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Schröter V, Könczöl C, Anders JO. Comparison of Pre- and Postoperative Motor-proprioceptive Abilities in Patients with Gonarthrosis. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024; 162:479-486. [PMID: 37798916 DOI: 10.1055/a-2151-4849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Both surgeons and patients want to achieve a high level of satisfaction and the best possible functional results within a short time after knee TEP surgery. By using a tool that digitally records various measurement parameters of balance and motor function preoperatively and postoperatively on a mobile basis and with little time expenditure, progressive results can be compared. Individual factors can thus be determined and these can influence the progress in regeneration and training progress perioperatively.In a prospective study, 100 patients before and 66 patients after installation of a cement-retained knee TEP were evaluated for the following parameters: balance, maximum strength, and power. All measurements were performed with the KMP measurement platform from MotoSana. The second measurements were performed in each case after a standardised follow-up treatment.It was shown that there are significant relationships between personal factors such as age, height, body weight and with baseline values and performance measures: maximum strength and power. Furthermore, it was shown that postoperative improvement could be achieved for the most part around balance support. All patients who previously had to hold on with one hand or both hands no longer needed support after surgery to maintain the single-leg stance for the specified time of 15 s. For a more detailed analysis of the balance parameters, the samples were adjusted and only the patients who did not hold on for support pre- and postoperatively were counted. In patients with low and medium initial stance, the sway area increased at the second measurement session, and in patients with large sway areas, it decreased, and the stance became more stable. In the area of maximum strength and power, patients with high baseline values still had higher values after AHB compared with the other patients, but lower values compared with their own baseline values.Patients who already had very good motor skills before surgery were able to achieve a greater increase in motor skills compared to the weaker group. However, all patients failed to reach their preoperative baseline values after completion of the AHB. Deficits in balance were still detectable in all groups. By using the presented force plate, measurement-based coordinated rehabilitation procedures are possible during and after completion of the AHB. Rehabilitation with individualised improvement of balance and motor function could be expected to prevent dissatisfaction after knee arthroplasty, e.g. due to muscular imbalance in femoropatellar pain syndromes.
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Affiliation(s)
| | - Clemens Könczöl
- Institut für Psychologie, Agentur für Struktur, Karl-Franzens-Universität Graz, Graz, Österreich
| | - Jens O Anders
- Orthopädie, Kliniken Dr. Erler, Nürnberg, Deutschland
- Lehrstuhl für Orthopädie und Unfallchirurgie, Universitätsklinikum Nürnberg-Erlangen, Erlangen
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Keating C, Muth S, Hui C, Hoglund LT. Utilization of Blood Flow Restriction Therapy with a Former Triathlete After Total Knee Arthroplasty: A Case Report. Int J Sports Phys Ther 2024; 19:1138-1150. [PMID: 39267627 PMCID: PMC11392462 DOI: 10.26603/001c.122488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 07/19/2024] [Indexed: 09/15/2024] Open
Abstract
Introduction and Purpose Knee osteoarthritis (OA) is a common condition that limits function and reduces quality of life. Total knee arthroplasty (TKA) is a surgical procedure that replaces the joint surfaces to address anatomical changes due to knee OA. While TKA improves symptoms and function, postoperative impairments are common, including reduced quadriceps strength. Blood flow restriction (BFR) may be a viable option for patients following TKA, as it can improve strength with a minimal amount of joint loading compared to traditional strength training. The purpose of this case report is to describe the impact of BFR use in an individual after TKA, employing pain measurements, quantitative sensory testing, patient-reported outcome measures, physical performance tests, and muscle strength and power testing to explore potential treatment effects and identify potential predictors of response for future studies. Case Description A 49-year-old former female triathlete with a history of knee injury and arthroscopic surgery underwent a right TKA and sought physical therapy (PT) due to pain, limited range of motion (ROM), and knee instability during weight bearing activity. PT interventions included manual therapy, gait training, and a home program. Despite participating in supervised PT, she had persistent pain, ROM deficits, and muscle weakness 16 weeks following TKA. BFR was incorporated into her home program, 16-weeks postoperatively. The Short Form McGill Pain Questionnaire-2 (SF-MPQ-2) and Numeric Pain Rating Scale (NPRS) were used to measure pain. Quantitative sensory testing included pressure pain threshold (PPT) and two-point discrimination (TPD) to measure change in sensory perception. Patient-reported outcome measures to assess perceived physical function were the Knee injury and Osteoarthritis Outcome Score (KOOS) and the KOOS- Joint Replacement (KOOS-JR). Physical performance was measured through the 30-second fast walk test (30SFW), timed stair climb test (SCT), 30-second chair standing test (CST), and the timed up and go (TUG). Knee ROM was assessed through standard goniometry. Knee extensor and flexor muscle strength and power were measured with an instrumented dynamometer for isokinetic and isometric testing, generating a limb symmetry index (LSI). Outcomes Pain and quantitative sensory testing achieved clinically meaningful improvement suggesting reduced sensitivity during and after BFR utilization. Perceived physical function and symptoms significantly improved, particularly in sports and recreation activities, and were best captured in the KOOS, not the KOOS-JR. Physical performance reached clinically meaningful improvement in walking speed, chair stand repetitions, and timed stair climb tests after BFR. Isokinetic and isometric strength and power in knee extensors and flexors increased significantly after BFR compared to the uninvolved leg as determined by LSI. Discussion In this case, BFR appeared to be a safe and well-tolerated intervention. The results suggest potential benefits in terms of increased function, strength, power, and reduced pain in this specific person after TKA. Comprehensive pain and sensory assessments alongside clinical measures may help identify suitable patients for BFR after TKA. The KOOS-Sport & Recreation subscale may be more responsive to monitor functional recovery compared to the KOOS-JR, possibly due to the subject's athletic background. Level of Evidence 4.
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Affiliation(s)
| | | | - Cameron Hui
- Physical Therapy Christiana Care Health System
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Xie W, He M, Zheng S, Li H, Jin H, Ji B, Yang G, Li Y. Clinical application research of intelligent monitoring system for knee rehabilitation: a randomized controlled trial. J Orthop Surg Res 2024; 19:477. [PMID: 39138567 PMCID: PMC11321123 DOI: 10.1186/s13018-024-04982-8] [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: 06/30/2024] [Accepted: 08/06/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND This study investigates the effectiveness of a self-developed intelligent monitoring system for home-based knee rehabilitation following total knee arthroplasty (TKA). METHODS In this randomized controlled trial, 120 patients undergoing TKA were divided using random digit allocation. Preoperative and one-month postoperative assessments of knee function, quality of life, and isometric knee extension strength were conducted with the Intelligent Monitoring System. Patients received group-specific rehabilitation instructions pre-discharge and performed exercises for one month. RESULTS Changes in isometric knee extensor strength on the affected side within one month post-surgery for the brace-monitored rehabilitation group showed a significant decrease three days after surgery compared to one day before surgery. Subsequent measurements taken at postoperative days 5, 7, 14, and 21 indicated a gradual increase in strength, although these increases did not reach statistical significance when compared with previous measurements. One month post-surgery, all groups demonstrated significant improvements in knee joint function and mobility compared to pre-surgery levels. Notably, the brace-monitored group showed statistically significant improvements in 36-Item Short-Form Health Survey (SF-36) scores over the conventional rehabilitation group. CONCLUSIONS The Intelligent Monitoring System provides effective real-time monitoring and guidance for home-based knee rehabilitation post-TKA. It significantly enhances knee joint function, isometric knee extension strength, and quality of life shortly after surgery compared to traditional rehabilitation methods. This system offers a promising approach for improving postoperative recovery in TKA patients. TRIAL REGISTRATION This study was approved by the Medical Ethics Committee of Xiangya Hospital, Central South University (Ethics Approval Number 202209008-2). It was registered with the China Clinical Trial Registry, a primary registry of the World Health Organization's International Clinical Trials Registry Platform (Registration Number ChiCTR2300068852).
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Affiliation(s)
- Wenqing Xie
- Deparment of Orthopedics, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Miao He
- Deparment of Orthopedics, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Shengyuan Zheng
- Deparment of Orthopedics, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Hengzhen Li
- Deparment of Orthopedics, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Hongfu Jin
- Deparment of Orthopedics, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Bingzhou Ji
- Deparment of Orthopedics, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Guang Yang
- Deparment of Orthopedics, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Yusheng Li
- Deparment of Orthopedics, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
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Tarantino D, Forte AM, Picone A, Sirico F, Ruosi C. The Effectiveness of a Single Hyaluronic Acid Injection in Improving Symptoms and Muscular Strength in Patients with Knee Osteoarthritis: A Multicenter, Retrospective Study. J Pers Med 2024; 14:784. [PMID: 39201976 PMCID: PMC11355087 DOI: 10.3390/jpm14080784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 07/17/2024] [Accepted: 07/20/2024] [Indexed: 09/03/2024] Open
Abstract
Knee osteoarthritis (KOA) is a progressive and multifactorial disease that leads to joint pain, muscle weakness, physical disability, and decreased quality of life. In KOA, the quantity of hyaluronic acid (HA) and the molecular weight (MW) are decreased, leading to joint pain due to increased wear of the knee articular cartilage. Arthrogenic muscle inhibition, which is usually found in patients with KOA, is associated with joint inflammation, pain, and swelling, also causing muscle atrophy, primarily of the anterior thigh muscles, and hindering the rehabilitation process. The aim of our work was to determine if a single HA infiltration could minimize the effects of arthrogenic muscle inhibition in patients with KOA in the short term, using isokinetic dynamometry to evaluate the strength of the knee extensor and flexor muscles of the thigh. Thirty patients with KOA who underwent both clinical and isokinetic assessment, and that received a single injection of HA, were retrospectively included. Our results showed that a single intra-articular injection of HA significantly reduces pain and improves joint function at four weeks, while non-statistically significant improvements were observed for the reference isokinetic parameter (maximum torque) at both 90°/s and 180°/s. Further high-quality studies are necessary to confirm the results of our study.
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Affiliation(s)
- Domiziano Tarantino
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (A.P.); (F.S.); (C.R.)
| | | | - Antonio Picone
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (A.P.); (F.S.); (C.R.)
| | - Felice Sirico
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (A.P.); (F.S.); (C.R.)
| | - Carlo Ruosi
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (A.P.); (F.S.); (C.R.)
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Dubin J, Hameed D, Moore MC, Bains SS, Patel S, Nace J, Mont MA, Delanois RE. Methodological Assessment of the 100 Most-Cited Articles in Total Knee Arthroplasty in the Last Decade Compared to the All-Time List. J Arthroplasty 2024; 39:1434-1443.e5. [PMID: 38135168 DOI: 10.1016/j.arth.2023.12.030] [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: 11/09/2023] [Revised: 12/04/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Recent advances in total knee arthroplasty (TKA) have been driven by a growing focus on evidence-based medicine. This transition is reflected in the critical appraisal of both, the quality of work and the potential impact on the orthopedic community. The purpose of our study was to (1) identify the top 100 most-cited articles in TKA in the last decade and from all-time, and (2) compare methodological rigor of the most-cited articles in TKA in the last decade to articles all-time by level of evidence. METHODS The top 100 cited articles were recorded for manuscripts from the last decade, January 1, 2012 to December 31, 2022, and manuscripts from all-time for TKA. We collected authors, year of publication, journal of the article, country of origin of authors, article type (basic science article, clinical research article), level of evidence, methodological index for non-randomized studies score, physiotherapy evidence database scale, and citation density (total citations/years published). RESULTS The largest number of studies for all-time TKA (53.0%) and decade TKA (42.0%) were Level III. The average methodological index for non-randomized studies score for comparative studies was 18.7 for all-time TKA and 20.7 for decade TKA (P < .001). The average physiotherapy evidence database score was 6.1 for all-time TKA and 8.1 for decade TKA (P > .05). The highest citation density for all-time TKA was 111 and for past decade was 63. The number of level II studies in TKA increased from 19.0% from all time to 38.0% from the last decade (P < .05). CONCLUSIONS Our findings of improved methodologies over time reflect positive steps toward evidence-based practice in TKA. A continued focus on producing methodologically sound studies may guide evidence-based clinical decision-making.
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Affiliation(s)
- Jeremy Dubin
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Daniel Hameed
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Mallory C Moore
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Sandeep S Bains
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Saarang Patel
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - James Nace
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Ronald E Delanois
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
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Wang YC, Wu SH, Chen CA, Liang JM, Yang CC, Chen CH, Chung WR, Chou PPH, Huang HT. Compare the Quadriceps Activity between Mini-Midvastus and Mini-Medial Parapatellar Approach in Total Knee Arthroplasty with Electromyography. J Clin Med 2024; 13:2736. [PMID: 38792280 PMCID: PMC11122619 DOI: 10.3390/jcm13102736] [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: 02/23/2024] [Revised: 03/18/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024] Open
Abstract
Background: The comparison between the mini-midvastus (mini-MV) and mini-parapatellar (mini-MPP) approach in total knee arthroplasty (TKA) remains a subject of debate. The present study compared quadriceps activation, pain levels, and clinical outcomes between the two approaches; quadricep activation was assessed using surface electromyography (sEMG). Methods: This retrospective cross-sectional study comprised a total of 78 patients aged between 50 and 85 years with primary osteoarthritis. Patients were divided into a mini-MV (n = 38) group and a mini-MPP (n = 40) group according to the surgical approach. Results: The two groups exhibited no significant differences in sEMG for the vastus medialis (VM) or rectus femoris (RF) at the follow-up time points, with the exception that the mini-MV group exhibited superior strength of RF during extensions at the 2-week follow-up. However, the mini-MPP group had superior Western Ontario and McMaster Universities Index (WOMAC) total and function scores at the 2- and 6-week follow-ups. The mini-MPP group also had superior WOMAC stiffness scores at the 2-week follow-up. The two groups did not differ significantly in terms of pain levels or morphine consumption. Conclusions: The sEMG data of quadriceps muscle would not differ significantly between the mini-MV and mini-MPP approaches for TKA. Moreover, the mini-MPP approach may yield superior WOMAC scores when compared with the mini-MV approach.
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Affiliation(s)
- Ying-Chun Wang
- Ph.D. Program in Biomedical Engineering, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Sports Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Sheng-Hua Wu
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (S.-H.W.); (C.-A.C.)
