1
|
Monteleone G, Tasso F, De Angelis A, Martorelli F, Simili V, Bovio M, Biamino C, Anzillotti G, Di Matteo B, Marcacci M, Scardino M. Sublingual sufentanil tablet system (SSTS) versus a single shot peri-nervous injection of ropivacaine for the management of postoperative pain after total knee arthroplasty: a single-center randomized trial. Musculoskelet Surg 2024; 108:297-303. [PMID: 38814427 DOI: 10.1007/s12306-024-00833-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 05/15/2024] [Indexed: 05/31/2024]
Abstract
INTRODUCTION For several years, ropivacaine has been the standard-of-care for establishing postoperative femoral nerve block in total knee arthroplasty (TKA) setting and is still widely in use but new approaches such as the patient-controlled administration of sublingual sufentanil tablets system (SSTS) seem to offer good clinical results. Our aim is to compare the SSTS to single shot peri-nervous injection of ropivacaine (single shot) after TKA in terms of effectiveness in pain management and of time to recovery. MATERIALS AND METHODS A total of 165 patients undergoing TKA were enrolled. Eighty-four patients were randomly allocated in the SSTS group and 81 patients in the single shot group. The primary objective of the study was to evaluate performance of Timed Up and Go test. Secondary objectives were to measure the length of stay, NRS pain scale, the adherence to the prescribed plan, the joint mobility, the frequency of rescue analgesic use, side effects and patients' satisfaction. RESULTS Of all patients of the single shot group, 64 were withdrawn from the study as they unable to achieve pain control; only one patient was withdrawn from the SSTS group. Times for the "Timed Up and Go" test on the 3rd postoperative day were 8.4 ± 1.6 and 11.8 ± 3.6 in the SSTS group (n = 83) and single shot group (n = 17), respectively (p < .001). CONCLUSIONS SSTS provides better pain management when compared to peri-nervous ropivacaine single shot injection after TKA.
Collapse
Affiliation(s)
- G Monteleone
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, MI, Italy
| | - F Tasso
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, MI, Italy
| | - A De Angelis
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, MI, Italy
| | - F Martorelli
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, MI, Italy
| | - V Simili
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, MI, Italy
| | - M Bovio
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, MI, Italy
| | - C Biamino
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, MI, Italy
| | - G Anzillotti
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, MI, Italy.
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, MI, Italy.
| | - B Di Matteo
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, MI, Italy
- Department of Traumatology, Orthopaedics and Disaster Surgery, Sechenov University, Moscow, Russia, 119991
| | - M Marcacci
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, MI, Italy
| | - M Scardino
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, MI, Italy
| |
Collapse
|
2
|
Sun JN, Shan YZ, Wu LX, Li N, Xu FH, Kong XR, Zhang B. Preoperative high-intensity strength training combined with balance training can improve early outcomes after total knee arthroplasty. J Orthop Surg Res 2023; 18:692. [PMID: 37715204 PMCID: PMC10504716 DOI: 10.1186/s13018-023-04197-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 09/13/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND To investigate the effect of preoperative high-intensity strength training combined with balance training on the knee function of end-stage knee osteoarthritis (KOA) patients after total knee arthroplasty (TKA). METHODS A prospective study was conducted on end-stage KOA patients awaiting TKA. The patients were divided into an experimental group and a control group according to whether they received a preoperative training intervention. The differences in knee flexor-extensor strength, knee range of motion (ROM), timed up and go (TUG) test result, stair ascend/descend test result, Knee Society score (KSS) and Berg balance scale (BBS) score were assessed in both groups at baseline (T1), before operation (T2), 3 months after operation (T3), and 1 year after operation (T4). RESULTS After high-intensity strength training and balance training, the knee flexor-extensor strength, TUG test result, stair ascend/descend test result, and KSS were all significantly improved at T2 in the experimental group over the control group. At T3, the knee ROM, knee flexor-extensor strength, TUG test result, BBS score, and KSS clinical and functional scores were all significantly superior in the experimental group. The experimental group enjoyed a superiority in KSS clinical and functional scores until T4. Group × time and between-group interactions were found in all assessment indicators in both groups (p < 0.01). CONCLUSION Preoperative high-intensity strength training combined with balance training can enhance the knee flexor-extensor strength and balance of patients with end-stage KOA in the short term and help improve early outcomes after KOA. Trial registration ChiCTR2000032857, 2020-05-13.
