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Su S, Wang R, Chen Z, Zhou F, Zhang Y. The effectiveness of extended reality on relieving pain after total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg 2024; 144:3217-3226. [PMID: 38960934 DOI: 10.1007/s00402-024-05440-0] [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: 01/07/2024] [Accepted: 06/27/2024] [Indexed: 07/05/2024]
Abstract
PURPOSE Patients with total knee arthroplasty (TKA) often suffer from severe postoperative pain, which seriously hinders postoperative rehabilitation. Extended reality (XR), including virtual reality, augmented reality, and mixed reality, has been increasingly used to relieve pain after TKA. The purpose of this study was to evaluate the effectiveness of XR on relieving pain after TKA. METHODS The electronic databases including PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and clinicaltrials.gov were searched for studies from inception to July 20, 2023. The outcomes were pain score, anxiety score, and physiological parameters related to pain. Meta-analysis was performed using the Review Manager 5.4 software. RESULTS Overall, 11 randomized control trials (RCTs) with 887 patients were included. The pooled results showed XR had lower pain scores (SMD = - 0.31, 95% CI [- 0.46 to - 0.16], P < 0.0001) and anxiety scores (MD = - 3.95, 95% CI [- 7.76 to - 0.13], P = 0.04) than conventional methods. The subgroup analysis revealed XR had lower pain scores within 2 weeks postoperatively (SMD = - 0.49, 95% CI [- 0.76 to - 0.22], P = 0.0004) and XR had lower pain scores when applying XR combined with conventional methods (SMD = - 0.43, 95% CI [- 0.65 to - 0.20], P = 0.0002). CONCLUSION This systematic review and meta-analysis found applying XR could significantly reduce postoperative pain and anxiety after TKA. When XR was combined with conventional methods, postoperative pain can be effectively relieved, especially within 2 weeks after the operation. XR is an effective non-pharmacological analgesia scheme.
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Affiliation(s)
- Shilong Su
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road. Haidian, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Peking University Third Hospital, No.49 North Garden Road. Haidian, Beijing, 100191, China
| | - Ruideng Wang
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road. Haidian, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Peking University Third Hospital, No.49 North Garden Road. Haidian, Beijing, 100191, China
| | - Zhengyang Chen
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road. Haidian, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Peking University Third Hospital, No.49 North Garden Road. Haidian, Beijing, 100191, China
| | - Fang Zhou
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road. Haidian, Beijing, 100191, China.
- Engineering Research Center of Bone and Joint Precision Medicine, Peking University Third Hospital, No.49 North Garden Road. Haidian, Beijing, 100191, China.
| | - Yunqing Zhang
- Department of Orthopedics, The First Hospital of Changsha, No.311 Yingpan Road, Changsha, Hunan Province, 410005, China.
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Bull T, Erzen A, O'Donnell J, Rafla M, Georgy D, Bailey M, Takla A. Hypertrophy Training Following A Total Hip Replacement: A Literature Review. Int J Sports Phys Ther 2024; 19:337-350. [PMID: 38439777 PMCID: PMC10909313 DOI: 10.26603/001c.93075] [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: 01/30/2023] [Accepted: 12/04/2023] [Indexed: 03/06/2024] Open
Abstract
Hip OA is becoming more common, with a greater number of younger individuals undergoing total hip arthroplasty (THA). These individuals have the desire to return to considerable loading and in some instances return to sport. The purpose of this review was to investigate the current guidelines and/or protocols for hypertrophy or strengthening in individuals who have undergone total hip arthroplasty. A total of 16 papers were identified, some of which also addressed total knee arthroplasty. There is no consensus for the best practice for a hypertrophy program following THA especially regarding when a direct anterior approach was used during hip arthroplasty. Further research is needed as this is a growing area in rehabilitation. This review aims to bridge the gap by offering a comprehensive synthesis of the available literature on postoperative rehabilitation after THA, with a specific emphasis on identifying the most effective muscular strengthening and hypertrophy training programs for patients undergoing anterior approach hip surgery.