- Department of Anesthesiology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Chi-An Chen
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (S.-H.W.); (C.-A.C.)
| | - Jing-Min Liang
- Department of Sports Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Chia-Chi Yang
- The Master Program of Long-Term Care in Aging, College of Nursing, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Center for Long-Term Care Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Chung-Hwan Chen
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Orthopedics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Orthopedic Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Wan-Rong Chung
- Department of Anesthesiology, E-Da Hospital, Kaohsiung 807, Taiwan;
- College of Medicine, I-Shou University, Kaohsiung 807, Taiwan
| | - Paul Pei-Hsi Chou
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Sports Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Orthopedics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Hsuan-Ti Huang
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Orthopedics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Orthopedic Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
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Núñez-Cortés R, López-Bueno L, López-Bueno R, Cuenca-Martínez F, Suso-Martí L, Silvestre A, Casaña J, Cruz-Montecinos C, Andersen LL, Calatayud J. Acute Effects of In-Hospital Resistance Training on Clinical Outcomes in Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Trial. Am J Phys Med Rehabil 2024; 103:401-409. [PMID: 38063321 DOI: 10.1097/phm.0000000000002366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
OBJECTIVE The aim of the study is to evaluate the acute responses, in the in-hospital setting, of intensive elastic resistance training on physical function, pain, psychosocial variables, and inflammatory markers in patients undergoing total knee arthroplasty. DESIGN In a randomized controlled trial, 40 patients with total knee arthroplasty (≥55 yrs) were assigned to either (1) the intervention group (elastic resistance strengthening) or (2) a control group (conventional protocol). Patients performed three sessions in the hospital at 24, 48, and 72 hrs after total knee arthroplasty. Outcome measures included: self-administered physical function, pain intensity, kinesiophobia, catastrophizing, self-efficacy, range of motion, perceived change, test timed up and go, knee joint effusion, isometric strength, pressure pain thresholds, and inflammatory markers (levels of procalcitonin and C-reactive protein). RESULTS The mixed analysis of variance model showed a significant group*time interaction in favor of the intervention group with a large effect size for kinesiophobia (ηp 2 = 0.308, P < 0.001), catastrophizing (ηp 2 = 0.242, P < 0.001), and passive range of motion flexion (ηp 2 = 0.167, P < 0.001) and a moderate effect size for physical function (ηp 2 = 0.103, P = 0.004), pain intensity (ηp 2 = 0.139, P < 0.001), timed up and go (ηp 2 = 0.132, P = 0.001), self-efficacy (ηp 2 = 0.074, P = 0.016), active range of motion flexion (ηp 2 = 0.121, P = 0.002), levels of procalcitonin (ηp 2 = 0.099, P = 0.005), and C-reactive protein (ηp 2 = 0.106, P = 0.004). CONCLUSIONS Three sessions of intensive elastic resistance training improve physical function, perceived pain, psychosocial variables, and inflammatory markers during the hospitalization period after total knee arthroplasty.
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Affiliation(s)
- Rodrigo Núñez-Cortés
- From the Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain (RN-C, CC-M); Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile (RN-C, CC-M); Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain (LL-B, RL-B, FC-M, LS-M, JCas, JCal); Physiotherapy Service, University Clinical Hospital of Valencia, Valencia, Spain (LL-B); Department of Physical Medicine and Nursing, University of Zaragoza, Zaragoza, Spain (RL-B); National Research Centre for the Working Environment, Copenhagen, Denmark (RL-B, LLA, JCal); Department of Orthopaedic Surgery, Clinic Hospital of Valencia, Valencia, Spain (AS); Department of Orthopaedic Surgery, School of Medicine, University of Valencia, Valencia, Spain (AS); and Section of Research, Innovation and Development in Kinesiology, Kinesiology Unit, San José Hospital, Santiago, Chile (CC-M)
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Churchill L, John Bade M, Koonce RC, Stevens-Lapsley JE, Bandholm T. The past and future of peri-operative interventions to reduce arthrogenic quadriceps muscle inhibition after total knee arthroplasty: A narrative review. OSTEOARTHRITIS AND CARTILAGE OPEN 2024; 6:100429. [PMID: 38304413 PMCID: PMC10832271 DOI: 10.1016/j.ocarto.2023.100429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 12/16/2023] [Indexed: 02/03/2024] Open
Abstract
Total knee arthroplasty (TKA) improves patient-reported function by alleviating joint pain, however the surgical trauma exacerbates already impaired muscle function, which leads to further muscle weakness and disability after surgery. This early postoperative strength loss indicates a massive neural inhibition and is primarily driven by a deficit in quadriceps muscle activation, a process known as arthrogenic muscle inhibition (AMI). To enhance acute recovery of quadriceps muscle function and long-term rehabilitation of individuals after TKA, AMI must be significantly reduced in the early post-operative period. The aim of this narrative review is to review and discuss previous efforts to mitigate AMI after TKA and to suggest new approaches and interventions for future efficacy evaluation. Several strategies have been explored to reduce the degree of post-operative quadriceps AMI and improve strength recovery after TKA by targeting post-operative swelling and inflammation or changing neural discharge. A challenge of this work is the ability to directly measure AMI and relevant contributing factors. For this review we focused on interventions that aimed to reduce post-operative swelling or improve knee extension strength or quadriceps muscle activation measured by twitch interpolation. For individuals undergoing TKA, the use of anti-inflammatory medications, tranexamic acid, cryotherapy, intra-articular drains, torniquets, and minimally invasive surgical techniques for TKA have limited benefit in attenuating quadriceps AMI early after surgery. However, interventions such as inelastic compression garments, voluntary muscle contractions, and neuro-muscular electrical stimulation show promise in mitigating or circumventing AMI and should continue to be refined and explored.
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Affiliation(s)
- Laura Churchill
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michael John Bade
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Eastern Colorado VA Geriatric Research Education and Clinical Center (GRECC), Aurora, CO, USA
| | - Ryan C. Koonce
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Highlands Ranch, CO, USA
| | - Jennifer E. Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Eastern Colorado VA Geriatric Research Education and Clinical Center (GRECC), Aurora, CO, USA
| | - Thomas Bandholm
- Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark
- Department of Clinical Research, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark
- Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark
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9
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Judd DL, Cheuy V, Peters A, Graber J, Hinrichs-Kinney L, Forster JE, Christiansen CL, Stevens-Lapsley JE. Incorporating Functional Strength Integration Techniques During Total Hip Arthroplasty Rehabilitation: A Randomized Controlled Trial. Phys Ther 2024; 104:pzad168. [PMID: 38102757 DOI: 10.1093/ptj/pzad168] [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: 07/11/2023] [Revised: 08/01/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE Total hip arthroplasty (THA) is a common orthopedic procedure that alleviates pain for millions of individuals. Yet, persistent physical function deficits, perhaps associated with movement compensations, are observed after THA. These deficits negatively affect quality of life and health for many individuals. Functional strength integration (FSI) techniques combine muscle strength training with specific movement retraining to improve physical function. This study aimed to determine if FSI would improve functional performance through remediation of movement compensations for individuals after THA. METHODS A double-blind randomized controlled trial was conducted. Ninety-five participants were randomized to either the FSI or control (CON) group for an 8-week intervention. The FSI protocol included exercise to improve muscular control and stability around the hip to minimize movement compensation during daily activity. The CON protocol included low-load resistance exercise, range-of-motion activities, and patient education. Functional performance, muscle strength, and self-reported outcomes were measured preoperatively, midway and after intervention, and 6 months after THA. Change from preoperative assessment to each time point was measured, and between-group differences were assessed. RESULTS There were minimal differences in outcomes between groups at the first postoperative assessment. There were no statistically significant between-group differences in the later assessments, including the primary endpoint. Both groups improved functional outcomes throughout the study period. CONCLUSION The FSI intervention did not result in greater improvements in function after THA compared to the CON intervention. Future work should further investigate additional biomechanical outcomes, timing of the FSI protocol, effective dosing, and patient characteristics predictive of success with FSI. IMPACT Recovery after THA is complex, and individuals after THA are affected by persistent movement deficits that affect morbidity and quality of life. The present study suggests that either approach to THA rehabilitation could improve outcomes for patients, and that structured rehabilitation programs may benefit individuals after THA.
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Affiliation(s)
- Dana L Judd
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Victor Cheuy
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, California, USA
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Amy Peters
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Jeremy Graber
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Lauren Hinrichs-Kinney
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Jeri E Forster
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- US Department of Veterans Affairs, Rocky Mountain Mental Illness, Research, Education and Clinical Center, Aurora, Colorado, USA
| | - Cory L Christiansen
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Jennifer E Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA
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10
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Cheng YY, Chen CH, Wang SP. Isokinetic training of lower extremity during the early stage promote functional restoration in elder patients with disability after Total knee replacement (TKR) - a randomized control trial. BMC Geriatr 2024; 24:173. [PMID: 38373934 PMCID: PMC10875742 DOI: 10.1186/s12877-024-04778-9] [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: 07/13/2023] [Accepted: 02/04/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Transient progressive weakness and disability of lower limb during the early stage after TKR will increase the risk of fall, but the superior postoperative strength training mode have not been elucidated for functional restoration. This study aimed to compare whether the isokinetic lower limb training is superior to either isotonic or home isometric exercise during early stage after TKR in older people. METHODS A total of 43 recruited old participants (mean age, 68.40 years old) receiving TKR were divided randomly based on the different four-week training modes into three groups including isokinetic, isotonic, and home isometric exercise (control group). The primary outcome was set as functional performance in terms of Timed Up and Go (TUG) test and the secondary outcomes include the peak torque of knee at 60 and 120 degree/ second, Short-Form 36 Health Survey (SF-36), and Western Ontario and McMaster Universities Arthritis index (WOMAC). RESULTS All of the peak torque measurements of the knee improved significantly in both the isokinetic and the isotonic group, but not in the control group. Although isotonic training resulted in more strength gains, a significant enhancement in TUG test was observed in the isokinetic group only (p = 0.003). However, there were no significantly improvement of TUG test after training in other two groups. SF-36 and WOMAC improved after training in all three groups, with no significant difference in the degree of improvement between groups. CONCLUSION Isokinetic training for 4 weeks following TKR effectively improved all the outcome parameters in this study, including the TUG test, lower limb strength, and functional scores. However, both isokinetic and isotonic training modes could be recommended after TKR because of no significant difference in the degree of improvement between these two groups. TRIAL REGISTRATION Clinical trial registration number: NCT02938416. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Yuan-Yang Cheng
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Cheng-Hsu Chen
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Ph.D. Program in Tissue Engineering and Regenerative Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Shun-Ping Wang
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan.
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11
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Prüfer F, Pavlović M, Matko Š, Löfler S, Fischer MJ, Šarabon N, Grote V. Responsiveness of Isokinetic Dynamometry in Patients with Osteoarthritis after Knee and Hip Arthroplasty: A Prospective Repeated-Measures Cohort Study. Healthcare (Basel) 2024; 12:314. [PMID: 38338199 PMCID: PMC10855832 DOI: 10.3390/healthcare12030314] [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: 12/18/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Functional assessments are crucial for the evaluation of rehabilitation after total knee (TKA) and hip (THA) arthroplasty. Muscle strength, a key determinant of physical function (PF), is often measured with isokinetic dynamometry (ID), which is considered the gold standard. However, studies lack evaluations of responsiveness-the ability to detect changes over time. This study aims to determine the responsiveness of ID in measuring PF in TKA and THA rehabilitation-is muscle strength a valid indicator for assessing improvement in rehabilitation processes? The pre- and post-surgery PF of 20 osteoarthritis patients (age 55-82) was assessed, using ID, performance-based and self-reported measures. Responsiveness was evaluated by comparing the observed relationship of changes in ID and PF scores with the a priori defined expected relationship of change scores. While the performance-based and self-reported measures showed significant improvements post-surgery (Cohen's d [0.42, 1.05] p < 0.05), ID showed no significant differences. Moderate correlations were found between changes in some ID parameters and selected functional tests (r ≈|0.5|, p < 0.05). Responsiveness was solely found for the peak torque of knee extension at 180°/s on the operated side. Responsiveness is an often-overlooked psychometric property of outcome measurements. The findings suggest that ID may not be fully responsive to the construct of PF after TKA and THA, raising questions about its role and usefulness in this context and the need for more appropriate assessment methods.
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Affiliation(s)
- Ferdinand Prüfer
- Ludwig Boltzmann Institute for Rehabilitation Research, A-1100 Vienna, Austria (M.J.F.); (V.G.)
| | - Monika Pavlović
- Faculty of Health Sciences, University of Ljubljana, SI-1000 Ljubljana, Slovenia;
| | - Špela Matko
- Ludwig Boltzmann Institute for Rehabilitation Research, A-1100 Vienna, Austria (M.J.F.); (V.G.)
| | - Stefan Löfler
- Ludwig Boltzmann Institute for Rehabilitation Research, A-1100 Vienna, Austria (M.J.F.); (V.G.)
| | - Michael J. Fischer
- Ludwig Boltzmann Institute for Rehabilitation Research, A-1100 Vienna, Austria (M.J.F.); (V.G.)
- Vamed Rehabilitation Center Kitzbühel, A-6370 Kitzbühel, Austria
| | - Nejc Šarabon
- Ludwig Boltzmann Institute for Rehabilitation Research, A-1100 Vienna, Austria (M.J.F.); (V.G.)
- Faculty of Health Sciences, University of Primorska, SI-6310 Izola, Slovenia
- Innorenew CoE, SI-6310 Izola, Slovenia
| | - Vincent Grote
- Ludwig Boltzmann Institute for Rehabilitation Research, A-1100 Vienna, Austria (M.J.F.); (V.G.)
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12
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Wang J, Zhu R, Xu XT, Liu S, Li Z, Guo C, Tao X, Qian L, Charles R, Fang L. Effects of strength training on functional ambulation following knee replacement: a systematic review, meta-analysis, and meta-regression. Sci Rep 2023; 13:10728. [PMID: 37400510 DOI: 10.1038/s41598-023-37924-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 06/29/2023] [Indexed: 07/05/2023] Open
Abstract
Strength training is recommended by the American Physical Therapy Association to improve muscle strength, mobility, and balance following knee replacement. Few studies have focused on the direct effects of strength training on functional ambulation, and potential dose-response relationships between strength training parameters and the effect remain unclear. The aim of this systematic review, meta-analysis, and meta-regression was to evaluate the effects of strength training on functional ambulation following knee replacement (KR). We also aimed to explore potential dose-response relationships between strength training parameters and performance in functional ambulation. A systematic literature search of eight online databases was performed on March 12, 2023, for randomized controlled trials evaluating the effects of strength training on functional ambulation by six-minute walk test (6MWT) or timed-up and go test (TUG) after KR. Data were pooled by random-effect meta-analyses and presented as weighted mean difference (WMD). A random-effect meta-regression was performed for four predetermined training parameters, namely, duration (weeks), frequency (sessions per week), volume (time per session), and initial time (after surgery) separately to explore dose-response relationships with WMD. Fourteen trials encompassing 956 participants were included in our study. Meta-analyses showed an improvement in 6MWT performance after strength training (WMD: 32.15, 95% CI 19.44-44.85) and a decrease in time to complete TUG (WMD: - 1.92, 95% CI - 3.43 to - 0.41). Meta-regression revealed a dose-response relationship only between volume and 6MWT, with a decreasing trend (P = 0.019, 95% CI - 1.63 to - 0.20). Increasing trends of improvement in 6MWT and TUG were observed with increasing training duration and frequency. A slight decreasing trend of improvement was observed in 6MWT with postponed initial time, while an opposite trend was observed in TUG. Based on existing studies, moderate-certainty evidence suggests that strength training could increase 6MWT distance, and low-certainty evidence shows that strength training could decrease the time to complete TUG after KR. Meta-regression results only suggested a dose-response relationship between volume and 6MWT with a decreasing trend.Registration: PROSPERO: CRD42022329006.