Collapse
Affiliation(s)
- Jian-Ning Sun
- Department of Orthopedics, Nanjing Drum Tower Hospital Group Suqian Hospital, Suqian, China
- Department of Orthopedics, Suqian hospital affiliated to Xuzhou Medical University, Suqian, China
| | - Yu-Zhou Shan
- Department of Orthopedics, Nanjing Drum Tower Hospital Group Suqian Hospital, Suqian, China
- Department of Orthopedics, Suqian hospital affiliated to Xuzhou Medical University, Suqian, China
| | - Li-Xia Wu
- Research Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ning Li
- Department of Orthopedics, Nanjing Drum Tower Hospital Group Suqian Hospital, Suqian, China
- Department of Orthopedics, Suqian hospital affiliated to Xuzhou Medical University, Suqian, China
| | - Fei-Hu Xu
- Department of Orthopedics, Nanjing Drum Tower Hospital Group Suqian Hospital, Suqian, China
- Department of Orthopedics, Suqian hospital affiliated to Xuzhou Medical University, Suqian, China
| | - Xiang-Ru Kong
- Department of Orthopedics, Nanjing Drum Tower Hospital Group Suqian Hospital, Suqian, China
- Department of Orthopedics, Suqian hospital affiliated to Xuzhou Medical University, Suqian, China
| | - Bei Zhang
- Department of Orthopedics, Nanjing Drum Tower Hospital Group Suqian Hospital, Suqian, China.
- Department of Orthopedics, Suqian hospital affiliated to Xuzhou Medical University, Suqian, China.
| |
Collapse
|
3
|
Vervullens S, Meert L, Baert I, Smeets RJEM, Verdonk P, Rahusen F, Meeus M. Prehabilitation before total knee arthroplasty: A systematic review on the use and efficacy of stratified care. Ann Phys Rehabil Med 2022; 66:101705. [PMID: 36115573 DOI: 10.1016/j.rehab.2022.101705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 08/04/2022] [Accepted: 08/09/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Preoperative rehabilitation (hereafter called "prehabilitation") has been proposed as a potentially effective treatment to target preoperative risk factors to prevent insufficient outcome after total knee arthroplasty (TKA). PURPOSE We aimed to assess whether previous clinical trials of non-surgical, non-pharmacological prehabilitation in individuals with knee osteoarthritis (KOA) awaiting TKA focused on specific clinical phenotypes or specific individual characteristics and whether the content of the prehabilitation was stratified accordingly. Second, we aimed to summarize and compare the long-term effects of stratified and non-stratified care on pain, satisfaction, function and quality of life. METHODS A systematic literature search of PubMed, Web of Science, Scopus and Embase was performed. All relevant articles published up to April 19, 2021 reporting "(randomized controlled) clinical trials or prospective cohort studies" (S) related to the key words "total knee arthroplasty" (P), "preoperative conservative interventions" (I), "pain, function, quality of life and/or satisfaction" (O) were included. RESULTS After screening 3498 potentially eligible records, 18 studies were assessed for risk of bias. Twelve studies had low, 2 moderate, 3 serious, and one high risk of bias. The latter study was excluded, resulting in 17 included studies. Five studies investigated a"stratified prehabilitation care" and 12 "non-stratified prehabilitation care". Stratified prehabilitation in 4 studies meant that the study sample was chosen considering a predefined intervention, and in the fifth study, the prehabilitation was stratified to individuals' needs. No direct comparison between the 2 approaches was possible. We found weak evidence for a positive effect of biopsychosocial prehabilitation compared to no prehabilitation on function (stratified studies) and pain neuroscience education prehabilitation compared to biomedical education on satisfaction (non-stratified studies) at 6 months post-TKA. We found strong evidence for positive effects of exercise prehabilitation compared to no prehabilitation on pain at 6 months and on function at 12 months post-TKA (non-stratified studies). CONCLUSION More research is needed of stratified prehabilitation care focusing on individual characteristics in people with KOA awaiting TKA. REGISTRATION NUMBER This systematic review was prospectively registered at PROSPERO on March 22, 2021 (no. CRD42021221098).