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Affiliation(s)
| | | | | | | | | | | | - Amir Takla
- Hip Arthroscopy Australia
- Department of Health professions Swinburne University of Technology
- Australian Sports Physiotherapy
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3
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Lu H, Yu J, Hong H. Effects of an enhanced recovery after surgery nursing programme on surgical site wound infection and postoperative complications in patients undergoing total knee arthroplasty: A meta-analysis. Int Wound J 2024; 21:e14485. [PMID: 37973530 PMCID: PMC10898380 DOI: 10.1111/iwj.14485] [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: 10/08/2023] [Revised: 10/18/2023] [Accepted: 10/22/2023] [Indexed: 11/19/2023] Open
Abstract
This meta-analysis aimed to investigate the effects of the enhanced recovery after surgery (ERAS) nursing program on surgical wound infection (SWI) and postoperative complications in patients undergoing total knee arthroplasty (TKA). The PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure and Wanfang databases were searched from the date of establishment of the database until August 2023 for randomised controlled trials (RCTs) that assessed the effects of the ERAS nursing program on SWI and postoperative complications in patients undergoing TKA. The literature was screened, data were extracted by two independent investigators, and the literature quality was assessed using the methods recommended by the Cochrane Collaboration. Data analysis was performed using Stata 17.0 software. Nineteen RCTs with 1580 patients were included in the study. The meta-analysis results showed that the rates of SWI (odds ratio [OR] = 0.19, 95% confidence interval [CI]: 0.10-0.37, p < 0.001) and postoperative complications (OR = 0.18, 95% CI: 0.12-0.25, p < 0.001) were significantly lower in the ERAS intervention group than those in the control group. Therefore, ERAS intervention after TKA can significantly reduce the occurrence of SWI and postoperative complications. It has a remarkable rehabilitation effect and can be widely used in clinical settings.
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Affiliation(s)
- Haiying Lu
- Department of EmergencyChun'an County Traditional Chinese Medicine HospitalHangzhouChina
| | - Jinjiao Yu
- Department of Orthopedics and TraumatologyChun'an County Traditional Chinese Medicine HospitalHangzhouChina
| | - Huiqin Hong
- Department of Acupuncture and MoxibustionChun'an County Traditional Chinese Medicine HospitalHangzhouChina
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4
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King SW, Eltayeb M, van Duren BH, Jain S, Kerry J, Pandit HG, Palan J. “Wearable Sensors to Guide Remote Rehabilitation Following Knee Arthroplasty Surgery”. Indian J Orthop 2022; 57:624-634. [PMID: 37128555 PMCID: PMC10147850 DOI: 10.1007/s43465-022-00785-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022]
Abstract
Background Total knee arthroplasty requires effective rehabilitation to achieve optimal results, but institutions often rely on unsupervised home exercises due to cost constraints. Wearable sensors have become increasingly popular as a potential method of monitoring patients remotely to ensure efficacy and compliance. This review assesses the current evidence for their use in remotely monitored rehabilitation following knee arthroplasty. Methods A systematic review of the literature from 1st January 2000 to 17th February 2022 was undertaken. Devices were categorised as joint-specific or physical activity sensors. Studies were classified as those providing remotely supervised rehabilitation as an additional or as an alternative intervention. Results Remotely supervised rehabilitation using wearable sensors demonstrated similar outcomes when provided as an alternative to standard care in most studies. One group found improved outcomes for knee-specific sensors compared with standard care. There were improved physical activity and healthcare resource use outcomes described in the literature where sensors were used in addition to standard care. Discussion This review found evidence for the use of wearable sensors in remotely supervised rehabilitation following knee arthroplasty surgery. This included methodological heterogeneity, differing definitions of standard care, and variable follow-up periods. Robust randomised control trial data with a longer follow-up period are needed.
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Affiliation(s)
- Samuel W. King
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA UK
- Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ UK
- Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Beckett Street, Leeds, LS9 7TF UK
| | - Momin Eltayeb
- Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Beckett Street, Leeds, LS9 7TF UK
| | - Bernard H. van Duren
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA UK
- Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Beckett Street, Leeds, LS9 7TF UK
| | - Sameer Jain
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA UK
- Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Beckett Street, Leeds, LS9 7TF UK
| | - Joel Kerry
- Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Beckett Street, Leeds, LS9 7TF UK
| | - Hemant G. Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA UK
- Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Beckett Street, Leeds, LS9 7TF UK
| | - Jeya Palan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA UK
- Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Beckett Street, Leeds, LS9 7TF UK
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5
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Adebero T, Bobos P, Somerville L, Howard J, Vasarhelyi EM, Lanting B, Hunter SW. Implementation of falls risk evaluation at one-year after total hip arthroplasty: a cross-sectional study. Arch Physiother 2022; 12:16. [PMID: 35836298 PMCID: PMC9284763 DOI: 10.1186/s40945-022-00141-6] [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: 09/02/2021] [Accepted: 05/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background Research has demonstrated an increased risk of falls after total hip arthroplasty (THA). Yet, people’s knowledge on falls risk factors and how falls prevention strategies are being used after THA have not been examined. If a person’s knowledge of falls and self-efficacy about falls prevention strategies is low this would indicate a pressing need for interventions to lessen risk. The study objectives were: 1) to determine the falls knowledge and what fall prevention strategies people used after (THA) and 2) to determine the outcomes of a falls risk assessment at 12-months after unilateral THA. Methods Overall, 108 people completed the Falls Risk for Older People – Community Setting (FROP-Com) scale, a falls questionnaire (covered occurrence of falls, knowledge on falls risk factors, falls prevention strategies implemented after THA surgery), 6-m Walk Test (6mWT), 30-Second Chair Stand Test (30CST), Timed-up and Go (TUG) Test, and Activities-specific Balance Confidence Scale (ABC). Results Twenty-five (23.2%) people fell at least once in the 12 months after THA. Scores on the FROP-Com ranged from 2–20 with an average of 8.2 ± 3.6 indicating a mild falls risk. The importance of falling compared to other health concerns was rated as moderate to high (6.8 ± 2.9) and the majority of participants (n = 98, 90.7%) believed falls can be prevented after THA. Total scores on the ABC scale ranged from 30.6% to 100.0% with an average score of 84.4 ± 15.5%, indicating high function. Only 47 people (43.5%) reported receiving falls prevention education. A total of 101 falls prevention strategies were completed by 67 people (62%), the most common strategy was environmental modifications (e.g., installation of grab bars) at 37.4%, while exercise was mentioned by only 2%. The majority of people had functional deficits in 30CST (62%) and TUG (76.9%) at 12-months after unilateral THA. Conclusions Almost a quarter of the sample had experienced a fall in the 12-months after THA and functional deficits were common. The majority of the sample had proactively implemented falls prevention strategies after the surgery. Yet importantly, people after THA had limited exposure to falls prevention education and implemented a limited range of prevention strategies. Supplementary Information The online version contains supplementary material available at 10.1186/s40945-022-00141-6.