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Affiliation(s)
- Jinxiang Wang
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ranran Zhu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiao-Ting Xu
- Institute of TCM International Standardization, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shuting Liu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhenrui Li
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chaoyang Guo
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xuchen Tao
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Liang Qian
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ravon Charles
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lei Fang
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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FUNCTIONAL OUTCOME OF PREOPERATIVE EXERCISES ON RANGE OF MOVEMENTS FOLLOWING TKA: A PROSPECTIVE COMPARITIVE STUDY. TRAUMATOLOGY AND ORTHOPEDICS OF RUSSIA 2023. [DOI: 10.17816/2311-2905-2014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
AIM
Range of motion prior to TKRis a key determinant of the post-operative range of motion.The likelihood that the accompanying stiffness of the extensor mechanism will result in limited flexion following surgery increases with the preoperative range of motion.It would make sense to enhance knee ROM before surgery in order to optimize flexion following TKA.Comparisons were made between the patient groups who had knee surgery with preoperative exercises and those who had surgery without them.
METHODS
156 patients with knee arthritis were collected over a period of 1.5years. They were divided into two groups. Pre-operative knee exercise was given to 78 patients for aone month. Prior to and following the test group's workouts, all patients were observed.All 156 underwent TKR, and their post-operative range of motion was evaluated at four weeks, three months, six months, and a year. We timed how long it took to fully extend and flex to 90 degrees.
RESULTS
Thisstudy suggested that the knee workouts were unquestionably helpful in achieving early knee flexion up to 90 in comparison to that of the control group. When the test group was compared to the control group, knee flexion to about 90 and more was attained in about 4 weeks; this difference was statistically significant (p 0.01).But after six months and a year of long-term follow-up, there were no discernible changes in the knee's range of motion.
CONCLUSION
Prehabilitation significantly improves the Knee Score for the intervention group both before surgery and three months after surgery. Exercises done before to surgery help patients recover more quickly from TKA and may speed up the process of achieving a good flexion and extension range of motion. However there is no significant difference in functional outcome after one year post surgery in both groups.
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14
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An J, Son YW, Lee BH. Effect of Combined Kinematic Chain Exercise on Physical Function, Balance Ability, and Gait in Patients with Total Knee Arthroplasty: A Single-Blind Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3524. [PMID: 36834218 PMCID: PMC9961064 DOI: 10.3390/ijerph20043524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
Total knee arthroplasty (TKA) is an effective treatment for end-stage osteoarthritis. However, evidence of combined kinematic chain exercise (CCE) in early-phase rehabilitation after TKA remains lacking. This study investigated the effects of CCE training on physical function, balance ability, and gait in 40 patients who underwent TKA. Participants were randomly assigned to the CCE (n = 20) and open kinematic chain exercise (OKCE) groups (n = 20). The CCE and OKCE groups were trained five times a week (for 4 weeks) for 30 min per session. Physical function, range of motion (ROM), balance, and gait were assessed before and after the intervention. The time × group interaction effects and time effect as measured with the Western Ontario and McMaster Universities Osteoarthritis Index, ROM, Knee Outcome Survey-Activities of Daily Living, balancing ability (e.g., confidence ellipse area, path length, and average speed), and gait parameters (e.g., timed up-and-go test, gait speed, cadence, step length, and stride length) were statistically significant (p < 0.05). In the group comparison of pre- and postintervention measurements for all variables, the CCE group showed substantial improvements compared to the OKCE group (p < 0.05). Both groups showed significant within-group improvement from baseline to postintervention. Our results suggest that CCE training positively affects physical function, balance ability, and gait as an early intervention for patients undergoing TKA.
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Affiliation(s)
- Jungae An
- Graduate School of Physical Therapy, Sahmyook University, Seoul 01795, Republic of Korea
| | - Young-Wan Son
- Graduate School of Physical Therapy, Sahmyook University, Seoul 01795, Republic of Korea
| | - Byoung-Hee Lee
- Department of Physical Therapy, Sahmyook University, Seoul 01795, Republic of Korea
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15
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Verdini E, Maestroni L, Clark M, Turner A, Huber J. Do people with musculoskeletal pain differ from healthy cohorts in terms of global measures of strength? A systematic review and meta-analysis. Clin Rehabil 2023; 37:244-260. [PMID: 36154313 PMCID: PMC9772898 DOI: 10.1177/02692155221128724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 09/02/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE It is currently unknown if people with musculoskeletal pain display different multi-joint strength capacities than healthy cohorts. The aim was to investigate whether people with musculoskeletal pain show differences in global measures of strength in comparison to healthy cohorts. DATA SOURCES A systematic review was conducted using three databases (Medline, CINAHL and SPORTDiscus) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. REVIEW METHODS Studies involving participants with painful musculoskeletal conditions and multi-joint strength assessment measured at baseline were included. A meta-analysis was also performed to compute standardized mean differences (± 95% confidence intervals), using Hedge's g, and examined the differences in multi-joint strength at baseline between participants with painful musculoskeletal conditions and healthy participants. RESULTS In total, 5043 articles were identified, of which 20 articles met the inclusion criteria and were included in the qualitative analysis. The available evidence revealed that multi-joint strength values were limited to knee osteoarthritis, fibromyalgia, chronic low back pain, and rheumatoid arthritis. Only four studies were included in the quantitative synthesis and revealed that only small differences in both chest press (g = -0.34, 95% CI [-0.64, -0.03]) and leg press (g = -0.25, 95% CI [-0.49, -0.02]) existed between adult women with fibromyalgia and active community women. CONCLUSION There is a paucity of multi-joint strength values in participants with musculoskeletal pain. Quantitative comparison with healthy cohorts was limited, except for those with fibromyalgia. Adult women with fibromyalgia displayed reduced multi-joint strength values in comparison to active community women.
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Affiliation(s)
- Enrico Verdini
- School of Health Sciences, University of Brighton, Brighton, UK
- Studio Medico Jacini, Rome, Italy
| | - Luca Maestroni
- London Sport Institute, School of Science and Technology, Middlesex University, London, UK
| | | | - Anthony Turner
- London Sport Institute, School of Science and Technology, Middlesex University, London, UK
| | - Jörg Huber
- School of Health Sciences, University of Brighton, Brighton, UK
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16
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Winkler T, Bell L, Bender A, Trepczynski A, Duda GN, Baur AJD, Damm P. Periarticular muscle status affects in vivo tibio-femoral joint loads after total knee arthroplasty. Front Bioeng Biotechnol 2023; 11:1075357. [PMID: 37034264 PMCID: PMC10073542 DOI: 10.3389/fbioe.2023.1075357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/09/2023] [Indexed: 04/11/2023] Open
Abstract
Background: Total knee arthroplasty (TKA) is a highly effective treatment for severe knee osteoarthritis that is increasingly performed in younger, more active patients. As postoperative muscular impairments may negatively affect surgical outcomes and implant longevity, functional muscle recovery gains increasing importance in meeting future patient demands. This study aimed to assess the status of periarticular muscles in the long-term follow-up after TKA and to evaluate its impact on in vivo tibio-femoral joint loads. Methods: A case series was created, with eight patients with knee osteoarthritis. All subjects received an instrumented knee implant in unilateral TKA. Native computed tomography scans, acquired pre and postoperatively, were used to evaluate distal muscle volumes and fatty infiltration. In vivo tibio-femoral joint loads were measured telemetrically during standing, walking, stair climbing and chair rising and were correlated to muscle status. Results: Postoperatively a reduction in fatty infiltration across all periarticular muscles was pronounced. High average peak loads acted in the tibio-femoral joint ranging from 264% during stand-to-sit activities up to 341% body weight (BW) during stair descent. Fatty infiltration of the m. quadriceps femoris and hamstrings were associated with increased tibio-femoral joint contact forces during walking (r = 0.542; 0.412 and 0.766). Conclusion: The findings suggest that a fatty infiltration of periarticular muscles may lead to increased tibio-femoral joint contact forces. However, we only observed weak correlations between these parameters. Improvements in functional mobility and the restoration of a pain-free joint likely explain the observed postoperative reductions in fatty infiltration. Perioperative rehabilitation approaches targeting residual impairments in muscle quality could, contribute to reduced tibio-femoral joint loads and improved long-term outcomes of TKA. However, it has to be pointed out that the study included a small number of patients, which may limit its validity.
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Affiliation(s)
- Tobias Winkler
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Center for Musculoskeletal Biomechanics and Regeneration (Julius Wolff Institute), Berlin, Germany
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Berlin Institute of Health Institute for Regenerative Therapies, Berlin, Germany
- Center for Musculoskeletal Surgery, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Louisa Bell
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Center for Musculoskeletal Biomechanics and Regeneration (Julius Wolff Institute), Berlin, Germany
| | - Alwina Bender
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Center for Musculoskeletal Biomechanics and Regeneration (Julius Wolff Institute), Berlin, Germany
| | - Adam Trepczynski
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Center for Musculoskeletal Biomechanics and Regeneration (Julius Wolff Institute), Berlin, Germany
| | - Georg N. Duda
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Center for Musculoskeletal Biomechanics and Regeneration (Julius Wolff Institute), Berlin, Germany
| | | | - Philipp Damm
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Center for Musculoskeletal Biomechanics and Regeneration (Julius Wolff Institute), Berlin, Germany
- *Correspondence: Philipp Damm,
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Immunohistochemical analysis of the quadriceps femoris muscle before and after total knee arthroplasty. Knee 2023; 40:42-51. [PMID: 36403397 DOI: 10.1016/j.knee.2022.10.010] [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: 03/24/2022] [Revised: 08/07/2022] [Accepted: 10/27/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The number of total knee arthroplasties (TKA) has increased steadily with the aging of the population. This surgical procedure is recognized for its success in pain relief and restoration of knee function. However, decreased quadriceps femoris (QF) muscle strength after TKA is frequently observed but with unknown etiology. Evidence suggests that the location of the operative incision (i.e., surgical access) can influence QF muscle structure and function. The present study aimed to assess the fiber type composition, structure and assembly of the QF's vastus medialis (VM) and vastus lateralis (VL) muscles before and after TKA. METHODS Muscle biopsies (VM and VL muscles) were collected from patients previously submitted to TKA via the medial parapatellar route and undergoing TKA revision (main group, n = 9) and patients with osteoarthrosis (OA) who were due to undergo TKA (control group: n = 18). The biopsied muscle tissue was prepared, stored, and then sectioned in a cryostat at -25 °C. The tissue sections were evaluated using routine staining techniques in pathological anatomy and histochemistry. RESULTS The normal mosaic pattern of the medial and lateral knee muscles was observed in the main and control groups, with no evidence of peripheral nerve damage. Notably, 88.9 % of the patients exhibited mild to severe VL atrophy, while only 11.1 % of patients in the control group presented this feature (P < 0.001). CONCLUSIONS The medial parapatellar incision for TKA surgical access does not generate definitive morphological changes in the VM and VL muscle fibers but may contribute to VL atrophy.
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Graber J, Juarez-Colunga E, Thigpen C, Waugh D, Bade M, Stevens-Lapsley J, Kittelson A. Development of reference charts for monitoring quadriceps strength with handheld dynamometry after total knee arthroplasty. Disabil Rehabil 2022; 44:7535-7542. [PMID: 34751608 PMCID: PMC9306324 DOI: 10.1080/09638288.2021.1995054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/25/2021] [Accepted: 10/13/2021] [Indexed: 01/18/2023]
Abstract
Purpose: To develop reference charts that describe normative quadriceps strength recovery after total knee arthroplasty (TKA) as measured by handheld dynamometry (HHD).Materials and Methods: We conducted a retrospective analysis of post-TKA quadriceps strength recovery in a longitudinal dataset consisting of both clinical and research HHD data. We created sex-specific models for recovery using Generalized Additive Models for Location, Scale, and Shape. We created reference charts from the models to display the recovery of population centiles over the first six postoperative months.Results: A total of 588 patient records with 1176 observations were analyzed. Reference charts for both sexes demonstrated a rapid increase in quadriceps strength over the first 60 postoperative days followed by a more gradual increase over the next 120 days. Males appeared to demonstrate faster recovery and greater strength on average compared to females. The quadriceps strength recovery of three female patient records was plotted on the reference chart to illustrate the charts' potential clinical utility.Conclusions: These reference charts provide normative data for quadriceps strength recovery after TKA as assessed by HHD. The reference charts may augment clinicians' ability to monitor and intervene upon quadriceps weakness-a pronounced and debilitating post-TKA impairment-throughout rehabilitation.Implications for RehabilitationHandheld dynamometry (HHD) is an objective and clinically feasible method for assessing muscle strength, but normative HHD values are lacking for quadriceps strength recovery after total knee arthroplasty (TKA).We created sex-specific reference charts which provide normative quadriceps strength HHD values for the first 180 days after TKA.These reference charts may improve clinicians' ability to monitor and intervene upon post-TKA quadriceps strength deficits.
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Affiliation(s)
- Jeremy Graber
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
| | - Elizabeth Juarez-Colunga
- Department of Biostatistics and Informatics, University of Colorado, Aurora, CO
- VA Eastern Colorado Geriatric, Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, CO
| | | | - Dawn Waugh
- ATI Physical Therapy, Greenville, SC, USA
| | - Michael Bade
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
- VA Eastern Colorado Geriatric, Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, CO
| | - Jennifer Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
- VA Eastern Colorado Geriatric, Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, CO
| | - Andrew Kittelson
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, MT
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Bowen W, Frazer AK, Tallent J, Pearce AJ, Kidgell DJ. Unilateral Strength Training Imparts a Cross-Education Effect in Unilateral Knee Osteoarthritis Patients. J Funct Morphol Kinesiol 2022; 7:jfmk7040077. [PMID: 36278738 PMCID: PMC9589957 DOI: 10.3390/jfmk7040077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Worldwide, 86 million individuals over the age of 20 were diagnosed with knee osteoarthritis (KOA) in 2020. Hallmark features of KOA are the loss in knee extensor strength, increasing knee pain severity, and deficits in functional performance. There is a critical need for the investigation into potential cost-effective therapeutic interventions in the treatment of KOA. A potential therapeutic option is the cross-education phenomenon. Methods: This was a non-blinded randomized control trial, with a 4-week intervention, with a pre, post and follow-up assessment (3 months post intervention). Outcome measures of isometric knee extensor strength, rectus femoris muscle thickness and neuromuscular activation were assessed at all-time points. Results: Compared to age-matched KOA controls, 4 weeks of unilateral strength training in end-stage KOA patients increased strength of the untrained affected KOA limb by 20% (p < 0.05) and reduced bilateral hamstring co-activation in the KOA intervention group compared to the KOA control group (p < 0.05). Conclusions: A 4-week-long knee extensor strength training intervention of the contralateral limb in a cohort with diagnosed unilateral KOA resulted in significant improvements to knee extensor strength and improved neuromuscular function of the KOA limb. Importantly, these results were maintained for 3 months following the intervention.