Collapse
Affiliation(s)
- Sophie Vervullens
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands; Pain in Motion International Research Group (PiM), www.paininmotion.be, the Netherlands
| | - Lotte Meert
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands; Pain in Motion International Research Group (PiM), www.paininmotion.be, the Netherlands
| | - Isabel Baert
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Pain in Motion International Research Group (PiM), www.paininmotion.be, the Netherlands
| | - Rob J E M Smeets
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands; CIR Revalidatie, location Eindhoven, the Netherlands; Pain in Motion International Research Group (PiM), www.paininmotion.be, the Netherlands
| | - Peter Verdonk
- ORTHOCA, Antwerp, Belgium and ASTARC department, Antwerp University, Belgium
| | - Frank Rahusen
- Department of Orthopaedics, St Jans Gasthuis Weert, the Netherlands
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium; Pain in Motion International Research Group (PiM), www.paininmotion.be, the Netherlands.
| |
Collapse
|
4
|
Wu Z, Wang Y, Li C, Li J, Chen W, Ye Z, Zeng Z, Hong K, Zhu Y, Jiang T, Lu Y, Liu W, Xu X. Preoperative Strength Training for Clinical Outcomes Before and After Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. Front Surg 2022; 9:879593. [PMID: 35937597 PMCID: PMC9349363 DOI: 10.3389/fsurg.2022.879593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 06/21/2022] [Indexed: 12/03/2022] Open
Abstract
Background There is an increasing interest in preoperative strength training for promoting post-operative rehabilitation, but the effectiveness of preoperative strength training for clinical outcomes after total knee arthroplasty (TKA) remains controversial. Objective This study aims to systematically evaluate the effect of preoperative strength training on clinical outcomes before and after TKA. Methods We systematically searched PubMed, Cochrane Library, Web of Science, and EMBASE databases from the inception to November 17, 2021. The meta-analysis was performed to evaluate the effects of preoperative strength training on clinical outcomes before and after TKA. Results Seven randomized controlled trials (RCTs) were included (n = 306). Immediately before TKA, the pooled results showed significant improvements in pain, knee function, functional ability, stiffness, and physical function in the strength training group compared with the control group, but not in strength (quadriceps), ROM, and WOMAC (total). Compared with the control group, the results indicated strength training had a statistically significant improvement in post-operative knee function, ROM, and functional ability at less than 1 month and 3 months, and had a statistically significant improvement in post-operative strength (quadriceps), stiffness, and WOMAC (total) at 3 months, and had a statistically significant improvement in post-operative pain at 6 months. However, the results indicated strength training had no statistically significant improvement in post-operative strength (quadriceps) at less than 1 month, 6, and 12 months, had no statistically significant improvement in post-operative pain at less than 1 month, 3, and 12 months, had no statistically significant improvement in post-operative knee function at 6 and 12 months, and had no statistically significant improvement in post-operative physical function at 3 months. Conclusions Preoperative strength training may be beneficial to early rehabilitation after TKA, but the long-term efficacy needs to be further determined. At the same time, more caution should be exercised when interpreting the clinical efficacy of preoperative strength training for TKA.