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Affiliation(s)
- Tony Adebero
- Faculty of Health Sciences, Department of Health and Rehabilitation Sciences, University of Western Ontario, London, ON, Canada
| | - Pavlos Bobos
- Faculty of Health Sciences, Department of Health and Rehabilitation Sciences, University of Western Ontario, London, ON, Canada.,Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada.,Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, Department of Clinical Epidemiology and Health Care Research, University of Toronto, Toronto, ON, Canada
| | - Lyndsay Somerville
- Schulich School of Medicine & Dentistry, Department of Surgery, University of Western Ontario, London, ON, Canada
| | - James Howard
- Schulich School of Medicine & Dentistry, Department of Surgery, University of Western Ontario, London, ON, Canada
| | - Edward M Vasarhelyi
- Schulich School of Medicine & Dentistry, Department of Surgery, University of Western Ontario, London, ON, Canada
| | - Brent Lanting
- Schulich School of Medicine & Dentistry, Department of Surgery, University of Western Ontario, London, ON, Canada
| | - Susan W Hunter
- Faculty of Health Sciences, Department of Health and Rehabilitation Sciences, University of Western Ontario, London, ON, Canada. .,School of Physical Therapy, University of Western Ontario, London, ON, Canada.
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6
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Courage O, Strom L, van Rooij F, Lalevée M, Heuzé D, Papin PE, Butnaru M, Müller JH. Higher rates of surgical and medical complications and mortality following TKA in patients aged ≥ 80 years: a systematic review of comparative studies. EFORT Open Rev 2021; 6:1052-1062. [PMID: 34909224 PMCID: PMC8631241 DOI: 10.1302/2058-5241.6.200150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The purpose of this systematic review was to synthesize studies published since the last systematic review in 2015 that compare outcomes of primary total knee arthroplasty (TKA) in older patients (≥ 80 years) and in younger patients (< 80 years), in terms of complication rates and mortality. An electronic literature search was conducted using PubMed, Embase®, and Cochrane Register. Studies were included if they compared outcomes of primary TKA for osteoarthritis in patients aged 80 years and over to patients aged under 80 years, in terms of complication rates, mortality, or patient-reported outcomes (PROs). Thirteen studies were eligible. Surgical complications in older patients ranged from 0.6–21.1%, while in younger patients they ranged from 0.3–14.6%. Wound complications in older patients ranged from 0.5–20%, while in younger patients they ranged from 0.8–22.0%. Medical complications (cardiac, respiratory, thromboembolic) in older patients ranged from 0.4–17.3%, while in younger patients they ranged from 0.2–11.5%. Mortality within 90 days in older patients ranged between 0–2%, while in younger patients it ranged between 0.0–0.03%. Compared to younger patients, older patients have higher rates of surgical and medical complications, as well as higher mortality following TKA. The literature also reports greater length of stay for older patients, but inconsistent findings regarding PROs. The present findings provide surgeons and older patients with clearer updated evidence, to make informed decisions regarding TKA, considering the risks and benefits within this age group. Patients aged over 80 years should therefore not be excluded from consideration for primary TKA based on age alone.