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Affiliation(s)
- Warren Bowen
- School of Exercise and Nutrition Sciences, Deakin University, Melbourne 3125, Australia
- College of Science, Health and Engineering, La Trobe University, Melbourne 3086, Australia
| | - Ashlyn K. Frazer
- Monash Exercise Neuroplasticity Research Unit, Department of Physiotherapy, Monash University, Melbourne 3800, Australia
| | - Jamie Tallent
- Monash Exercise Neuroplasticity Research Unit, Department of Physiotherapy, Monash University, Melbourne 3800, Australia
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester CO4 3SQ, UK
| | - Alan J. Pearce
- College of Science, Health and Engineering, La Trobe University, Melbourne 3086, Australia
| | - Dawson J. Kidgell
- Monash Exercise Neuroplasticity Research Unit, Department of Physiotherapy, Monash University, Melbourne 3800, Australia
- Correspondence: ; Tel.: +61-3-9904-4119
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20
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Lopes TDS, Ballas SK, Santana JERS, de Melo-Carneiro P, de Oliveira LB, Sá KN, Lopes LCD, Silva WDS, Lucena R, Baptista AF. Sickle cell disease chronic joint pain: Clinical assessment based on maladaptive central nervous system plasticity. Front Med (Lausanne) 2022; 9:679053. [PMID: 36203767 PMCID: PMC9530388 DOI: 10.3389/fmed.2022.679053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
Chronic joint pain (CJP) is among the significant musculoskeletal comorbidities in sickle cell disease (SCD) individuals. However, many healthcare professionals have difficulties in understanding and evaluating it. In addition, most musculoskeletal evaluation procedures do not consider central nervous system (CNS) plasticity associated with CJP, which is frequently maladaptive. This review study highlights the potential mechanisms of CNS maladaptive plasticity related to CJP in SCD and proposes reliable instruments and methods for musculoskeletal assessment adapted to those patients. A review was carried out in the PubMed and SciELO databases, searching for information that could help in the understanding of the mechanisms of CNS maladaptive plasticity related to pain in SCD and that presented assessment instruments/methods that could be used in the clinical setting by healthcare professionals who manage chronic pain in SCD individuals. Some maladaptive CNS plasticity mechanisms seem important in CJP, including the impairment of pain endogenous control systems, central sensitization, motor cortex reorganization, motor control modification, and arthrogenic muscle inhibition. Understanding the link between maladaptive CNS plasticity and CJP mechanisms and its assessment through accurate instruments and methods may help healthcare professionals to increase the quality of treatment offered to SCD patients.
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Affiliation(s)
- Tiago da Silva Lopes
- Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, BA, Brazil
- Adventist Neuromodulation and Neuroscience Laboratory, Bahia Adventist College, Cachoeira, Brazil
- NAPEN Network (Nucleus of Assistance, Research, and Teaching in Neuromodulation), São Paulo, SP, Brazil
| | - Samir K. Ballas
- Department of Medicine, Jefferson Medical College, Cardeza Foundation for Hematologic Research, Thomas Jefferson University, Philadelphia, PA, United States
| | - Jamille Evelyn Rodrigues Souza Santana
- Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, BA, Brazil
- NAPEN Network (Nucleus of Assistance, Research, and Teaching in Neuromodulation), São Paulo, SP, Brazil
- Center for Mathematics, Computation, and Cognition, Federal University of ABC, São Bernardo do Campo, SP, Brazil
| | - Pedro de Melo-Carneiro
- Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, BA, Brazil
| | - Lilian Becerra de Oliveira
- Adventist Neuromodulation and Neuroscience Laboratory, Bahia Adventist College, Cachoeira, Brazil
- Graduate program of Medicine and Human Health, Bahiana School of Medicine and Public Health, Salvador, BA, Brazil
| | - Katia Nunes Sá
- NAPEN Network (Nucleus of Assistance, Research, and Teaching in Neuromodulation), São Paulo, SP, Brazil
- Graduate program of Medicine and Human Health, Bahiana School of Medicine and Public Health, Salvador, BA, Brazil
| | | | | | - Rita Lucena
- Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, BA, Brazil
| | - Abrahão Fontes Baptista
- Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, BA, Brazil
- NAPEN Network (Nucleus of Assistance, Research, and Teaching in Neuromodulation), São Paulo, SP, Brazil
- Center for Mathematics, Computation, and Cognition, Federal University of ABC, São Bernardo do Campo, SP, Brazil
- Graduate program of Medicine and Human Health, Bahiana School of Medicine and Public Health, Salvador, BA, Brazil
- Laboratory of Medical Investigations 54 (LIM-54), Universidade de São Paulo, São Paulo, SP, Brazil
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21
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Vasileiadis D, Drosos G, Charitoudis G, Dontas I, Vlamis J. Does preoperative physiotherapy improve outcomes in patients undergoing total knee arthroplasty? A systematic review. Musculoskeletal Care 2022; 20:487-502. [PMID: 35122455 DOI: 10.1002/msc.1616] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To systematically review the scientific literature and to investigate the effectiveness of preoperative rehabilitation on subjective and objective outcomes after total knee arthroplasty (TKA) when compared with patients in a control group. DATA SOURCES A search was conducted in PubMed, PubMed Central, Embase, Cochrane Library and Physiotherapy Evidence Database databases in May 2021. STUDY SELECTION randomized controlled trials (RCTs) were reviewed if they compared a preoperative physiotherapy exercise intervention with no intervention group for patients undergoing TKA for severe Osteoarthritis (OA). A total of 24 RCTs were included at the end of the evaluation process. By the end of the evaluation process, a total of 24 RCTs were included. DATA EXTRACTION Two authors independently screened the literature, extracted data, and assessed the quality of included studies. The outcomes were knee extension, knee flexion, pain Visual Analogue Scale (VAS), overall Western Ontario and McMaster Universities OA Index, 6 min walking test, and Timed Up and Go test. RESULTS The majority of the studies included in this systemic review demonstrated a comparable trend of long-term postoperative improvement of knee extension strength, VAS, range of movement and functional scores, and those of quality of life between two groups. Many studies showed a significant improvement in terms of preoperative pain, length of hospital stay and functional performance shortly after the operation, but all studies failed to show a prolonged effect on knee motion or patient function between 3 and 12 months. CONCLUSIONS Low to moderate evidence from mostly small RCTs demonstrated that preoperative physiotherapy interventions reduce pain and improve functional performance for patients with knee OA prior shortly after the TKA.
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Affiliation(s)
- Dimitrios Vasileiadis
- Laboratory for Research of the Musculoskeletal System, KAT General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Drosos
- Department of Orthopaedic Surgery, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Georgios Charitoudis
- Department of Orthopaedic Surgery, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Ismene Dontas
- Laboratory for Research of the Musculoskeletal System, KAT General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - John Vlamis
- 3rd Department of Orthopaedic Surgery, University of Athens, KAT Hospital, Athens, Greece
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22
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Eymir M, Unver B, Karatosun V. Relaxation exercise therapy improves pain, muscle strength, and kinesiophobia following total knee arthroplasty in the short term: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2022; 30:2776-2785. [PMID: 34230983 DOI: 10.1007/s00167-021-06657-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/30/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE This study aimed to compare progressive muscle relaxation (PMR) + standard physiotherapy (PT) to standard PT during inpatient rehabilitation of total knee arthroplasty (TKA) patients in terms of post-operative outcomes. The hypothesis was that PMR + standard PT would lead to better pain, function, and neuromuscular outcomes than standard PT. METHODS A total of 106 patients were randomly allocated into PMR or standard rehabilitation (SR) groups. Both groups received standard PT during their hospital stay. PMR group additionally performed PMR exercise on post-operative days 1, 2, and 3. Patients were evaluated regarding pain intensity, functional outcomes, muscle strength, active range of motion, knee edema, anxiety, depression, and kinesiophobia. RESULTS There were no differences between groups at baseline (n.s.). During the inpatient period and at discharge, the PMR group had better results in terms of pain relief (p < 0.05), quadriceps strength (p = 0.001), kinesiophobia level (p = 0.011) compared to the SR group. No difference was detected between groups regarding other evaluation parameters during the inpatient period, at discharge, and third post-operative month (n.s.). The within-group analysis showed statistically significant differences over time in both groups in each variable (p < 0.05). CONCLUSION Our findings support that PMR therapy offers beneficial results in subjective and objective measures of TKA patients during the inpatient period. Therefore, PMR therapy could be implemented into the rehabilitation program of TKA patients to enhance their early recovery from various symptoms following TKA. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Musa Eymir
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, TR-35340, Balçova, Izmir, Turkey.
| | - Bayram Unver
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, TR-35340, Balçova, Izmir, Turkey
| | - Vasfi Karatosun
- Department of Orthopaedics and Traumatology, School of Medicine, Dokuz Eylul University, TR-35340, Balçova, Izmir, Turkey
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23
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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.
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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
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24
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Kondo Y, Yoshida Y, Iioka T, Kataoka H, Sakamoto J, Hirase T, Honda Y, Nawata A, Okita M. Short-Term Effects of Isometric Quadriceps Muscle Exercise with Auditory and Visual Feedback on Pain, Physical Function, and Performance after Total Knee Arthroplasty: A Randomized Controlled Trial. J Knee Surg 2022; 35:922-931. [PMID: 33241542 DOI: 10.1055/s-0040-1721035] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Severe acute pain after total knee arthroplasty (TKA) may cause delay in muscle strength and functional recovery, and it is a risk factor for chronic postoperative pain. Although pharmacological approaches are the typical firstline to treat acute pain; recently, nonpharmacological approaches such as exercise have been increasingly applied. The purpose of this investigation was to evaluate the effects of a rehabilitation program involving isometric quadriceps exercise with auditory and visual feedback to improve the short-term outcome after TKA. Sixty-two patients, planning a primary unilateral TKA, were randomly assigned to either an intervention group (n = 31) involving isometric quadriceps exercise with auditory and visual feedback in usual rehabilitation after TKA or a control group (n = 31) involving a standardized program for TKA. Patients in the intervention group performed the isometric quadriceps muscle exercise using the Quadriceps Training Machine from 2 to 14 days after TKA instead of the traditional quadriceps sets. Pain intensity, isometric knee extension strength, range of motion, timed up and go test (TUG), 10-m gait speed, 6-minute walking distance, the Western Ontario and McMaster University Osteoarthritis index (WOMAC), the hospital anxiety and depression scale, and the pain catastrophizing scale were assessed before TKA (baseline) and 1 to 3 weeks after TKA. Pain intensity significantly decreased in the intervention group than in the control group at 1 (p = 0.005), 2 (p = 0.002), and 3 (p = 0.010) weeks after TKA. Greater improvements in TUG (p = 0.036), 10-m gait speed (p = 0.047), WOMAC total score (p = 0.017), pain (p = 0.010), and function (p = 0.028) 3 weeks after TKA were observed in the intervention group. These results suggest that isometric quadriceps exercises with auditory and visual feedback provided early knee pain relief, possibly leading to better improvements in physical performance, and patient's perception of physical function in the early stages of postoperative TKA. Further studies should investigate whether this short-term effect is sustainable.
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Affiliation(s)
- Yasutaka Kondo
- Department of Rehabilitation, The Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan.,Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yoshihiro Yoshida
- Department of Rehabilitation, The Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Takashi Iioka
- Department of Orthopedic Surgery, The Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Hideki Kataoka
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Rehabilitation, Nagasaki Memorial Hospital, Nagasaki, Japan
| | - Junya Sakamoto
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Institute of Biomedical Sciences (Health Sciences), Nagasaki University, Nagasaki, Japan
| | - Tatsuya Hirase
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Institute of Biomedical Sciences (Health Sciences), Nagasaki University, Nagasaki, Japan
| | - Yuichiro Honda
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Institute of Biomedical Sciences (Health Sciences), Nagasaki University, Nagasaki, Japan
| | - Atsushi Nawata
- Medical Engineering Laboratory, ALCARE Co, Ltd, Tokyo, Japan
| | - Minoru Okita
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Institute of Biomedical Sciences (Health Sciences), Nagasaki University, Nagasaki, Japan
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25
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Chakravarthy K, Lee D, Tram J, Sheth S, Heros R, Manion S, Patel V, Kiesel K, Ghandour Y, Gilligan C. Restorative Neurostimulation: A Clinical Guide for Therapy Adoption. J Pain Res 2022; 15:1759-1774. [PMID: 35756364 PMCID: PMC9231548 DOI: 10.2147/jpr.s364081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/26/2022] [Indexed: 11/23/2022] Open
Abstract
In this review, we present a comprehensive clinical approach to restorative neurostimulation, a novel form of stimulation for refractory chronic mechanical low back pain, targeting impaired neuromuscular control and degeneration of the multifidus muscle. We focus on patient identification, technique guidance, and review of the scientific background and clinical evidence. As our understanding of back pain grows, there is clear evidence that impaired neuromuscular control and consequent degeneration of the multifidus muscle contribute to mechanical low back pain development and maintenance. We provide clinical guidance regarding an implantable restorative neurostimulation system that targets impaired neuromuscular control. Supported by results from a randomized, active-sham-controlled clinical trial with long-term follow-up, we provide clinicians with a comprehensive overview and practical clinical guidance for the adoption of this therapy modality.
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Affiliation(s)
- Krishnan Chakravarthy
- Department of Anesthesiology and Pain Medicine, University of California San Diego Health Sciences, San Diego, CA, USA.,VA San Diego Healthcare System, San Diego, CA, USA
| | - David Lee
- Fullerton Orthopedic Surgery Medical Group, Fullerton, CA, USA
| | - Jennifer Tram
- Department of Anesthesiology and Pain Medicine, University of California San Diego Health Sciences, San Diego, CA, USA
| | | | | | - Smith Manion
- Advent Health Pain Specialists, Merriam, KS, USA
| | - Vikas Patel
- Department of Orthopedic Surgery, University of Colorado, Denver, CO, USA
| | - Kyle Kiesel
- Department of Physical Therapy, University of Evansville, Evansville, IN, USA
| | - Yousef Ghandour
- Physical Rehabilitation Network (PRN), University of St. Augustine, San Diego, CA, USA
| | - Christopher Gilligan
- Division of Pain Medicine, Brigham & Women's Hospital/Harvard Medical School, Boston, MA, USA
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26
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Effects of Electromyographic Biofeedback on Functional Recovery of Patients Two Months after Total Knee Arthroplasty: A Randomized Controlled Trial. J Clin Med 2022; 11:jcm11113182. [PMID: 35683566 PMCID: PMC9181595 DOI: 10.3390/jcm11113182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 05/24/2022] [Accepted: 06/01/2022] [Indexed: 02/04/2023] Open
Abstract
The incidence of total knee arthroplasty (TKA) is steadily increasing worldwide. Therefore, it is crucial to develop efficient rehabilitation protocols and investigate the innovations in medical technology, which could improve rehabilitation outcomes. The aim of the study was to investigate the effect of adding electromyographic biofeedback (EMG-BF) to the conventional program of rehabilitation after TKA on quality of life, intensity of pain, and functional performance. The study was designed as a randomized controlled trial. A total of 131 patients were randomly assigned to two groups: an experimental group (n = 67; median age 70 (IQR 10)), and a control group (n = 64; median age 69 (IQR 9)). Both groups participated in an inpatient program of 21 days of rehabilitation, including land-based and aquatic exercise therapy, electrotherapy, and education. In the experimental group, a portion of land-based exercise therapy was supplemented by EMG-BF. A numeric rating scale (NRS), Knee Injury and Osteoarthritis Outcome Score (KOOS), use of mobility aids, 30 s chair stand test (CST), and timed up and go (TUG) test were used to measure outcomes. Both groups improved their functional abilities from day 1 to day 21 of rehabilitation. A higher proportion of participants did not use a walking aid (p < 0.002), and their NRS, KOOS, 30 s CST and TUG scores improved (p < 0.001). There were no significant differences between the groups in the outcomes. EMG-BF did not provide additional benefits to the conventional rehabilitation after TKA.