Collapse
Affiliation(s)
- Zugui Wu
- The Fifth Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yi Wang
- The Fifth Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Congcong Li
- The Fifth Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Junyi Li
- The Fifth Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Weijian Chen
- The Fifth Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zixuan Ye
- The Fifth Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ziquan Zeng
- The Fifth Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Second Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Kunhao Hong
- The Fifth Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Second Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Yue Zhu
- Baishui Health Center, Qujing, China
| | - Tao Jiang
- The Fifth Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Second Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Yanyan Lu
- Luoyang Orthopedic Hospital Of Henan Province (Orthopedic Hospital of Henan Province), Zhengzhou, China
| | - Wengang Liu
- The Fifth Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Second Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Xuemeng Xu
- The Fifth Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Second Hospital of Traditional Chinese Medicine, Guangzhou, China
| |
Collapse
|
5
|
Husted RS, Troelsen A, Husted H, Grønfeldt BM, Thorborg K, Kallemose T, Rathleff MS, Bandholm T. Knee-extensor strength, symptoms, and need for surgery after two, four, or six exercise sessions/week using a home-based one-exercise program: a randomized dose-response trial of knee-extensor resistance exercise in patients eligible for knee replacement (the QUADX-1 trial). Osteoarthritis Cartilage 2022; 30:973-986. [PMID: 35413476 DOI: 10.1016/j.joca.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/28/2022] [Accepted: 04/05/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate firstly the efficacy of three different dosages of one home-based, knee-extensor resistance exercise on knee-extensor strength in patients eligible for knee replacement, and secondly, the influence of exercise on symptoms, physical function and decision on surgery. METHOD One-hundred and forty patients eligible for knee replacement were randomized to three groups: 2, 4 or 6 home-based knee-extensor resistance exercise-sessions per week (group 2, 4 and 6 respectively) for 12 weeks. PRIMARY OUTCOME isometric knee-extensor strength. SECONDARY OUTCOMES Oxford Knee Score, Knee injury and Osteoarthritis Outcome Score, average knee pain last week (0-10 numeric rating scale), 6-min walk test, stair climbing test, exercise adherence and "need for surgery". RESULTS Primary analysis: Intention-to-treat analysis of 140 patients did not find statistically significant differences between the groups from baseline to after 12 weeks of exercise in isometric knee-extensor strength: Group 2 vs 4 (0.003 Nm/kg (0.2%) [95% CI -0.15 to 0.15], P = 0.965) and group 4 vs 6 (-0.04 Nm/kg (-2.7%) [95% CI -0.15 to 0.12], P = 0.628). Secondary analysis: Intention-to-treat analyses showed statistically significant differences between the two and six sessions/week groups in favor of the two sessions/week group for Oxford Knee Score: 4.8 OKS points (15.2%) [1.3 to 8.3], P = 0.008) and avg. knee pain last week (NRS 0-10): -1.3 NRS points (-19.5%) [-2.3 to -0.2], P = 0.018. After the 12-week exercise intervention, data were available for 117 patients (N = 39/group): 38 (32.5%) patients wanted surgery and 79 (67.5%) postponed surgery. This was independent of exercise dosage. CONCLUSION In patients eligible for knee-replacement we found no between-group differences in isometric knee extensor strength after 2, 4 and 6 knee-extensor resistance exercise sessions per week. We saw no indication of an exercise dose-response relationship for isometric knee-extensor strength and only clinically irrelevant within group changes. For some secondary outcome (e.g., KOOS subscales) we found clinically relevant within group changes, which could help explain why only one in three patients decided to have surgery after the simple home-based exercise intervention. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02931058. Preprint: https://doi.org/10.1101/2021.04.07.21254965.
Collapse
Affiliation(s)
- R S Husted
- Department of Clinical Research, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark; Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark; Clinical Orthopedic Research Hvidovre (CORH), Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark.
| | - A Troelsen
- Clinical Orthopedic Research Hvidovre (CORH), Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark.
| | - H Husted
- Clinical Orthopedic Research Hvidovre (CORH), Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark.
| | - B M Grønfeldt
- Department of Clinical Research, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark; Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark.
| | - K Thorborg
- Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark; Sports Orthopaedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark.
| | - T Kallemose
- Department of Clinical Research, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark.
| | - M S Rathleff
- Center for General Practice at Aalborg University, Aalborg, Denmark; Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark; Department of Health Science and Technology, Aalborg University, Denmark.
| | - T Bandholm
- Department of Clinical Research, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark; Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark; Clinical Orthopedic Research Hvidovre (CORH), Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark.
| |
Collapse
|
6
|
Su W, Zhou Y, Qiu H, Wu H. The effects of preoperative rehabilitation on pain and functional outcome after total knee arthroplasty: a meta-analysis of randomized controlled trials. J Orthop Surg Res 2022; 17:175. [PMID: 35313897 PMCID: PMC8935773 DOI: 10.1186/s13018-022-03066-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/09/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
There have been controversial findings for the effectiveness of rehabilitation before operation after total knee arthroplasty (TKA). This study aimed to conduct an updated, comprehensive systematic review. On that basis, the review was to be combined with meta-analysis to measure the effects of rehabilitation before operation on functions and pain after TKA.