Cite this article: EFORT Open Rev 2021;6:1052-1062. DOI: 10.1302/2058-5241.6.200150
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Affiliation(s)
| | | | | | - Matthieu Lalevée
- Ramsay Santé, Hopital Prive de l'Estuaire, LeHavre, France.,Hôpital Charles Nicolle, CHU de Rouen, Rouen, France
| | - Donatien Heuzé
- Ramsay Santé, Hopital Prive de l'Estuaire, LeHavre, France.,Hôpital Charles Nicolle, CHU de Rouen, Rouen, France
| | - Pierre Emanuel Papin
- Ramsay Santé, Hopital Prive de l'Estuaire, LeHavre, France.,Hôpital Charles Nicolle, CHU de Rouen, Rouen, France
| | - Michael Butnaru
- Ramsay Santé, Hopital Prive de l'Estuaire, LeHavre, France.,Hôpital Charles Nicolle, CHU de Rouen, Rouen, France
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7
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Zheng FY, Liu YB, Huang H, Xu S, Ma XJ, Liu YZ, Chu HC. The impact of IPACK combined with adductor canal block under ultrasound guidance on early motor function after total knee arthroplasty. Braz J Anesthesiol 2021; 72:110-114. [PMID: 33915199 PMCID: PMC9373452 DOI: 10.1016/j.bjane.2021.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 04/01/2021] [Accepted: 04/14/2021] [Indexed: 11/19/2022] Open
Abstract
Background This study aimed to evaluate the impact of Infiltration between the Popliteal Artery and Capsule of the posterior Knee (IPACK) combined with an adductor canal block under the guidance of ultrasound on early motor function after Total Knee Arthroplasty (TKA). Methods A sample of 60 cases who were scheduled for elective unilateral TKA were divided into two groups using random number table method: a group with IPACK combined with an adductor canal block (I group, n = 30), and a group with femoral nerve block combined with superior popliteal sciatic nerve block (FS group, n = 30). Before anesthesia induction was completed, the patients in I group received an ultrasound-guided adductor canal block with 15 mL of 0.375% ropivacaine and an IPACK block with 25 mL of ropivacaine, and the patients in FS group received a femoral nerve block and a superior popliteal sciatic nerve block with 20 mL of 0.375% ropivacaine under ultrasound guidance. Post-operation, all the patients received patient-controlled intravenous analgesia combined with an oral celecoxib capsule to relieve pain and maintain a visual analogue scale score of ≤ 3. Results The quadriceps femoris muscle strength score was significantly higher in Ⅰ group than in FS group (p = 0.001), while the modified Bromage score were significantly lower and walking distance results were significantly higher in Ⅰ group than in FS group (both p = 0.000). Conclusion Compared with femoral nerve block combined with superior popliteal sciatic nerve block, IPACK combined with adductor canal block had a mild impact on early motor functions after TKA.
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Affiliation(s)
- Fang-Yu Zheng
- The Affiliated Hospital of Qingdao University, Department of Anesthesiology, Qingdao, China; Women and Children's Hospital, Qingdao University, Department of Anesthesiology, Qingdao, China
| | - Yong-Bo Liu
- The Affiliated Hospital of Qingdao University, Department of Operating Room, Qingdao, China
| | - Hui Huang
- The Affiliated Hospital of Qingdao University, Department of Anesthesiology, Qingdao, China
| | - Shuai Xu
- The Affiliated Hospital of Qingdao University, Department of Cardiovascular Surgery Intensive Care Unit, Qingdao, China
| | - Xiao-Jun Ma
- The Affiliated Hospital of Qingdao University, Department of Anesthesiology, Qingdao, China
| | - Ying-Zhi Liu
- The Affiliated Hospital of Qingdao University, Department of Anesthesiology, Qingdao, China.
| | - Hai-Chen Chu
- The Affiliated Hospital of Qingdao University, Department of Anesthesiology, Qingdao, China
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8
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Oh TK, Chung SH, Park J, Shin H, Chang CB, Kim TK, Do SH. Effects of Perioperative Magnesium Sulfate Administration on Postoperative Chronic Knee Pain in Patients Undergoing Total Knee Arthroplasty: A Retrospective Evaluation. J Clin Med 2019; 8:jcm8122231. [PMID: 31861187 PMCID: PMC6947579 DOI: 10.3390/jcm8122231] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/07/2019] [Accepted: 12/16/2019] [Indexed: 01/24/2023] Open
Abstract
We aimed to investigate whether perioperative magnesium sulfate administration was associated with the incidence of chronic persistent postoperative pain (PPP) following total knee arthroplasty (TKA). This retrospective observational study was performed at a single tertiary academic hospital. We reviewed the medical records of adult patients who were admitted between August 2012 and July 2017. Patients who received magnesium sulfate during surgery were the magnesium group. The presence of PPP, one year after TKA, was evaluated using a binary logistic regression analysis. A total of 924 patients were included in the analysis, and 148 patients (16.0%) experienced PPP one year after TKA. In the multivariable model, the magnesium group had a 62% lower rate of PPP one year after TKA compared to the control group (odds ratio (OR): 0.38, 95% confidence interval (CI): 0.16 to 0.90; p = 0.027). This finding was similar in the sensitivity analysis using propensity score adjustment (OR: 0.38, 95% CI: 0.16 to 0.93; p = 0.036). We showed that perioperative magnesium sulfate administration was associated with a lower rate of PPP one year after TKA. Our results suggest that magnesium sulfate administered perioperatively is effective for the alleviation of acute and chronic pain after surgery.