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27
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Cheng YY, Liu CC, Lin SY, Lee CH, Chang ST, Wang SP. Comparison of the Therapeutic Effects Between Isokinetic and Isotonic Strength Training in Patients After Total Knee Replacement: A Prospective, Randomized Controlled Trial. Orthop J Sports Med 2022; 10:23259671221105852. [PMID: 35757239 PMCID: PMC9218459 DOI: 10.1177/23259671221105852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 03/09/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Rebuilding the strength of the quadriceps as soon as possible after total knee replacement (TKR) is important so as to restore gait stability. To date, there are no standard postoperative strength training programs during the early recovery stage after TKR. Purpose: To compare the therapeutic effects between isokinetic and isotonic strengthening in patients after TKR. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: From April 2018 to August 2020, 37 patients met the inclusion criteria and were randomly assigned to perform either 4-week isokinetic or isotonic strength training programs. Other components of the rehabilitation program were kept the same between the 2 groups. All cases were evaluated by the Timed Up and Go (TUG) test, peak torque of knee extension and flexion (60 and 120 deg/s), 36-item Short Form Health Survey (SF-36), and Western Ontario and McMaster Universities Arthritis Index (WOMAC). Results: After undergoing a 4-week strength training regimen, significant improvements in the TUG test were noted in both groups; however, the time improvement in the isotonic group did not reach the minimal detectable change. All peak torque measurements improved in the isokinetic group but not in the isotonic group for knee flexion at 60 deg/s. The pain subdomain, physical domain, mental domain, total SF-36 score, and WOMAC index all improved significantly in both groups after training. Both training groups improved significantly in peak torque of knee strength, TUG test, and functional scores, but the differences between isokinetic and isotonic training were not statistically significant. Conclusion: The study findings showed that a 4-week strengthening exercise program in the early postoperative stage, involving either isokinetic or isotonic training, resulted in significant improvements in patients undergoing TKR. Registration: NCT02938416 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Yuan-Yang Cheng
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung.,Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung.,School of Medicine, National Yang Ming Chiao Tung University, Taipei.,Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung
| | - Chuan-Ching Liu
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung
| | - Shih-Yi Lin
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung
| | - Cheng-Hung Lee
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung.,Department of Food Science and Technology, Hung Kuang University, Taichung
| | - Shin-Tsu Chang
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung.,Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, Taipei.,School of Medicine, National Defense Medical Center, Taipei.,School of Medicine, Chung Shan Medical University, Taichung
| | - Shun-Ping Wang
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung.,Department of Orthopedics, Taichung Veterans General Hospital, Taichung.,Sports Recreation and Health Management Continuing Studies-Bachelor's Degree Completion Program, Tunghai University, Taichung
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28
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de Faro Silva R, Barreto AS, Trindade GDGG, Lima CM, Araújo AADS, Menezes IRA, Candido EAF, Santana ÉTN, Silva-Júnior WM, Quintans JSS, Coutinho HDM, Kim B, Quintans-Júnior LJ. Enhancement of the functionality of women with knee osteoarthritis by a gel formulation with Caryocar coriaceum Wittm ("Pequi") nanoencapsulated pulp fixed oil. Biomed Pharmacother 2022; 150:112938. [PMID: 35413602 DOI: 10.1016/j.biopha.2022.112938] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 11/28/2022] Open
Abstract
Osteoarthritis (OA) is a degenerative joint disease that occurs when there is a change in the mechanical and biological properties of the articular cartilage and the subchondral bone; The condition is more prevalent in women than in men. Pequi oil (PO), which is extracted from the fruits of the pequi tree (Caryocar coriaceum Wittm), is widely used in traditional medicine in the Brazilian northeast for the management of inflammation and joint pain. The aim of this study was to develop a pharmaceutical formulation containing Carbopol® hydrogel nanoencapsulated with pequi pulp fixed oil (PeONC) and evaluate its therapeutic effect on functionality and pain in women with knee osteoarthritis. The study was divided into two stages: Stage 1 - preparation and physico-chemical characterization of the pharmaceutical formulation containing PeONC, cell viability assays and skin irritability testing. Step 2 - A double-blind randomized clinical trial evaluating knee symptoms, quality of life, pressure pain, function, muscle strength and range of motion. The nanoformulation was in a gel form, with a particle size of 209.5 ± 1.06 nm, a pH of 6.23 ± 0.45, a zeta potential of - 23.1 ± 0.4 mV, a polydispersity index of 0.137 ± 0.52, and containing nanocapsules with a spherical shape a polymeric wall and an oily nucleus. The gel showed no cytotoxicity and was not irritating to human skin. The treatment with PeONC increased the strength of the knee flexor and extensor muscles and the total motion range of the knee. In addition, the treatment reduced knee instability, pain, swelling, and locking; There was also an improvement in some items of the SF-36 quality of life questionnaire such as in respect of functional capacity and social aspects. In conclusion, PeONC was found to be a stable, safe formulation with no toxicity in respect of topical use in humans. Additionally, the treatment produced an increase in muscle strength and functionality that was associated with reduced knee symptoms and improved quality of life. Our findings showed that in a group of women treated with PeONC mitigated the symptoms of knee osteoarthritis.
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Affiliation(s)
- Rodrigo de Faro Silva
- Postgraduate in Health Sciences (PPGCS). Laboratory of Neuroscience and Pharmacological Assays (LANEF) and Laboratory of Pharmaceutical Assays and Toxicity (LEFT), Federal University of Sergipe (UFS), 49.100-000 São Cristóvão, SE, Brazil.
| | - André Sales Barreto
- Postgraduate in Health Sciences (PPGCS). Laboratory of Neuroscience and Pharmacological Assays (LANEF) and Laboratory of Pharmaceutical Assays and Toxicity (LEFT), Federal University of Sergipe (UFS), 49.100-000 São Cristóvão, SE, Brazil.
| | - Gabriela das Graças Gomes Trindade
- Postgraduate in Health Sciences (PPGCS). Laboratory of Neuroscience and Pharmacological Assays (LANEF) and Laboratory of Pharmaceutical Assays and Toxicity (LEFT), Federal University of Sergipe (UFS), 49.100-000 São Cristóvão, SE, Brazil.
| | - Cláudio Moreira Lima
- Postgraduate in Health Sciences (PPGCS). Laboratory of Neuroscience and Pharmacological Assays (LANEF) and Laboratory of Pharmaceutical Assays and Toxicity (LEFT), Federal University of Sergipe (UFS), 49.100-000 São Cristóvão, SE, Brazil.
| | - Adriano Antunes de Souza Araújo
- Postgraduate in Health Sciences (PPGCS). Laboratory of Neuroscience and Pharmacological Assays (LANEF) and Laboratory of Pharmaceutical Assays and Toxicity (LEFT), Federal University of Sergipe (UFS), 49.100-000 São Cristóvão, SE, Brazil.
| | - Irwin Rose Alencar Menezes
- Department of Biological Chemistry, Postgraduate Program in Biological Chemistry, Regional University of Cariri (URCA), 63.105000 Crato, CE, Brazil.
| | | | - Érika Thatyana Nascimento Santana
- Postgraduate in Health Sciences (PPGCS). Laboratory of Neuroscience and Pharmacological Assays (LANEF) and Laboratory of Pharmaceutical Assays and Toxicity (LEFT), Federal University of Sergipe (UFS), 49.100-000 São Cristóvão, SE, Brazil.
| | - Walderi Monteiro Silva-Júnior
- Postgraduate in Health Sciences (PPGCS). Laboratory of Neuroscience and Pharmacological Assays (LANEF) and Laboratory of Pharmaceutical Assays and Toxicity (LEFT), Federal University of Sergipe (UFS), 49.100-000 São Cristóvão, SE, Brazil.
| | - Jullyana Souza Siqueira Quintans
- Postgraduate in Health Sciences (PPGCS). Laboratory of Neuroscience and Pharmacological Assays (LANEF) and Laboratory of Pharmaceutical Assays and Toxicity (LEFT), Federal University of Sergipe (UFS), 49.100-000 São Cristóvão, SE, Brazil.
| | - Henrique Douglas Melo Coutinho
- Department of Biological Chemistry, Postgraduate Program in Biological Chemistry, Regional University of Cariri (URCA), 63.105000 Crato, CE, Brazil.
| | - Bonglee Kim
- Department of Pathology, College of Korean Medicine, Kyung Hee University, Seoul 02447, South Korea.
| | - Lucindo José Quintans-Júnior
- Postgraduate in Health Sciences (PPGCS). Laboratory of Neuroscience and Pharmacological Assays (LANEF) and Laboratory of Pharmaceutical Assays and Toxicity (LEFT), Federal University of Sergipe (UFS), 49.100-000 São Cristóvão, SE, Brazil.
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Labanca L, Bonsanto F, Raffa D, Orlandi Magli A, Benedetti MG. Does adding neuromuscular electrical stimulation to rehabilitation following total knee arthroplasty lead to a better quadriceps muscle strength recovery? A systematic review. Int J Rehabil Res 2022; 45:118-125. [PMID: 35256573 DOI: 10.1097/mrr.0000000000000525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patients undergoing total knee arthroplasty (TKA) show postsurgical quadriceps weakness. Neuromuscular electrical stimulation (NMES) has been shown to be an effective treatment for muscle strength recovery in a number of orthopaedic conditions. The aim of this review is to investigate whether adding NMES to TKA rehabilitation leads to a better quadriceps strength recovery in comparison with standardized rehabilitation. A second aim is to investigate which are the most commonly used NMES pulse settings and their effectiveness. A systematic review of literature was conducted on PubMed, Cochrane, Scopus and Web-of-Science. Intervention studies evaluating the effects of a rehabilitation intervention based on quadriceps NMES in patients undergoing TKA were retrieved. Methodological quality was assessed using the risk of bias-2 Cochrane tool. Features of NMES rehabilitation and technical data on NMES settings were extracted from the studies. Four studies met the inclusion criteria. Due to the limited number and the heterogeneity of the selected studies, it was not appropriate to carry out a meta-analysis. All the studies reported higher quadriceps strength in patients undergoing quadriceps NMES, particularly early after TKA. The addition of NMES or traditional strength training shows similar long-term effects. Short duration and low-intensity NMES have limited effects on quadriceps strength. Heterogeneity was found on NMES methodologies and pulse settings. In conclusion, NMES is effective for quadriceps strength recovery following TKA. NMES intensity and duration are essential for good NMES outcomes on quadriceps strength. Further studies on NMES methodologies, pulse features and settings are required to address the gaps in knowledge on NMES following TKA.
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Affiliation(s)
- Luciana Labanca
- Physical Medicine and Rehabilitation Unit, IRCCS - Istituto Ortopedico Rizzoli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Fabio Bonsanto
- Physical Medicine and Rehabilitation Unit, IRCCS - Istituto Ortopedico Rizzoli
| | - Debora Raffa
- Physical Medicine and Rehabilitation Unit, IRCCS - Istituto Ortopedico Rizzoli
| | | | - Maria Grazia Benedetti
- Physical Medicine and Rehabilitation Unit, IRCCS - Istituto Ortopedico Rizzoli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Paravlic AH, Meulenberg CJ, Drole K. The Time Course of Quadriceps Strength Recovery After Total Knee Arthroplasty Is Influenced by Body Mass Index, Sex, and Age of Patients: Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:865412. [PMID: 35692543 PMCID: PMC9174520 DOI: 10.3389/fmed.2022.865412] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 04/14/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction For patients with osteoarthritis who have undergone total knee arthroplasty (TKA), quadriceps strength is a major determinant of general physical function regardless of the parameters adopted for functional assessment. Understanding the time course of quadriceps strength recovery and effectiveness of different rehabilitation protocols is a must. Therefore, the aim of this study was to: (i) determine the magnitude of maximal voluntary strength (MVS) loss and the time course of recovery of the quadriceps muscle following TKA, (ii) identify potential moderators of strength outcomes, and (iii) investigate whether different rehabilitation practices can moderate the strength outcomes following TKA, respectively. Design General scientific databases and relevant journals in the field of orthopedics were searched, identifying prospective studies that investigated quadriceps’ MVS pre-to post-surgery. Results Seventeen studies with a total of 832 patients (39% males) were included. Results showed that in the early post-operative days, the involved quadriceps’ MVS markedly declined, after which it slowly recovered over time in a linear fashion. Thus, the greatest decline of the MVS was observed 3 days after TKA. When compared to pre-operative values, the MVS was still significantly lower 3 months after TKA and did not fully recover up to 6 months following TKA. Furthermore, a meta-regression analysis identified that the variables, time point of evaluation, patient age, sex, and BMI, significantly moderate the MVS of the quadriceps muscle. Conclusion The analyzed literature data showed that the decrease in strength of the involved quadriceps muscles following TKA is considerable and lasts for several months post-surgery. Therefore, we recommend to specifically target the strengthening of knee extensor muscles, preserve motor control, and apply appropriate nutrition to ensure a holistic quadriceps muscle recovery. Since age, sex, and BMI were found to be moderating factors in patients’ recovery, further research should include specific analyses considering these moderators.