Methods
Articles were searched by using Central Register of Controlled Trials (CENTRAL), Web of Science, EMBASE, Cochrane, Pubmed, CNKI, Wanfang, Weipu and the Chinese Biomedical Database from the beginning to December 10, 2021. The major outcomes included pain, knee flexion and extension, as well as knee range of motion (ROM). Secondary outcomes included timed-up-and-go (TUG), 6-min walk, and patient-reported functional outcome (the Knee Injury and Osteoarthritis Outcome Score (KOOS) or Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)). Third outcomes included the length of hospital stay.
Results
Nineteen studies recruiting 1008 patients satisfied with the inclusion criteria. Significant difference was identified in knee flexion, TUG, KOOS (knee-associated life quality and functions in sports and recreation), as well as the length of hospital stay (P < 0.05). Insignificant statistical difference was identified in pain, 6-min walk, ROM, knee extension, KOOS (pain, symptoms and function of daily living) after TKA between the two groups. No difference was found between the groups in WOMAC.
Conclusions
Preoperative rehabilitation could significantly shorten hospital stay, whereas there is not any conclusive evidence of the improvement of postoperative functions. Accordingly, in-depth high-quality studies should be conducted to confirm the effectiveness of preoperative rehabilitation in patients having received TKA.
Collapse
|
7
|
Vasileiadis D, Drosos G, Charitoudis G, Dontas IA, Vlamis J. The Efficacy of High-Intensity Preoperative Physiotherapy Training on Postoperative Outcomes in Greek Patients Undergoing Total Knee Arthroplasty: A Quasi-Experimental Study. Cureus 2022; 14:e23191. [PMID: 35444879 PMCID: PMC9010031 DOI: 10.7759/cureus.23191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2022] [Indexed: 01/21/2023] Open
Abstract
Purpose: Several studies have shown that patients with severe osteoarthritis (OA) of the knee can reduce their knee pain, improve their quadriceps strength, and improve their functional ability through regular exercise training. The purpose of this study was to investigate the efficacy of a six-week supervised high-intensity preoperative training program on muscle strength, functional performance, and patient-reported outcomes in patients undergoing total knee arthroplasty (TKA). Methods: Ninety-eight patients scheduled for unilateral TKA for severe OA were allocated to an intervention group (N = 49) who completed a six-week preoperative training program, five days per week prior to surgery, and a control group (N=49) who did not follow any preoperative training program. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Physical Functioning Scale of the Short Form-36 questionnaire (SF-36), Knee Injury and Osteoarthritis Outcome Score (KOOS), quadriceps strength, 20-meter walk test, and 30-second chair stand test were assessed at six weeks before surgery (T0), just before surgery (T1), four weeks (T2) and finally 12 weeks (T3) after TKA. Results: Of 98 patients included in our study, 10 individuals withdrew from the study at different stages. Finally, 44 patients were allocated to the intervention group and 44 patients to the control group. When comparing the changes from baseline to the primary test points at T1, T2, and T3, we found a significant group difference in favor of the intervention group for quadriceps strength (<0.001, 0.001, 0.009), 20-meter walk test (<0.001, 0.023, 0.032), 30-second chair stand test (0.001, <0.001, <0.001) and all patient-reported outcomes WOMAC (<0.001, 0.001, 0.007) except from KOOS that showed significant difference only at T1 (<0.001) at T2 (0.048) but not at T3 (0.087). Conclusions: Our study demonstrated that a six-week preoperative physiotherapy training program supervised by a physiotherapist before TKA is efficacious for decreasing knee pain, improving knee function, and enhancing daily living activities.