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Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (T.K.O.); (J.P.); (H.S.)
| | - Seung Hyun Chung
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (T.K.O.); (J.P.); (H.S.)
| | - Jinwoo Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (T.K.O.); (J.P.); (H.S.)
| | - Hyunjung Shin
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (T.K.O.); (J.P.); (H.S.)
| | - Chong Bum Chang
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam 13620, Korea;
| | | | - Sang-Hwan Do
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (T.K.O.); (J.P.); (H.S.)
- Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul 03080, Korea
- Correspondence:
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9
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Comparison of functional and patient-reported outcomes between direct anterior and lateral surgical approach one-year after total hip arthroplasty in a Canadian population: A cross-sectional study. J Orthop 2019; 19:36-40. [PMID: 32021033 DOI: 10.1016/j.jor.2019.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 11/02/2019] [Indexed: 01/18/2023] Open
Abstract
Background From a clinical perspective, it is important to understand the outcomes that occur after total hip arthroplasty (THA) and do these vary with surgical approach. The objective of the study was to compare physical performance-based and patient-report outcomes between the Direct Anterior (DA) and Direct Lateral (DL) surgical approach at one-year after THA surgery. Methods We evaluated patients attending their one-year follow-up assessment after primary elective unilateral THA surgery for osteoarthritis of the hip. The Activities-specific Balance Confidence Scale, Falls Risk in Older People in a Community Setting, Timed Up and Go Test, 30-Second Chair Stand Test, Step Test, 6-Meter Walk Test, Harris Hip Score (HHS), Short-form 12 and the Western Ontario and McMaster Osteoarthritis Index (WOMAC) were assessed. The standardized mean difference (SMD) and 95% confidence intervals (CI) was calculated to evaluate the statistical difference between groups and the magnitude of the effects. Results In total, 135 individuals met the inclusion criteria and participated in the study. A statistically significant and clinically important difference in favor of the DA was found for the WOMAC (0.60, 95% CI (0.25, 0.95), p = .004), SF-12 Physical component (0.42, 95% CI (0.07, 0.76), p = .01) and 6-Meter Walk Test (0.52, 95% CI (-0.86, -0.17), p = .009). Small effect sizes, though not statistically significant differences, were found in favor of the DA approach for the other patient-report and physical performance-based measures. Conclusion The WOMAC, gait speed and SF-12 Physical component scores were significantly different in favor of the DA procedure at one-year after THA. However, only the WOMAC scores exceeded a clinically important threshold in favor of DA approach. The other self-report and physical performance measures were not significantly different between the two procedures at one-year postoperatively.
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10
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Yan CH, Arciola CR, Soriano A, Levin LS, Bauer TW, Parvizi J. Team Approach: The Management of Infection After Total Knee Replacement. JBJS Rev 2019; 6:e9. [PMID: 29664872 DOI: 10.2106/jbjs.rvw.17.00058] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Chun Hoi Yan
- Department of Orthopaedics & Traumatology, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Carla Renata Arciola
- Research Unit on Implant Infections, Rizzoli Orthopaedic Institute, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Spain
| | - L Scott Levin
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Thomas W Bauer
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, NY
| | - Javad Parvizi
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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11
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Oh TK, Chang CB, Shin HJ, Han S, Do SH, Cho HH, Hwang JW. Association of preoperative pain in knee and external to knee with postoperative pain outcome after total knee arthroplasty. Anesth Pain Med (Seoul) 2019; 14:480-488. [PMID: 33329781 PMCID: PMC7713800 DOI: 10.17085/apm.2019.14.4.480] [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: 03/14/2019] [Revised: 05/20/2019] [Accepted: 06/03/2019] [Indexed: 11/17/2022] Open
Abstract
Background Preoperative pain in the symptomatic knee may predict postoperative pain severity in patients undergoing total knee arthroplasty (TKA). However, the effect of preoperative pain external to the knee on postoperative pain is unclear. This study evaluated postoperative pain outcomes in TKA patients according to the presence of preoperative pain in the knee only or in the knee and external to the knee. Methods We retrospectively assessed medical records of patients who underwent unilateral TKA. The relationship between reported preoperative pain characteristics and morphine equivalent consumption or numerical rating scale (NRS) pain scores on postoperative day (POD) 0-3 was assessed using a multivariable generalized linear model. Results In total, 3,429 adult patients who underwent their first TKA were included; 2,864 (83.5%) patients preoperatively experienced only knee pain and 565 (16.5%) knee pain with external to knee pain. Preoperative pain in the knee and external to the knee was associated with 5% higher morphine equivalent consumption on POD 0-3 compared to preoperative knee pain only (exponentiated regression coefficient: 1.05; 95% confidence interval: 1.02 to 1.09; P = 0.004). However, the NRS pain scores on POD 0, 1, 2, and 3 and adjuvant analgesics consumption (acetaminophen and ketorolac) on POD 0-3 were not significantly different between the two groups (P > 0.05). Conclusions This study showed that there was an increase of morphine equivalent consumption during POD 0-3 in patients with preoperative knee pain with external to knee pain than in patients with preoperative only knee pain.