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Affiliation(s)
- Armin H. Paravlic
- Institute for Kinesiology Research, Scientific Research Center Koper, Koper, Slovenia
- Faculty of Sport, Institute of Kinesiology, University of Ljubljana, Ljubljana, Slovenia
- Faculty of Sport Studies, Masaryk University, Brno, Czechia
- *Correspondence: Armin H. Paravlic,
| | - Cécil J. Meulenberg
- Institute for Kinesiology Research, Scientific Research Center Koper, Koper, Slovenia
| | - Kristina Drole
- Faculty of Sport, Institute of Kinesiology, University of Ljubljana, Ljubljana, Slovenia
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Tung EV, Marriott KA, Laing AC, Mourtzakis M, Maly MR. The relationship between muscle capacity utilization during gait and pain in people with symptomatic knee osteoarthritis. Gait Posture 2022; 94:58-66. [PMID: 35247826 DOI: 10.1016/j.gaitpost.2022.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 02/16/2022] [Accepted: 02/20/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Muscle capacity utilization reflects the percentage of maximal knee extensor strength required to complete physical activities. RESEARCH QUESTION Is pain associated with muscle capacity utilization during walking in older adults with knee osteoarthritis? Secondarily, is muscle capacity utilization in older adults with knee osteoarthritis sex-specific? METHODS Twenty-three participants (15 females) with symptomatic knee OA completed this study [age 67 ( ± 8) years, body mass index 29.7 ( ± 3.9) kg/m2, gait speed during the Six Minute Walk test 1.25 ( ± 0.25) m/s]. Pain was measured using the Knee injury and Osteoarthritis Outcome Score. Muscle capacity utilization was quantified as the peak external knee flexor moment during level walking normalized to knee extensor maximum voluntary isometric contraction. The knee flexor moment was calculated from kinematic and kinetic data during barefoot level walking at a self-selected speed and at 1.1 m/s. Knee extensor maximum voluntary isometric contraction was measured on a dynamometer. Multiple linear regressions were used to determine the relationship between pain and muscle capacity utilization after adjusting for age, sex, body mass index, and gait speed. Independent sample t-tests examined sex differences. RESULTS Pain was not associated with muscle capacity utilization during self-selected and standardized walking speeds (p = 0.38 and p = 0.36, respectively). Females did not require a greater muscle capacity utilization than males to complete gait at self-selected and standardized speeds (p = 0.28, and p = 0.40, respectively). SIGNIFICANCE Muscle capacity utilization was not associated with pain during walking in people with knee osteoarthritis. Future work should explore more challenging activities of daily living in knee OA.
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Affiliation(s)
- Emma V Tung
- University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
| | - Kendal A Marriott
- University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
| | - Andrew C Laing
- University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
| | - Marina Mourtzakis
- University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
| | - Monica R Maly
- University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada.
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Ruspi A, Temporiti F, Adamo P, Mina F, Traverso F, Gatti R. Neuromuscular activation of quadriceps bellies during tasks performed in the same biomechanical condition in patients undergoing total knee arthroplasty. J Electromyogr Kinesiol 2022; 64:102659. [DOI: 10.1016/j.jelekin.2022.102659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/24/2022] [Accepted: 04/08/2022] [Indexed: 11/28/2022] Open
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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.
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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
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Wen C, Cates HE, Weinhandl JT, Crouter SE, Zhang S. Knee biomechanics of patients with total knee replacement during downhill walking on different slopes. JOURNAL OF SPORT AND HEALTH SCIENCE 2022; 11:50-57. [PMID: 33540108 PMCID: PMC8847919 DOI: 10.1016/j.jshs.2021.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/29/2020] [Accepted: 12/18/2020] [Indexed: 06/12/2023]
Abstract
PURPOSE The purpose of this study was to compare knee biomechanics of the replaced limb to the non-replaced limb of total knee replacement (TKR) patients and healthy controls during walking on level ground and on decline surfaces of 5°, 10°, and 15°. METHODS Twenty-five TKR patients and 10 healthy controls performed 5 walking trials on different decline slopes on a force platform and an instrumented ramp system. Two analyses of variance, 2 × 2 (limb × group) and 2 × 4 (limb × decline slope), were used to examine selected biomechanics variables. RESULTS The replaced limb of TKR patients had lower peak loading-response and push-off knee extension moment than the non-replaced and the matched limb of healthy controls. No differences were found in loading-response and push-off knee internal abduction moments among replaced, non-replaced, and matched limb of healthy controls. The knee flexion range of motion, peak loading-response vertical ground reaction force, and peak knee extension moment increased across all slope comparisons between 0° and 15° in both the replaced and non-replaced limb of TKR patients. CONCLUSION Downhill walking may not be appropriate to include in early stage rehabilitation exercise protocols for TKR patients.
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Affiliation(s)
- Chen Wen
- Department of Kinesiology, Recreation, and Sport Studies, University of Tennessee, Knoxville, TN 37996, USA
| | | | - Joshua T Weinhandl
- Department of Kinesiology, Recreation, and Sport Studies, University of Tennessee, Knoxville, TN 37996, USA
| | - Scott E Crouter
- Department of Kinesiology, Recreation, and Sport Studies, University of Tennessee, Knoxville, TN 37996, USA
| | - Songning Zhang
- Department of Kinesiology, Recreation, and Sport Studies, University of Tennessee, Knoxville, TN 37996, USA.
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Şavkin R, Büker N, Güngör HR. The effects of preoperative neuromuscular electrical stimulation on the postoperative quadriceps muscle strength and functional status in patients with fast-track total knee arthroplasty. Acta Orthop Belg 2021; 87:735-744. [PMID: 35172441 DOI: 10.52628/87.4.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This study aimed to investigate the effect of pre- operative neuromuscular electrical stimulation (NMES) on postoperative quadriceps muscle strength, functional status, and quality of life in patients with fast-track total knee arthroplasty (TKA). This prospective study was carried out at Orthopedics department from September 2017 to October 2018. A total of 40 patients were randomly divided into NMES (n=20) and control group (n=20). Patients in NMES group were asked to use home NMES device daily for 20 minutes, 5 times a day, for 6 weeks before surgery. The control group was placed on the 6-week waiting list for surgery without any preoperative intervention. Standard home exercise program was applied to both groups after discharge. The patients were evaluated baseline, preoperatively (6-weeks after baseline) and at the 4th and 12th weeks after surgery. Knee range of motion, quadriceps muscle strength, patient-reported (WOMAC and KOOS) and performance-based activity limitation (30-second chair-stand test, 40-meter fast-paced walk test, and stair-climb test) were evaluated at each visit. Preoperative NMES resulted in significant improvement in KOOS-function in daily living and WOMAC total score (p≤0.05) but had a non-significant trend toward to improve quadriceps muscle strength, KOOS-pain and -other symptoms, performance- based activity limitation, and quality of life scores (p>0.05). However, there was no significant difference between groups in the postoperative period (p>0.05). NMES has beneficial effects in terms of patient- reported and performance-based physical functions and quality of life in preoperative period ; however, it does not provide any additional benefit for post- operative outcomes in patients with fast-track TKA.
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Winther SB, Foss OA, Klaksvik J, Husby VS. Pain and load progression following an early maximal strength training program in total hip- and knee arthroplasty patients. J Orthop Surg (Hong Kong) 2021; 28:2309499020916392. [PMID: 32301372 DOI: 10.1177/2309499020916392] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients significantly increase muscle strength after maximal strength training (MST) initiated soon after surgery. Owing to severe postoperative pain, knee patients are anticipated to be more limited in performing heavy load exercises than hip patients. The aim of the present study was to describe pain and load progression during early MST in THA and TKA patients. METHODS Explorative study based on secondary analyses from two randomized controlled trials: 26 THA and 16 TKA patients had their training sessions logged. They trained at 85-90% of their maximal capacity in leg press, and abduction/knee-extension of the operated leg (4 × 5 repetitions) for 8-10 weeks, initiated early postoperatively. RESULTS Knee patients experienced significantly more pain than hip patients during the training sessions (p < 0.03), however, pain before and after training was not different (p > 0.09). All patients significantly increased leg press training load until the last intervention week (p < 0.01). CONCLUSION This study demonstrates that TKA patients experience more pain than THA patients during training following a MST program but not more than moderate levels during or after training. Pain before and after training is not different. Both groups significantly increased load progression during the intervention. These findings indicate that both THA and TKA patients might perform MST with extensive load progression early after surgery without compromising pain. The studies were registered at ClinicalTrials.gov .
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Affiliation(s)
- Siri B Winther
- Department of Orthopaedic Surgery, Clinic of Orthopaedics, Rheumatology, and Dermatology, St. Olavs Hospital HF, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology NTNU, Trondheim, Norway
| | - Olav A Foss
- Department of Orthopaedic Surgery, Clinic of Orthopaedics, Rheumatology, and Dermatology, St. Olavs Hospital HF, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology NTNU, Trondheim, Norway
| | - Jomar Klaksvik
- Department of Orthopaedic Surgery, Clinic of Orthopaedics, Rheumatology, and Dermatology, St. Olavs Hospital HF, Trondheim, Norway
| | - Vigdis S Husby
- Department of Orthopaedic Surgery, Clinic of Orthopaedics, Rheumatology, and Dermatology, St. Olavs Hospital HF, Trondheim, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine and Health Science, Norwegian University of Science and Technology NTNU, Trondheim, Norway
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Gamma Loop Dysfunction as a Possible Neurophysiological Mechanism of Arthrogenic Muscle Inhibition: A Narrative Review of the Literature. J Sport Rehabil 2021; 31:736-741. [DOI: 10.1123/jsr.2021-0232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/09/2021] [Accepted: 12/03/2021] [Indexed: 11/18/2022]
Abstract
Context: Quadriceps activation failure has been observed following various pathological conditions in a knee joint such as knee surgery, pain, effusion in knee, and osteoarthritis also could be aging matter. Those patients are unable to attain maximal quadriceps strength for a long period of time although their quadriceps itself is not damaged. This impairment is termed arthrogenic muscle inhibition (AMI). AMI has been of concern to clinicians because this weakness hinders the rehabilitation process considerably and delays recovery because strengthening protocols for the AMI could be largely ineffective. Clinically, it is important to understand neurophysiological mechanisms of the AMI to treat patients with the impairment. Objectives: This is a narrative review of the literature. The purpose of this review is to understand the following: (1) Why investigations of only peripheral spinal reflexive pathways are not enough for elucidation of the mechanisms of the AMI? (2) What we know about the role of the gamma spindle system in AMI so far? (3) Could a dysfunctional gamma spindle system contribute to AMI lead neural changes in upper central nervous system? and (4) Concerns that a clinician should take into consideration when deciding whether to apply therapeutic interventions for AMI. Data Sources: The databases PubMed, MEDLINE, SPORTDiscus, and CINAHL were searched with the terms arthrogenic muscle inhibition (AMI), reflex inhibition, joint mechanoreceptor, gamma loop, corticospinal pathway, spinal reflex, effusion, and joint injury. The remaining citations were collected from references of similar papers. Conclusions: AMI is a limiting factor in the rehabilitation of joint injury. Motor unit recruitment could be hindered in patients with AMI as a result of a dysfunctional gamma spindle system. Clinicians should understand the mechanism of AMI well in order to establish effective rehabilitation programs for AMI. Indeed, AMI is not caused by a single factor, but rather, multiple neural factors can change over time following the appearance of AMI. Therefore, multiple interventions targeting different neural pathways should be combined to achieve the ideal therapeutic goal for the treatment of AMI.
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Barker KL, Room J, Knight R, Dutton SJ, Toye F, Leal J, Kent S, Kenealy N, Schussel MM, Collins G, Beard DJ, Price A, Underwood M, Drummond A, Cook E, Lamb SE. Outpatient physiotherapy versus home-based rehabilitation for patients at risk of poor outcomes after knee arthroplasty: CORKA RCT. Health Technol Assess 2020; 24:1-116. [PMID: 33250068 DOI: 10.3310/hta24650] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Over 100,000 primary knee arthroplasty operations are undertaken annually in the UK. Around 15-30% of patients do not report a good outcome. Better rehabilitation strategies may improve patient-reported outcomes. OBJECTIVES To compare the outcomes from a traditional outpatient physiotherapy model with those from a home-based rehabilitation programme for people assessed as being at risk of a poor outcome after knee arthroplasty. DESIGN An individually randomised, two-arm controlled trial with a blinded outcome assessment, a parallel health economic evaluation and a nested qualitative study. SETTING The trial took place in 14 NHS physiotherapy departments. PARTICIPANTS People identified as being at high risk of a poor outcome after knee arthroplasty. INTERVENTIONS A multicomponent home-based rehabilitation package delivered by rehabilitation assistants with supervision from qualified therapists compared with usual-care outpatient physiotherapy. MAIN OUTCOME MEASURES The primary outcome was the Late Life Function and Disability Instrument at 12 months. Secondary outcomes were the Oxford Knee Score (a disease-specific measure of function); Knee injury and Osteoarthritis Outcome Score; Quality of Life subscale; Physical Activity Scale for the Elderly; EuroQol-5 Dimensions, five-level version; and physical function assessed using the Figure-of-8 Walk Test, 30-Second Chair Stand Test and Single Leg Stance. Data on the use of health-care services, time off work and informal care were collected using participant diaries. RESULTS In total, 621 participants were randomised. A total of 309 participants were assigned to the COmmunity based Rehabilitation after Knee Arthroplasty (CORKA) home-based rehabilitation programme, receiving a median of five treatment sessions (interquartile range 4-7 sessions). A total of 312 participants were assigned to usual care, receiving a median of four sessions (interquartile range 2-6 sessions). The primary outcome, Late Life Function and Disability Instrument function total score at 12 months, was collected for 279 participants (89%) in the home-based CORKA group and 287 participants (92%) in the usual-care group. No clinically or statistically significant difference was found between the groups (intention-to-treat adjusted difference 0.49 points, 95% confidence interval -0.89 to 1.88 points; p = 0.48). There were no statistically significant differences between the groups in any of the patient-reported or physical secondary outcome measures at 6 or 12 months post randomisation. The health economic analysis found that the CORKA intervention was cheaper to provide than usual care (£66 less per participant). Total societal costs (combining health-care costs and other costs) were lower for the CORKA intervention than usual care (£316 less per participant). Adopting a societal perspective, CORKA had a 75% probability of being cost-effective at a threshold of £30,000 per quality-adjusted life-year. Adopting the narrower health and social care perspective, CORKA had a 43% probability of being cost-effective at the same threshold. LIMITATIONS The interventions were of short duration and were set within current commissioning guidance for UK physiotherapy. Participants and treating therapists could not be blinded. CONCLUSIONS This randomised controlled trial found no important differences in outcomes when post-arthroplasty rehabilitation was delivered using a home-based, rehabilitation assistant-delivered rehabilitation package or a traditional outpatient model. However, the health economic evaluation found that when adopting a societal perspective, the CORKA home-based intervention was cost-saving and more effective than, and thus dominant over, usual care, owing to reduced time away from paid employment for this group. Further research could look at identifying the risk of poor outcome and further evaluation of a cost-effective treatment, including the workforce model to deliver it. TRIAL REGISTRATION Current Controlled Trials ISRCTN13517704. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 65. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Karen L Barker
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jon Room
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ruth Knight
- Centre for Statistics in Medicine, Oxford Clinical Trials Research Unit, University of Oxford, Oxford, UK
| | - Susan J Dutton
- Centre for Statistics in Medicine, Oxford Clinical Trials Research Unit, University of Oxford, Oxford, UK
| | - Fran Toye
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jose Leal
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Seamus Kent
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nicola Kenealy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Michael M Schussel
- Centre for Statistics in Medicine, Oxford Clinical Trials Research Unit, University of Oxford, Oxford, UK
| | - Gary Collins
- Centre for Statistics in Medicine, Oxford Clinical Trials Research Unit, University of Oxford, Oxford, UK
| | - David J Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Andrew Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Avril Drummond
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | | | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,School of Medicine and Health, University of Exeter, Exeter, UK
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Abstract
Swelling is a common phenomenon after total knee arthroplasty, with potential for negative impact on the rehabilitation process and final outcome. The aim of this study was to investigate the effectiveness of a new compression protocol with a self-adjustable, nonelastic compression wrap for the knee region. This study was conducted as a prospective comparative study. Total leg volume and the circumference of the knee at three levels were compared between groups. The results of our study suggest that the application of the new compression protocol has no effect on swelling in the acute postoperative phase (0-2 days) but reduces swelling at Day 14 within the subacute phase. The observed positive effect of the compression protocol could be of clinical importance in the subacute phase as well as for a subgroup of patients suffering from aberrant quadriceps weakness concomitant with knee swelling.