Collapse
Affiliation(s)
- Dimitrios Vasileiadis
- Laboratory for Research of the Musculoskeletal System, KAT General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, GRC
| | - Georgios Drosos
- Department of Orthopaedic Surgery, University General Hospital of Alexandroupolis, School of Medicine, Democritus University of Thrace, Alexandroupolis, GRC
| | - Georgios Charitoudis
- Department of Orthopaedic Surgery, University General Hospital of Alexandroupolis, School of Medicine, Democritus University of Thrace, Alexandroupolis, GRC
| | - Ismene A Dontas
- Veterinary Medicine, Laboratory for Research of the Musculoskeletal System, KAT General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, GRC
| | - John Vlamis
- 3rd Department of Orthopaedic Surgery, KAT General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, GRC
| |
Collapse
|
8
|
Almeida GJ, Khoja SS, Zelle BA. Effect of prehabilitation in older adults undergoing total joint replacement: An Overview of Systematic Reviews. CURRENT GERIATRICS REPORTS 2020; 9:280-287. [PMID: 33344110 DOI: 10.1007/s13670-020-00342-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Purpose of Review To review and discuss the findings of systematic reviews that synthesized the evidence on the effect of preoperative exercises (prehabilitation) on postoperative functional recovery in older adults undergoing total knee or hip joint replacement. Recent Findings Ten systematic reviews (8 meta-analyses) were included in this review. Findings from the systematic reviews indicated that prehabilitation decreases length of hospital stay but does not improve postoperative functional recovery in older adults undergoing joint replacement. Individual studies in the systematic reviews varied considerably in prehabilitation protocol, assessment timepoints, and outcome measures. Most importantly, systematic reviews did not assess the outcomes pre-post prehabilitation as this timepoint was not addressed in most individual studies. Therefore, it is not known whether the prehabilitation programs improved outcomes preoperatively. Summary There is a need to develop comprehensive prehabilitation protocols and systematically assess the preoperative and postoperative effectiveness of prehabilitation protocols on functional outcomes (i.e., self-reported and performance-based) in older adults undergoing total joint replacement.
Collapse
Affiliation(s)
- Gustavo J Almeida
- Department of Physical Therapy, School of Health Professions, University of Texas Health Science Center at San Antonio; Department of Orthopaedics, Long School of Medicine, University of Texas Health Science Center at San Antonio
| | - Samannaaz S Khoja
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh
| | - Boris A Zelle
- Department of Orthopaedics, Long School of Medicine, University of Texas Health Science Center at San Antonio
| |
Collapse
|
9
|
Boudenot A. Intérêt d’une rééducation préopératoire de prothèse totale de genou, effets en postopératoire. Sci Sports 2020. [DOI: 10.1016/j.scispo.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
10
|
Reynaud V, Dobija L, Fournier PL, Lanhers C, Coudeyre E. Pre-TKR isokinetic quadriceps strengthening has a positive effect which may diminish following the intervention despite pain and functional improvements: A case study. ISOKINET EXERC SCI 2020. [DOI: 10.3233/ies-203122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report a longitudinal survey of a 53-year-old man suffering from right knee osteoarthritis who has undergone total knee replacement (TKR). We aimed at evaluating the effect of a short preoperative isokinetic strengthening program on the functional status, pain, and quadriceps and hamstrings strength before and after TKR. The patient performed a 4-week (6 sessions) preoperative isokinetic strengthening program of the quadriceps and hamstrings. The findings for the concentric strength at 60∘/s, 6-minute walk test (6MWT), and Knee injury and Osteoarthritis Outcome Score (KOOS) were recorded. At baseline the patient presented with an overall KOOS score of 44%, a 6MWT of 444 m, a 63% and 21% strength deficits of the quadriceps and hamstrings, respectively. Following the strengthening program, the quadriceps strength of the operated limb improved (+121 Nm; +83%), but the function as reflected by the KOOS score remained unchanged. Following the TKR, the concentric isokinetic strength of the quadriceps reappeared altered (63% of deficit) despite pain and functional improvements. This case report underlines the importance of functional evaluation rather than the maximal strength to assess the effectiveness of TKR. However, further studies are necessary to conceptualize the meaning of maximal strength measurement and the impact of associated deficits, if any.