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Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Seoul, Korea
| | - Chong Bum Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun-Jung Shin
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Seoul, Korea
| | - Sunghee Han
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Seoul, Korea.,Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Hwan Do
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Seoul, Korea.,Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Hee Cho
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Seoul, Korea
| | - Jung-Won Hwang
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Seoul, Korea.,Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
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12
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Stasi S, Papathanasiou G, Chronopoulos E, Dontas IA, Baltopoulos IP, Papaioannou NA. The Effect of Intensive Abductor Strengthening on Postoperative Muscle Efficiency and Functional Ability of Hip-Fractured Patients: A Randomized Controlled Trial. Indian J Orthop 2019; 53:407-419. [PMID: 31080280 PMCID: PMC6501618 DOI: 10.4103/ortho.ijortho_183_18] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hip fractures are common in the elderly and many patients fail to regain prefracture hip abductor strength or functional status. The purpose of this clinical trial was to compare the effects of an intensive abductor muscle exercise program versus a standard physiotherapy intervention in hip-fractured patients. MATERIALS AND METHODS Ninety six femoral neck-fractured patients were randomized into equal-sized groups. A 12-week standard physiotherapy program was implemented in the control group(S-PT) whereas an intensive exercise program, emphasizing on abductors' strengthening, was implemented in the research group(I-PT). Abductors' isometric strength of the fractured hip, abductor ratio% in the fractured compared to contralateral hip, and functional level were assessed at the 3rd (postintervention) and 6th (followup) months. RESULTS Postintervention, abductors' isometric strength was 35.7% greater (P < 0.0005) and abductor ratio% was 2.5% higher (P < 0.0005) in I-PT group, compared to S-PT group. With regard to functional assessments, I-PT group was 29.1% faster during Timed Up and Go (TUG) test and achieved a 26.7% higher Lower Extremity Functional Scale Greek version's (LEFS-Greek) total score, compared to S-PT group (P < 0.0005). At followup, abductors' isometric strength was 37.0% greater (P < 0.0005) and abductor ratio% was 7.1% higher (P < 0.0005) in I-PT group, compared to S-PT group. In addition, I-PT group was 45.9% faster during TUG test (P < 0.0005) and achieved an 11.2% higher LEFS-Greek total score, compared to S-PT group (P = 0.013). CONCLUSIONS Compared to the standard physiotherapy intervention, the intensive abductor-strengthening program significantly increased both abductors' isometric strength of the fractured hip and abductor ratio% and resulted in patients' enhanced functional level. CLINICAL TRIAL IDENTIFIER ISRCTN30713542.
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Affiliation(s)
- Sophia Stasi
- Department of Physiotherapy, Faculty of Health and Caring Sciences, University of West Attica, Athens, Greece,Laboratory for Research of the Musculoskeletal System (LRMS), National and Kapodistrian University of Athens Medical School, Athens, Greece,Address for correspondence: Dr. Sophia Stasi, 30 Ouranias Street, 14121 Heraklion, Athens, Greece. E-mail:
| | - George Papathanasiou
- Department of Physiotherapy, Faculty of Health and Caring Sciences, University of West Attica, Athens, Greece
| | - Efstathios Chronopoulos
- 2nd Department of Orthopaedic, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Ismene A Dontas
- Laboratory for Research of the Musculoskeletal System (LRMS), National and Kapodistrian University of Athens Medical School, Athens, Greece
| | | | - Nikolaos A Papaioannou
- Laboratory for Research of the Musculoskeletal System (LRMS), National and Kapodistrian University of Athens Medical School, Athens, Greece
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13
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Deng QF, Gu HY, Peng WY, Zhang Q, Huang ZD, Zhang C, Yu YX. Impact of enhanced recovery after surgery on postoperative recovery after joint arthroplasty: results from a systematic review and meta-analysis. Postgrad Med J 2018; 94:678-693. [PMID: 30665908 DOI: 10.1136/postgradmedj-2018-136166] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 11/07/2018] [Accepted: 12/01/2018] [Indexed: 12/22/2022]
Abstract
STUDY DESIGN Systematic review with meta-analysis. OBJECTIVES To evaluate the effects of enhanced recovery after surgery (ERAS) on the postoperative recovery of patients who underwent total hip arthroplasty (THA) or total knee arthroplasty (TKA). METHODS The PubMed, Embase, Cochrane and ISI Web of Science databases were searched to identify literature including randomised controlled trials (RCTs), cohort studies and case-control studies through 2 May 2018. The analysed outcomes were mortality rate, transfusion rate, range of motion (ROM), 30-day readmission rate, postoperative complication rate and in-hospital length of stay (LOS). RESULTS A total of 25 studies involving 16 699 patients met the inclusion criteria and were included in the meta-analysis. Compared with conventional care, ERAS was associated with a significant decrease in mortality rate (relative risk (RR) 0.48, 95% CI 0.27 to 0.85), transfusion rate (RR 0.43, 95% CI 0.37 to 0.51), complication rate (RR 0.74, 95% CI 0.62 to 0.87) and LOS (mean difference (MD) -2.03, 95% CI -2.64 to -1.42) among all included trials. However, no significant difference was found in ROM (MD 7.53, 95% CI -2.16 to 17.23) and 30-day readmission rate (RR 0.86, 95% CI 0.56 to 1.30). There was no significant difference in complications of TKA (RR 0.84, 95% CI 0.34 to 2.06) and transfusion rate in RCTs (RR 0.66, 95% CI 0.15 to 2.88) between the ERAS group and the control group. CONCLUSIONS This meta-analysis showed that ERAS significantly reduced the mortality rate, transfusion rate, incidence of complications and LOS of patients undergoing TKA or THA. However, ERAS did not show a significant impact on ROM and 30-day readmission rate. Complications after hip replacement are less than those of knee replacement, and the young patients recover better. LEVEL OF EVIDENCE Level 1.