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Paravlic AH, Maffulli N, Kovač S, Pisot R. Home-based motor imagery intervention improves functional performance following total knee arthroplasty in the short term: a randomized controlled trial. J Orthop Surg Res 2020; 15:451. [PMID: 33008432 PMCID: PMC7531130 DOI: 10.1186/s13018-020-01964-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 09/14/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Motor imagery (MI) is effective in improving motor performance in the healthy asymptomatic adult population. However, its possible effects among older orthopaedic patients are still poorly investigated. Therefore, this study explored whether the addition of motor imagery to routine physical therapy reduces the deterioration of quadriceps muscle strength and voluntary activation (VA) as well as other variables related to motor performance in patients after total knee arthroplasty (TKA). METHODS Twenty-six patients scheduled for TKA were randomized to either MI practice combined with routine physical therapy group (MIp) or to a control group receiving physical therapy alone (CON). MIp consisted of maximal voluntary isometric contraction (MViC) task: 15 min/day in the hospital, then 5 times/week in their homes for 4 weeks. MViC and VA of quadriceps muscle, knee flexion and extension range of motion, pain level, along with a Timed Up-and-Go Test (TUG) and self-reported measure of physical function (assessed using the Oxford Knee Score questionnaire [OKS]) were evaluated before (PRE) and 1 month after surgery (POST). RESULTS Significantly better rehabilitation outcomes were evident on the operated leg for the MIp group compared to CON: at POST, the MIp showed lower strength decrease (p = 0.012, η2 = 0.237) and unaltered VA, significantly greater than CON (p = 0.014, η2 = 0.227). There were no significant differences in knee flexion and extension range of motion and pain level (p > 0.05). Further, MIp patients performed better in TUG (p < 0.001, η2 = 0.471) and reported better OKS scores (p = 0.005, η2 = 0.280). The non-operated leg showed no significant differences in any outcomes at POST (all p > 0.05). In addition, multiple linear regression analysis showed that failure of voluntary activation explained 47% of the quadriceps muscle strength loss, with no significant difference in perceived level of pain. CONCLUSION MI practice, when added to physical therapy, improves both objective and subjective measures of patients' physical function after TKA, and facilitates transfer of MI strength task on functional mobility. TRIAL REGISTRATION Retrospectively registered on ClinicalTrials.gov NCT03684148.
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Affiliation(s)
- Armin H Paravlic
- Science and Research Centre Koper, Institute for Kinesiology Research, Koper, Slovenia
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy.
- Centre for Sports and Exercise Medicine, Queen Mary University of London, London, UK.
- School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent, UK.
| | - Simon Kovač
- Orthopaedic Hospital Valdoltra, Ankaran, Slovenia
| | - Rado Pisot
- Science and Research Centre Koper, Institute for Kinesiology Research, Koper, Slovenia
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
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Muyskens JB, Winbush A, Foote DM, Turnbull DW, Dreyer HC. Essential amino acid supplementation alters the p53 transcriptional response and cytokine gene expression following total knee arthroplasty. J Appl Physiol (1985) 2020; 129:980-991. [PMID: 32881622 DOI: 10.1152/japplphysiol.00022.2020] [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: 11/22/2022] Open
Abstract
Reducing muscle atrophy following orthopedic surgery is critical during the postoperative period. Our previous work in patients who underwent total knee arthroplasty (TKA) showed that the vast majority of atrophy occurs within 2 wk following surgery and that essential amino acid (EAA) supplementation attenuates this atrophy. We used RNA-sequencing (RNA-seq) to identify genes associated with atrophy after TKA with and without EAAs. Analysis of overrepresented gene-ontology terms revealed that p53 signaling and the cytokine-cytokine receptor pathways were highly upregulated after TKA. Relative to the placebo group, the EAA group had altered expression of p53 regulators such as MDM2. This altered expression may account for differences between groups in timing of upregulation of some p53 targets such as apoptosis genes, and may account for the reduction in muscle loss in the subjects receiving EAAs. Furthermore, we observed altered expression of a large number of cytokine-signaling genes including TNFRSF12A, which plays a critical role in muscle atrophy, myogenesis, fibrosis, and the noncanonical NF-κB pathway.NEW & NOTEWORTHY Total knee arthroplasty is the most frequently performed inpatient surgical procedure for those over 45 yr in the United States. Following surgery, patients lose a large amount of muscle, which impacts functional mobility. Previously, our laboratory found that supplementing patients' diets with essential amino acids (EAAs) reduces postsurgical muscle loss. Here, our goal was to characterize the transcriptional changes associated with surgery with and without EAA supplementation to uncover the underlying mechanisms by which EAAs attenuate this muscle loss.
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Affiliation(s)
| | - Ari Winbush
- Institute of Ecology and Evolution, University of Oregon, Eugene, Oregon
| | - Douglas M Foote
- Department of Human Physiology, University of Oregon, Eugene, Oregon
| | - Douglas W Turnbull
- Genomics and Cell Characterization Core Facility, University of Oregon, Eugene, Oregon
| | - Hans C Dreyer
- Department of Human Physiology, University of Oregon, Eugene, Oregon
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Xu H, Kang B, Li Y, Xie J, Sun S, Zhong S, Gao C, Xu X, Zhao C, Qiu G, Xiao L. Using electroacupuncture to recover muscle strength in patients with knee osteoarthritis after total knee arthroplasty: a study protocol for a double-blinded, randomized, and placebo-controlled trial. Trials 2020; 21:705. [PMID: 32778158 PMCID: PMC7418422 DOI: 10.1186/s13063-020-04601-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 07/12/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is a gold standard for patients with terminal term gonarthrosis for reducing pain, correcting deformities, and regaining stability. However, post-TKA muscle strength recovery is often difficult. Although electroacupuncture (EA) enhances lower extremity muscle strength of the lower extremity, there is limited evidence regarding its effect on lower extremity muscle strength in post-TKA patients. Consequently, this trial intends to evaluate the efficacy of post-TKA EA on the recovery of lower extremity muscle strength, specifically, during the early post-TKA period. METHODS/DESIGN This is a double-blinded, randomized, and controlled trial. It will be conducted between August 2020 and December 2020. Ninety-four participants with KOA who have undergone unilateral TKA will be randomized into a treatment (EA) group and a control (sham EA) group. The former and latter groups will receive EA and sham EA, respectively, at ST37, ST36, SP10, and SP9 acupoints. The participants will undergo ten treatment sessions over 2 weeks (5 sessions per week). The primary outcomes will include changes in muscle strength and the Hospital for Special Surgery score at the second week from baseline (pre-op 1 day or POD 3). The secondary outcomes will include a 4-m walk test, numerical rating scale score, the Hamilton Anxiety Scale score, and additional analgesia use. Additional outcomes will include the incidence of analgesia-related side effects and the participant satisfaction rate. Participant blinding will also be assessed where they will be asked to guess whether they received EA after the latest intervention. Adverse EA events will be documented and assessed throughout the trial. DISCUSSION EA is helpful for post-TKA recovery and enhancement of lower limb muscle strength. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR1900027806 . Registered on 29 November 2019.
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Affiliation(s)
- Hui Xu
- Department of Joint Orthopaedics, Guanghua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, 200050, China
- Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Bingxin Kang
- Department of Joint Orthopaedics, Guanghua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, 200050, China
| | - Yulin Li
- Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Jun Xie
- Department of Joint Orthopaedics, Guanghua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, 200050, China
- Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, 200050, China
| | - Songtao Sun
- Department of Joint Orthopaedics, Guanghua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, 200050, China
- Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, 200050, China
| | - Sheng Zhong
- Department of Joint Orthopaedics, Guanghua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, 200050, China
- Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, 200050, China
| | - Chenxin Gao
- Department of Joint Orthopaedics, Guanghua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, 200050, China
- Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, 200050, China
| | - Xirui Xu
- Department of Joint Orthopaedics, Guanghua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, 200050, China
- Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, 200050, China
| | - Chi Zhao
- Department of Joint Orthopaedics, Guanghua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, 200050, China
| | - Guowei Qiu
- Department of Joint Orthopaedics, Guanghua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, 200050, China
| | - Lianbo Xiao
- Department of Joint Orthopaedics, Guanghua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, 200050, China.
- Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, 200050, China.
- Arthritis Institute of Integrated Traditional Chinese and Western Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai, 200050, China.
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Choi JH, Kim BR, Kim SR, Nam KW, Lee SY, Kim WB, Kim YJ. Physical Performance Correlates with Self-Reported Physical Function and Quality of Life in Patients at 3 Months after Total Knee Arthroplasty. Ann Geriatr Med Res 2020; 24:99-106. [PMID: 32743330 PMCID: PMC7370793 DOI: 10.4235/agmr.20.0018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/21/2020] [Accepted: 05/21/2020] [Indexed: 11/01/2022] Open
Abstract
Background Although total knee arthroplasty (TKA) is an effective treatment for knee osteoarthritis, assessment of postoperative outcomes remains unclear. This study aimed to identify postoperative physical performance factors that are correlated with self-reported physical function and quality of life (QoL) at 3 months after unilateral TKA. Methods In total, 158 patients who underwent unilateral primary TKA completed performance-based physical function tests at 3 months after surgery, including Stair Climbing Tests (SCT), 6-Minute Walk Tests (6MWT), Timed Up and Go tests (TUG), and instrumental gait analysis. We also measured the isometric knee flexor and extensor strengths of the operated and non-operated knees. Self-reported physical function and QoL were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Euro-QoL Five Dimensions (EQ-5D) questionnaire, respectively. Results Bivariate analyses showed that WOMAC function and EQ-5D were correlated with age, other self-reported measures, and performance-based measures. The WOMAC pain (r=0.71, p<0.001) showed a high positive correlation. While the EQ-5D (r=-0.7, p<0.001) showed a highly negative correlation with WOMAC function, WOMAC pain (r=-0.67, p<0.001) showed a moderately negative correlation with EQ-5D. In multivariate linear regression analyses, WOMAC pain, peak torque of the flexor of the non-operated knee, and reductions in extensor and stride length were associated with self-reported physical function, whereas WOMAC pain, SCT ascent, and cadence were associated with postoperative QoL. Conclusions Physical performance factors were significantly associated with self-reported physical function and QoL in patients at 3 months after unilateral TKA. These findings suggest that performance-based physical function could be used to assess outcomes after TKA.
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Affiliation(s)
- Jun Hwan Choi
- Department of Rehabilitation Medicine, Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
| | - Bo Ryun Kim
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Seoul, Korea
| | - Sang Rim Kim
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
| | - Kwang Woo Nam
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
| | - Won Bin Kim
- Department of Rehabilitation Medicine, Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
| | - Youn Ji Kim
- Department of Rehabilitation Medicine, Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
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Hirose H, Ogawa H, Matsumoto K, Akiyama H. Periarticular injection of tranexamic acid promotes early recovery of the range of knee motion after total knee arthroplasty. J Orthop Surg (Hong Kong) 2020; 27:2309499019864693. [PMID: 31359848 DOI: 10.1177/2309499019864693] [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] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Tranexamic acid (TXA) is a commonly used compound that reduces postoperative blood loss. Periarticular injection of TXA is a recently reported procedure with some advantages such as cost-effectiveness and the ease of performance over an intravenous or topical administration. However, its association with functional recovery remains unclear. This study aimed to examine the effect of periarticular injection of TXA on early postoperative recovery of knee functionality after total knee arthroplasty (TKA). METHODS Eighty-four patients who underwent primary unilateral TKA from February 2013 to August 2016 were classified into two groups based on whether they received TXA injection (44 cases each in the TXA and control groups). Patients in the TXA group received periarticular injection of TXA (1000 mg) just prior to incision closure. Ten-meter walk test (s), pain visual analog scale, knee extension muscle force (N), range of motion (ROM) (maximum flexion angle, maximum extension angle, and motion arc), and blood loss (mL) were assessed. RESULTS The maximum flexion angle and maximal extension angle on postoperative day (POD) 4, POD7, POD10, and POD14 in the TXA group were significantly larger than those in the control group. The postoperative drained blood in the TXA group was significantly less than that of the control group (543.9 ± 464.3 mL and 814.9 ± 481.4 mL, respectively, p < 0.05). No significant difference was observed in the other parameters at any time point. CONCLUSION Periarticular injection of TXA significantly promotes early recovery of knee ROM after TKA. Level of Evidence: Level IV, therapeutic case series.
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Affiliation(s)
- Hitoshi Hirose
- 1 Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hiroyasu Ogawa
- 1 Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan.,2 Department of Advanced Joint Reconstructive Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kazu Matsumoto
- 1 Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Haruhiko Akiyama
- 1 Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
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Kim G, Kim WS, Kim TW, Lee YS, Lee H, Paik NJ. Home-based rehabilitation using smart wearable knee exercise device with electrical stimulation after anterior cruciate ligament reconstruction: A study protocol for a randomized controlled trial. Medicine (Baltimore) 2020; 99:e20256. [PMID: 32443364 PMCID: PMC7254399 DOI: 10.1097/md.0000000000020256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Rehabilitation after anterior cruciate ligament (ACL) reconstruction is critical to patient outcome. Despite its importance; however, hospital-based rehabilitation is limited, with barriers, including distance and cost. With recent technological advancements, wearable devices have actively been used to address these barriers. In this study, we propose a randomized controlled trial protocol investigating the efficacy and feasibility of home-based rehabilitation after ACL reconstruction using a smart wearable device providing electrical stimulation that allows knee exercise. METHODS AND ANALYSIS This is a protocol proposal for a prospective, single-center, randomized, controlled study. We plan to recruit adults discharged after ACL reconstruction; the recruited subjects will be randomly allocated to 1 of 2 groups, using a computer-generated randomization method: the intervention (n = 20) or control group (n = 20). The intervention group will receive a 6-week home-based rehabilitation program using smart wearable device. The control group will undergo a 6-week self-exercise program as normal. The following outcomes will be assessed at baseline, 2 weeks, and 6 weeks post the 6-week intervention program: quadriceps strength of the affect side as measured by a dynamometer (primary outcome); range of motion; root mean square of quadriceps muscle using surface electromyography; knee function using questionnaire; quality of life; subject's satisfaction score using questionnaire; frequency and duration of exercise; and knee pain. An intention-to-treat analysis will be conducted for the primary outcome. DISCUSSION This study is a prospective, single-center, randomized, controlled study. This study aims to research the feasibility and efficacy of a 6-week, structured home-based rehabilitation program for patients after ACL reconstruction using a smart wearable device. The findings of this study will help to establish a home-based rehabilitation program to better recovery in patients with ACL reconstruction. TRIAL REGISTRATION NUMBER This protocol was registered in ClinicalTrials.gov, under the number NCT04079205.