Collapse
Affiliation(s)
- Vivien Reynaud
- Service de Médecine Physique et de Réadaptation, CHU Clermont-Ferrand, France
- Université Clermont Auvergne, INRA, UNH, Clermont-Ferrand, France
| | - Lech Dobija
- Service de Médecine Physique et de Réadaptation, CHU Clermont-Ferrand, France
- Université Clermont Auvergne, INRA, UNH, Clermont-Ferrand, France
| | | | - Charlotte Lanhers
- Centre de Médecine Physique et de Réadaptation Notre Dame, Chamalières, France
| | - Emmanuel Coudeyre
- Service de Médecine Physique et de Réadaptation, CHU Clermont-Ferrand, France
- Université Clermont Auvergne, INRA, UNH, Clermont-Ferrand, France
| |
Collapse
|
11
|
Alexander N, Wegener R, Lengnick H, Payne E, Klima H, Cip J, Studer K. Compensatory gait deviations in patients with increased outward tibial torsion pre and post tibial derotation osteotomy. Gait Posture 2020; 77:43-51. [PMID: 31981934 DOI: 10.1016/j.gaitpost.2020.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Tibial torsion describes the rotation between the proximal and distal joint axis along the shaft, which can be, as rotational deformity, pathologically increased or decreased. Some patients might increase hip internal rotation during walking to compensate increased outward tibial torsion. RESEARCH QUESTION The aim of this study was to assess the effect of tibial derotation osteotomy on gait deviations in patients with increased outward tibial torsion. METHODS Thirteen patients (13.5 ± 1.4 yrs, 22 limbs) with increased tibial torsion (CT confirmed 49.2 ± 4.8°) were analyzed pre and post tibial derotation osteotomy and compared with 17 typically developing children (TDC, 13.5 ± 2.3 yrs, 32 limbs). Kinematic and kinetic data were recorded. Subgroup analyses were performed whether patients showed compensatory hip internal rotation (Comp) or not (NoComp). Principal component (PC) analysis was used to achieve data transformation. A linear mixed model was used to estimate the main effect of PC-scores of retained PCs explaining 90% of the cumulative variance. RESULTS Compensatory hip internal rotation (Comp, present in 45.5% of limbs analyzed) led to a lower external foot progression angle compared to patients without compensatory hip internal rotation (NoComp). In both patient groups foot progression angle was normalized after tibial derotation osteotomy. Post-operative NoComp had normalized frontal plane joint loadings, while Comp showed an increased hip and knee adduction moment. SIGNIFICANCE Future studies should investigate if more time is needed for Comp to normalize gait patterns post-operative or if a pre and post-operative gait training might help. Otherwise the increased knee adduction moment might be clinically relevant due to previous studies reporting a possible association with knee osteoarthritis.
Collapse
Affiliation(s)
- Nathalie Alexander
- Laboratory for Motion Analysis, Department of Paediatric Orthopaedics, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland; Department of Orthopaedics and Traumatology, Cantonal Hospital, St. Gallen, Switzerland.
| | - Regina Wegener
- Laboratory for Motion Analysis, Department of Paediatric Orthopaedics, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland; Department of Orthopaedics and Traumatology, Cantonal Hospital, St. Gallen, Switzerland
| | - Harald Lengnick
- Department of Paediatric Orthopaedics, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Erika Payne
- Department of Paediatric Orthopaedics, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Harry Klima
- Department of Paediatric Orthopaedics, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Johannes Cip
- Department of Paediatric Orthopaedics, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Kathrin Studer
- Department of Paediatric Orthopaedics, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| |
Collapse
|
12
|
Dennis J, Wylde V, Gooberman-Hill R, Blom AW, Beswick AD. Effects of presurgical interventions on chronic pain after total knee replacement: a systematic review and meta-analysis of randomised controlled trials. BMJ Open 2020; 10:e033248. [PMID: 31964670 PMCID: PMC7045074 DOI: 10.1136/bmjopen-2019-033248] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Nearly 100 000 primary total knee replacements (TKR) are performed in the UK annually. The primary aim of TKR is pain relief, but 10%-34% of patients report chronic pain. The aim of this systematic review was to evaluate the effectiveness of presurgical interventions in preventing chronic pain after TKR. DESIGN MEDLINE, Embase, CINAHL, The Cochrane Library and PsycINFO were searched from inception to December 2018. Screening and data extraction were performed by two authors. Meta-analysis was conducted using a random effects model. Risk of bias was assessed using the Cochrane tool and quality of evidence was assessed by Grading of Recommendations Assessment, Development and Evaluation. PRIMARY AND SECONDARY OUTCOMES Pain at 6 months or longer; adverse events. INTERVENTIONS Presurgical interventions aimed at improving TKR outcomes. RESULTS Eight randomised controlled trials (RCTs) with data from 960 participants were included. The studies involved nine eligible comparisons. We found moderate-quality evidence of no effect of exercise programmes on chronic pain after TKR, based on a meta-analysis of 6 interventions with 229 participants (standardised mean difference 0.20, 95% CI -0.06 to 0.47, I2=0%). Sensitivity analysis restricted to studies at overall low risk of bias confirmed findings. Another RCT of exercise with no data available for meta-analysis showed no benefit. Studies evaluating combined exercise and education intervention (n=1) and education alone (n=1) suggested similar findings. Adverse event data were reported by most studies, but events were too few to draw conclusions. CONCLUSIONS We found low to moderate-quality evidence to suggest that neither preoperative exercise, education nor a combination of both is effective in preventing chronic pain after TKR. This review also identified a lack of evaluations of other preoperative interventions, such as multimodal pain management, which may improve long-term pain outcomes after TKR. PROSPERO REGISTRATION NUMBER CRD42017041382.