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Affiliation(s)
- Qi-Feng Deng
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Hui-Yun Gu
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Wu-Ya Peng
- Department of Orthopedics, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Qiong Zhang
- Department of Orthopedics, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Zheng-Dong Huang
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Chao Zhang
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Yun-Xiang Yu
- Department of Orthopedics, Taihe Hospital, Hubei University of Medicine, Shiyan, China
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14
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Lin YH, Lee SY, Su WR, Kao CC, Tai TW, Chen TB. Effects of nurse-led lower extremity strength training on knee function recovery in patients who underwent total knee replacement. J Clin Nurs 2018; 27:1836-1845. [PMID: 29603823 DOI: 10.1111/jocn.14368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2018] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To examine the effects of lower extremity muscle strength training on knee function recovery and quality of life in patients who underwent total knee replacement. BACKGROUND Patients with knee osteoarthritis after surgery experience decreased knee function that impacts their quality of life. However, patients typically lack a long-term, home-based and continuous leg exercise training method and rarely have studies explored the effects of exercise training on knee function recovery and quality of life. DESIGN A experimental and longitudinal study design. METHODS The simple randomised sampling (based on patients' admission priority order) was used to collect participant data. Outcome measurements included the Knee Injury and Osteoarthritis Outcome Score. Participants were randomised to receive and starting lower extremity muscle strength training before surgery (training group, n = 100) or to receive usual care (nontraining group, n = 100). Data were collected and followed up with the patients before surgery (T1) and at 2 weeks (T2), 1 month (T3), 2 months (T4) and 3 months (T5) after discharge. RESULTS The Knee Injury and Osteoarthritis Outcome Score subscale scores showed that both groups of patients experienced knee function and quality of life decreases 2 weeks after total knee replacement, but all subscale scores gradually increased from the first month to the third month after total knee replacement. Both groups and times were significantly different, but the training group's knee function and quality of life recovered earlier and better than the nontraining group does. CONCLUSIONS This study confirmed that lower extremity muscle strength training helps to improve quality of life and knee function in patients who undergo total knee replacement. Healthcare staff should include this training in presurgical nursing care and in patients' discharge plans as a continuous, daily rehabilitation activity at home. RELEVANCE TO CLINICAL PRACTICE When patients are diagnosed with knee osteoarthritis and undergo surgery, a presurgical exercise education and discussion of knee function rehabilitation should be part of standard care.
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Affiliation(s)
- Yu-Hua Lin
- Nursing Department, I-Shou University, Kaohsiung, Taiwan
| | - Su-Ying Lee
- Nursing Department, National Cheung Kung University, Tainan, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, College of Medicine, National Cheng Kung University Hospital, National Cheung Kung University, Tainan, Taiwan
| | - Chia-Chan Kao
- Nursing Department, I-Shou University, Kaohsiung, Taiwan
| | - Ta-Wei Tai
- Department of Orthopaedics, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Tai-Been Chen
- Department of Medical Imaging and Radiological Science, I-Shou University, Kaohsiung, Taiwan
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15
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Jäppinen AM, Hämäläinen H, Kettunen T, Piirainen A. Patient education in physiotherapy in total hip arthroplasty (THA) - The perspective of physiotherapists. Physiother Theory Pract 2018; 36:946-955. [PMID: 30204535 DOI: 10.1080/09593985.2018.1513617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND PURPOSE There is limited knowledge about patients' and physiotherapists' perceptions of patient education in physiotherapy in hip arthroplasty. The aim of this study was to describe physiotherapists' conceptions of the patient education in physiotherapy needed by patients undergoing total hip arthroplasty. METHODS The data for this qualitative study were collected using group and individual semi-structured interviews. Seven physiotherapists were interviewed. The research data were analyzed using a phenomenographic method. RESULTS Three categories of patient education in physiotherapy in hip arthroplasty were produced and the categories formed a hierarchy. The narrowest descriptive category was Schematic physiotherapy complying with the protocol. Identifying individual rehabilitation needs was the second category, and the third, widest category was Coaching home rehabilitation. The differences between the categories were described in four themes: 1) Moving; 2) Exercising; 3) Interaction in relation to patient; and 4) Health care system. CONCLUSION According to the results, patient education in physiotherapy optimally aims to identify patients' individual rehabilitation needs, advice on coping at home and especially helping patients to be prepared for and capable of long rehabilitation for which they are themselves responsible. These findings resulting from descriptive categories can be utilized in developing education methods and physiotherapists' competence in patient education.
