measurement tools in assessing recovery of balance function following TKA. METHODS A total of 134 individuals with TKA (95 women; age: 66.3±6.6years) completed the Balance Evaluation Systems Test (BESTest), Mini-BESTest, Brief-BESTest, and Berg Balance Scale (BBS) at 2, 4, 8, 12, and 24 weeks post-TKA. The Functional Gait Assessment (FGA) served as the anchor measure, and was also measured across these time points. Internal responsiveness was indicated by the standardized response mean (SRM), while external responsiveness was reflected by the degree of association of the changes of balance scores with those of FGA. RESULTS The SRM ranged from 0.60-1.14 for the BESTest, 0.40-0.94 for the Mini-BESTest, 0.27-0.91 for the Brief-BESTest, and 0.19-0.70 for the BBS, over time. The change in BESTest and Mini-BESTest scores predicted the change in the FGA scores across all time periods, except for the Mini-BESTest between weeks 12-24, accounting for 13-27%, and 12-24% of the variance, respectively. The Brief-BESTest scores only predicted FGA scores between the weeks 2-4 (R2=20%). The changes in BBS scores were not associated with the FGA. CONCLUSION The BESTest is the most responsive in measuring recovery of balance among individuals with TKA. The Mini-BESTest is a reasonable option during time constraints.
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Affiliation(s)
- Andy C M Chan
- Physiotherapy Department, Queen Elizabeth Hospital, Hong Kong; Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong.
| | - Xi H Ouyang
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong
| | - Deborah A M Jehu
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong
| | - Raymond C K Chung
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong
| | - Marco Y C Pang
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong
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Weber-Spickschen TS, Colcuc C, Hanke A, Clausen JD, James PA, Horstmann H. Fun During Knee Rehabilitation: Feasibility and Acceptability Testing of a New Android-Based Training Device. Open Med Inform J 2017; 11:29-36. [PMID: 29081870 PMCID: PMC5633709 DOI: 10.2174/1874431101711010029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 05/31/2017] [Accepted: 06/02/2017] [Indexed: 11/22/2022] Open
Abstract
PURPOSE The initial goals of rehabilitation after knee injuries and operations are to achieve full knee extension and to activate quadriceps muscle. In addition to regular physiotherapy, an android-based knee training device is designed to help patients achieve these goals and improve compliance in the early rehabilitation period. This knee training device combines fun in a computer game with muscular training or rehabilitation. Our aim was to test the feasibility and acceptability of this new device. METHODS 50 volunteered subjects enrolled to test out the computer game aided device. The first game was the high-striker game, which recorded maximum knee extension power. The second game involved controlling quadriceps muscular power to simulate flying an aeroplane in order to record accuracy of muscle activation. The subjects evaluated this game by completing a simple questionnaire. RESULTS No technical problem was encountered during the usage of this device. No subjects complained of any discomfort after using this device. Measurements including maximum knee extension power, knee muscle activation and control were recorded successfully. Subjects rated their experience with the device as either excellent or very good and agreed that the device can motivate and monitor the progress of knee rehabilitation training. CONCLUSION To the best of our knowledge, this is the first android-based tool available to fast track knee rehabilitation training. All subjects gave very positive feedback to this computer game aided knee device.
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Affiliation(s)
- Thomas Sanjay Weber-Spickschen
- Institute of Sports Medicine and Trauma Department, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Christian Colcuc
- Institute of Sports Medicine and Trauma Department, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Alexander Hanke
- Institute of Sports Medicine and Trauma Department, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Jan-Dierk Clausen
- Institute of Sports Medicine and Trauma Department, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Paul Abraham James
- Institute of Sports Medicine and Trauma Department, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Hauke Horstmann
- Institute of Sports Medicine and Trauma Department, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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18
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Lange T, Rataj E, Kopkow C, Lützner J, Günther KP, Schmitt J. Outcome Assessment in Total Knee Arthroplasty: A Systematic Review and Critical Appraisal. J Arthroplasty 2017; 32:653-665.e1. [PMID: 28341034 DOI: 10.1016/j.arth.2016.09.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 09/05/2016] [Accepted: 09/13/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The Outcome Measures in Rheumatology (OMERACT) initiative developed a core outcome set (COS) of domains to assess effectiveness of interventions for knee osteoarthritis. These domains (pain, physical function, patient global assessment, imaging at 1 year) should be assessed in every trial to make research evidence meaningful and comparable. We systematically evaluated and critically appraised the use of measurement instruments and outcome domains in prospective studies evaluating patients with knee osteoarthritis undergoing total knee arthroplasty (TKA) and assessed their accordance with the OMERACT COS. METHODS Literature search was performed until August 26, 2014, in Medline and Embase. Clinical trials and prospective observational studies with ≥50 participants and a follow-up of ≥1 year were included. We collected general study characteristics, comprehensive information on measurement instruments, and corresponding domains used. RESULTS This systematic review identified low accordance of used outcome domains with the OMERACT COS of domains published in 1997. Only 4 of 100 included studies included all recommended core domains. Pain (85% of studies) and physical function (86%) were assessed frequently, whereas patient global assessment (21%) and joint imaging (≥1 year; 27%) were rarely assessed. There was substantial heterogeneity in the use of measurement instruments (n = 111) investigating TKA. CONCLUSION More efforts are required to implement the existing COS. In addition, a more consistent use of adequate measurement instruments is important to make research evidence on TKA more relevant, better comparable, and thus more useful for guideline developers and clinical decision makers.
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Affiliation(s)
- Toni Lange
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany; University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Elisabeth Rataj
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany; University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Christian Kopkow
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Jörg Lützner
- University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Klaus-Peter Günther
- University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Jochen Schmitt
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
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