Collapse
Affiliation(s)
- Jane Dennis
- Musculoskeletal Research Unit, Translational Health Sciences, University of Bristol, Bristol, UK
| | - Vikki Wylde
- Musculoskeletal Research Unit, Translational Health Sciences, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, Translational Health Sciences, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - A W Blom
- Musculoskeletal Research Unit, Translational Health Sciences, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Andrew David Beswick
- Musculoskeletal Research Unit, Translational Health Sciences, University of Bristol, Bristol, UK
| |
Collapse
|
13
|
Borrell-Vega J, Esparza Gutierrez AG, Humeidan ML. Multimodal Prehabilitation Programs for Older Surgical Patients. Anesthesiol Clin 2019; 37:437-452. [PMID: 31337477 DOI: 10.1016/j.anclin.2019.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Despite advances in perioperative care, short-term and long-term postoperative complications are still experienced by many patients, which is of special relevance to the older adult population, considered to be high-risk surgical candidates because of less functional reserve and comorbidity burden. Through the implementation of prehabilitation programs, patients can be optimized to handle the physical and mental stress of surgery. Benefits have been described in a variety of surgical populations, but more studies targeting older surgical patients are needed. These studies should include standardized prehabilitation protocols and large sample sizes to avoid the limitations of the existing prehabilitation literature.
Collapse
Affiliation(s)
- Jaume Borrell-Vega
- Department of Anesthesiology - Clinical Research, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, N-411 Doan Hall, Columbus, OH 43210, USA.
| | - Alan G Esparza Gutierrez
- Department of Anesthesiology - Clinical Research, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, N-411 Doan Hall, Columbus, OH 43210, USA
| | - Michelle L Humeidan
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, N-411 Doan Hall, Columbus, OH 43210, USA
| |
Collapse
|
14
|
Richie D, Bullard D. Postoperative Convalescence. Clin Podiatr Med Surg 2019; 36:153-161. [PMID: 30446042 DOI: 10.1016/j.cpm.2018.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Foot and ankle surgery can impose significant hardship on a patient when carrying out their essential activities of daily living including mobility, sourcing and preparing food, as well as maintaining personal hygiene. Pre-operative planning between the surgeon, patient and caregivers can circumvent most of the challenges imposed by the post-operative restrictions of foot and ankle surgery. Depending on the weight bearing status of the operated extremity, a wide array of durable medical equipment devices are available to provide mobility and safety for the patient. Various devices are also available to protect the patient and the operative site during bathing. Pre-operative gait training can be valuable in selecting the most appropriate mobility aid for the patient, assuring safe ambulation while keeping the operated extremity protected.
Collapse
Affiliation(s)
- Doug Richie
- Private Practice, Alamitos-Seal Beach Podiatry Group, 550 Pacific Coast Highway, Suite 209, Seal Beach, CA 90740, USA; Department of Biomechanics, California School of Podiatric Medicine at Samuel Merritt University, Oakland, CA, USA; Western University of Health Sciences, Pomona, CA, USA.
| | - Daniel Bullard
- St Vincent Charity Medical Center, 2322 East 22nd Street, Cleveland, OH 44115, USA
| |
Collapse
|