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Affiliation(s)
- Gowun Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si
- Department of Rehabilitation Medicine, Kangwon National University Hospital, Chuncheon
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si
| | - Tae Woo Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul
| | - Yong Seuk Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital
| | - Hooman Lee
- EXOSYSTEMS Inc., Seongnam-si, Republic of Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si
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Total Knee Arthroplasty with a Ti6Al4V/PEEK Prosthesis on an Osteoarthritis Rat Model: Behavioral and Neurophysiological Analysis. Sci Rep 2020; 10:5277. [PMID: 32210280 PMCID: PMC7093407 DOI: 10.1038/s41598-020-62146-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 03/02/2020] [Indexed: 11/08/2022] Open
Abstract
Arthroplasty is a surgical procedure to restore the function of the joint of patient suffering from knee osteoarthritis. However, postoperative functional deficits are reported even after a rehabilitation program. In order to determine the origin of functional deficits of patient suffering from knee osteoarthritis and total knee arthroplasty, we developed a rodent model including a chemically-induced-osteoarthritis and designed a knee prosthesis (Ti6Al4V/PEEK) biomechanically and anatomically adapted to rat knee joint. Dynamic Weight-Bearing, gait kinematics, H-reflex from vastus medialis muscle and activities from metabosensitive III and IV afferent fibers in femoral nerve were assessed at 1 and 3 months post-surgery. Results indicate that knee osteoarthritis altered considerably the responses of afferent fibers to their known activators (i.e., lactic acid and potassium chloride) and consequently their ability to modulate the spinal sensorimotor loop, although, paradoxically, motor deficits seemed relatively light. On the contrary, results indicate that, after the total knee arthroplasty, the afferent responses and the sensorimotor function were slightly altered but that motor deficits were more severe. We conclude that neural changes attested by the recovery of the metabosensitive afferent activity and the sensorimotor loop were induced when a total knee replacement was performed and that these changes may disrupt or delay the locomotor recovery.
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Cerqueira MS, Do Nascimento JDS, Maciel DG, Barboza JAM, De Brito Vieira WH. Effects of blood flow restriction without additional exercise on strength reductions and muscular atrophy following immobilization: A systematic review. JOURNAL OF SPORT AND HEALTH SCIENCE 2020; 9:152-159. [PMID: 32117574 PMCID: PMC7031770 DOI: 10.1016/j.jshs.2019.07.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/13/2019] [Accepted: 05/30/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE To investigate whether blood flow restriction (BFR) without concomitant exercise mitigated strength reduction and atrophy of thigh muscles in subjects under immobilization for lower limbs. METHODS The following databases were searched: PubMed, CINAHL, PEDro, Web of Science, Central, and Scopus. RESULTS The search identified 3 eligible studies, and the total sample in the identified studies consisted of 38 participants. Isokinetic and isometric torque of the knee flexors and extensors was examined in 2 studies. Cross-sectional area of thigh muscles was evaluated in 1 study, and thigh girth was measured in 2 studies. The BFR protocol was 5 sets of 5 min of occlusion and 3 min of free flow, twice daily for approximately 2 weeks. As a whole, the included studies indicate that BFR without exercise is able to minimize strength reduction and muscular atrophy after immobilization. It is crucial to emphasize, however, that the included studies showed a high risk of bias, especially regarding allocation concealment, blinding of outcome assessment, intention-to-treat analyses, and group similarity at baseline. CONCLUSION Although potentially useful, the high risk of bias presented by original studies limits the indication of BFR without concomitant exercise as an effective countermeasure against strength reduction and atrophy mediated by immobilization.
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Affiliation(s)
- Mikhail Santos Cerqueira
- Department of Physical Therapy, Laboratory of Muscle Performance, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte 59072-970, Brazil.
| | - José Diego Sales Do Nascimento
- Department of Physical Therapy, Neuromuscular Performance Analysis Laboratory, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte 59072-970, Brazil
| | - Daniel Germano Maciel
- Department of Physical Therapy, Laboratory of Muscle Performance, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte 59072-970, Brazil
| | - Jean Artur Mendonça Barboza
- Department of Physical Therapy, Laboratory of Muscle Performance, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte 59072-970, Brazil
| | - Wouber Hérickson De Brito Vieira
- Department of Physical Therapy, Laboratory of Muscle Performance, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte 59072-970, Brazil
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Mancinelli R, Toniolo L, Di Filippo ES, Doria C, Marrone M, Maroni CR, Verratti V, Bondi D, Maccatrozzo L, Pietrangelo T, Fulle S. Neuromuscular Electrical Stimulation Induces Skeletal Muscle Fiber Remodeling and Specific Gene Expression Profile in Healthy Elderly. Front Physiol 2019; 10:1459. [PMID: 31827446 PMCID: PMC6890722 DOI: 10.3389/fphys.2019.01459] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 11/12/2019] [Indexed: 01/08/2023] Open
Abstract
Skeletal muscle aging is a multifactorial process strictly related to progressive weakness. One of the results that were focused on was the fiber phenotype modification and their loss. The physiological muscle recruitment to contraction, basically prosecuted under volitional control, can also be engaged by means of Neuromuscular Electrical Stimulation (NMES). Knowing that the NMES is effective in improving muscle strength in active healthy elderly, the aim was to investigate which physiological modifications were able to produce in the Vastus lateralis muscle and the pathways involved. It was found that NMES increased the cross sectional area and the isometric strength of type II myofibers together with the activated myogenic pathway in order to shift glycolytic toward the oxidative phenotype II myofibers, at a molecular level and with an increase of maximal voluntary contraction (MVC) at a functional level. Using the TaqMan low density array on 48 different genes, we found that NMES specific gene regulation highlighted: (i) increased protein synthesis with respect to protein degradation; (ii) the activation of an apoptotic pathway involved in the differentiation process; (iii) increased regeneration signals; (iv) oxidative enzyme regulation. These pathways were validated via confirmatory RT-PCR for genes involved in the regeneration process as well as Myosin isoforms. We also investigated the oxidative stress status analyzing superoxide anion levels, the protein expression of two different superoxide dismutase and the activity of both catalase and superoxide anion dismutase, being two main antioxidant enzymes. In conclusion, data demonstrates that NMES is effective in producing physiological adaptation on Vastus Lateralis of active healthy elderly as well as providing new insights for further research on elderly who experienced muscle detriment for periodic or permanent immobility.
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Affiliation(s)
- Rosa Mancinelli
- Department of Neuroscience Imaging and Clinical Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Chieti, Italy.,Interuniversity Institute of Myology, Rome, Italy.,Laboratory of Functional Evaluation, 'G. d'Annunzio' University of Chieti-Pescara, Chieti, Italy
| | - Luana Toniolo
- Department of Biomedical Sciences, University of Padova, Padua, Italy
| | - Ester Sara Di Filippo
- Department of Neuroscience Imaging and Clinical Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Chieti, Italy.,Interuniversity Institute of Myology, Rome, Italy.,Laboratory of Functional Evaluation, 'G. d'Annunzio' University of Chieti-Pescara, Chieti, Italy
| | - Christian Doria
- Department of Neuroscience Imaging and Clinical Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Chieti, Italy.,Laboratory of Functional Evaluation, 'G. d'Annunzio' University of Chieti-Pescara, Chieti, Italy
| | - Mariangela Marrone
- Department of Neuroscience Imaging and Clinical Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Chieti, Italy.,Interuniversity Institute of Myology, Rome, Italy.,Laboratory of Functional Evaluation, 'G. d'Annunzio' University of Chieti-Pescara, Chieti, Italy
| | - Camilla Reina Maroni
- Department of Neuroscience Imaging and Clinical Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Chieti, Italy.,Interuniversity Institute of Myology, Rome, Italy
| | - Vittore Verratti
- Laboratory of Functional Evaluation, 'G. d'Annunzio' University of Chieti-Pescara, Chieti, Italy.,Department of Psychological, Health and Territorial Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Chieti, Italy
| | - Danilo Bondi
- Department of Neuroscience Imaging and Clinical Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Chieti, Italy.,Laboratory of Functional Evaluation, 'G. d'Annunzio' University of Chieti-Pescara, Chieti, Italy
| | - Lisa Maccatrozzo
- Department of Comparative Biomedicine and Food Science, University of Padova, Padua, Italy
| | - Tiziana Pietrangelo
- Department of Neuroscience Imaging and Clinical Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Chieti, Italy.,Interuniversity Institute of Myology, Rome, Italy.,Laboratory of Functional Evaluation, 'G. d'Annunzio' University of Chieti-Pescara, Chieti, Italy
| | - Stefania Fulle
- Department of Neuroscience Imaging and Clinical Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Chieti, Italy.,Interuniversity Institute of Myology, Rome, Italy.,Laboratory of Functional Evaluation, 'G. d'Annunzio' University of Chieti-Pescara, Chieti, Italy
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49
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Dabadghav R, Potdar A, Patil V, Sancheti P, Shyam A. Additional effect of neuromuscular electrical stimulation on knee extension lag, pain and knee range of motion in immediate postsurgical phase (0-2 weeks) in primary total knee arthroplasty patient. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S253. [PMID: 31728377 DOI: 10.21037/atm.2019.09.79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background There are various studies on younger adults which have shown that neuromuscular electrical stimulation (NMES), at sufficient intensities, combined with active exercises had better improvement in muscle strength and functional performance than exercises alone. But very limited research is available for giving NMES in the early acute stages post total knee arthroplasty (TKA). So, the short-term effect of NMES had not yet been researched upon widely. As there were conflicting evidences in giving NMES post TKA, this study was proposed to assess the short-term effect of early NMES on knee joint pain, range of motion (ROM) and extension lag on patients undergoing bilateral TKA. Methods The study included 28 bilateral TKA patients following osteoarthritis (OA) knee within the age group of 50-75 years (60.82±5.69). The knees of 28 bilaterally operated patients were randomly divided into two groups; 1 knee was allocated in the experimental group and the other knee of the same patient became the control. The experimental group was given NMES with exercises, while the control group was given only exercises for 7 days. The patients were asked to continue to follow exercises even after the discharge, i.e., beyond 7 days. The patients were measured for pain; knee flexion ROM and extensor lag both before and after intervention. Results There was a significant improvement in pain, knee ROM and extensor lag post intervention P<0.05 in both the groups. But there was no significant difference between the groups with respect to pain, knee ROM and extensor lag, P>0.05. Conclusions The NMES and exercises worked equally in case of patients operated for TKA. Hence our results concluded that there was no additional effect of NMES on extensor lag, knee ROM and pain when applied for 7 days in patients operated with TKA.
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Affiliation(s)
- Rachana Dabadghav
- Sport Injury Management and Therapy, Research Coordinator, Sancheti Institute College of Physiotherapy, Pune, India
| | - Amruta Potdar
- Physiotherapy Department, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, India
| | - Vishakha Patil
- Department of Orthopaedics, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, India
| | - Parag Sancheti
- Department of Orthopaedics, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, India
| | - Ashok Shyam
- Department of Orthopaedics, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, India
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50
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Hsiao YH, Chien SH, Tu HP, Fu JCM, Tsai ST, Chen YS, Chen YJ, Chen CH. Early Post-Operative Intervention of Whole-Body Vibration in Patients After Total Knee Arthroplasty: A Pilot Study. J Clin Med 2019; 8:jcm8111902. [PMID: 31703305 PMCID: PMC6912668 DOI: 10.3390/jcm8111902] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 11/03/2019] [Accepted: 11/05/2019] [Indexed: 12/12/2022] Open
Abstract
(1) Background: Knee osteoarthritis causes pain, weakness, muscle atrophy, and disability. The application of whole-body vibration in patients with knee osteoarthritis can improve strength, balance, and functional activities. The purpose of the study is to evaluate the effects of early whole-body vibration intervention in patients after total knee arthroplasty. (2) Method: A single-blinded randomized control trial. Fifty-two patients with knee osteoarthritis post total knee replacement from a medical center in southern Taiwan were randomly assigned to either a whole-body vibration group or control group. Main outcome measures included pain severity, leg circumference, knee range of motion, knee extensor strength, a five-times sit to stand test, and a timed up and go test. (3) Results: Immediately post treatment, the patients in the vibration group showed a significant increase in knee extensor strength and improvement in calf swelling compared to the control group. A trend toward decrease in pain severity and improvement in functional performance were observed in both groups without a significant difference between the groups. There was no significant difference in knee range of motion (ROM) and functional performance between the groups. (4) Conclusions: The whole-body vibration intervention in patients early post total knee arthroplasty showed significant immediate effect in increasing knee extensor strength and decreasing calf swelling.
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Affiliation(s)
- Yu-Hsuan Hsiao
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (Y.-H.H.); (J.C.-M.F.); (S.-T.T.); (Y.-S.C.)
| | - Song-Hsiung Chien
- Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan;
| | - Hung-Pin Tu
- Department of Public Health and Environmental Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Jimmy Chun-Ming Fu
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (Y.-H.H.); (J.C.-M.F.); (S.-T.T.); (Y.-S.C.)
| | - Shih-Ting Tsai
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (Y.-H.H.); (J.C.-M.F.); (S.-T.T.); (Y.-S.C.)
| | - Ying-Shan Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (Y.-H.H.); (J.C.-M.F.); (S.-T.T.); (Y.-S.C.)
| | - Yi-Jen Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (Y.-H.H.); (J.C.-M.F.); (S.-T.T.); (Y.-S.C.)
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Correspondence: (Y.-J.C.); (C.-H.C.); Tel.: +886-7-312-1101 (ext. 5962) (Y.-J.C.); +886-7-312-1101 (ext. 5962) (C.-H.C.)
| | - Chia-Hsin Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (Y.-H.H.); (J.C.-M.F.); (S.-T.T.); (Y.-S.C.)
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Physical Medicine and Rehabilitation, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung 801, Taiwan
- Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Correspondence: (Y.-J.C.); (C.-H.C.); Tel.: +886-7-312-1101 (ext. 5962) (Y.-J.C.); +886-7-312-1101 (ext. 5962) (C.-H.C.)
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