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Affiliation(s)
- Anna-Maija Jäppinen
- Faculty of Sport and Health Sciences, University of Jyväskylä , Jyväskylä, Finland.,Department of Internal Medicine and Rehabilitation, Helsinki University Hospital , Helsinki, Finland
| | - Harri Hämäläinen
- Department of Internal Medicine and Rehabilitation, Helsinki University Hospital , Helsinki, Finland
| | - Tarja Kettunen
- Faculty of Sport and Health Sciences, University of Jyväskylä , Jyväskylä, Finland.,Unit of Primary Health Care, Central Finland Health Care District, Jyväskylä, Finland
| | - Arja Piirainen
- Faculty of Sport and Health Sciences, University of Jyväskylä , Jyväskylä, Finland
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16
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Bahadori S, Immins T, Wainwright TW. A review of wearable motion tracking systems used in rehabilitation following hip and knee replacement. J Rehabil Assist Technol Eng 2018; 5:2055668318771816. [PMID: 31191937 PMCID: PMC6453074 DOI: 10.1177/2055668318771816] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 03/29/2018] [Indexed: 01/08/2023] Open
Abstract
Clinical teams are under increasing pressure to facilitate early hospital
discharge for total hip replacement and total knee replacement patients
following surgery. A wide variety of wearable devices are being marketed to
assist with rehabilitation following surgery. A review of wearable devices was
undertaken to assess the evidence supporting their efficacy in assisting
rehabilitation following total hip replacement and total knee replacement. A
search was conducted using the electronic databases including Medline, CINAHL,
Cochrane, PsycARTICLES, and PubMed of studies from January 2000 to October 2017.
Five studies met the eligibility criteria, and all used an accelerometer and a
gyroscope for their technology. A review of the studies found very little
evidence to support the efficacy of the technology, although they show that the
use of the technology is feasible. Future work should establish which wearable
technology is most valuable to patients, which ones improve patient outcomes,
and the most economical model for deploying the technology.
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Affiliation(s)
- Shayan Bahadori
- Orthopaedic Research Institute, Bournemouth University, Bournemouth, UK
| | - Tikki Immins
- Orthopaedic Research Institute, Bournemouth University, Bournemouth, UK
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17
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Abstract
PURPOSE The purpose of this study was to investigate the indications and outcomes of dynamic splinting (DS) of the arthrofibrotic knee in the pediatric population. METHODS Seventy-four patients (41 males, 33 females) with postoperative arthrofibrosis treated with DS after an index knee surgery were reviewed. Median age was 13 years (range, 4 to 18 y), and median follow-up was 17 months (interquartile range, 10 to 28 mo). Demographics, index surgery procedure, preoperative and postoperative knee range of motion (ROM) measurements, treatment length and subsequent need for manipulation under anesthesia (MUA), and surgical lysis of adhesions (LOA) were evaluated. A ROM deficit was defined as lack of extension ≥10 degrees or lack of flexion <130 degrees. Successful improvement of ROM was defined as an increase of ≥10 degrees in flexion, extension, or both. There were 23 patients with flexion deficit only, 17 with extension deficit only, and 34 with combined flexion and extension deficits. Wilcoxon signed-rank test was used to assess median improvement in ROM. Patients were classified into 4 surgical groups: anterior cruciate ligament (ACL) reconstruction without meniscal repair (n=19), ACL reconstruction with meniscal repair (n=12), tibial spine fracture repair (n=21), and other (n=22). Multivariable logistic regression was used to identify independent predictors of failure of DS requiring MUA and LOA. RESULTS A total of 57 patients with flexion deficits showed median improvement of 30 degrees in flexion (95% confidence interval, 0-90 degrees; P<0.001), and 51 patients with extension deficits showed median improvement of 7 degrees in extension (95% confidence interval, 0-60 degrees; P<0.001). DS was associated with ROM improvement in 84% and avoided the need for surgery in 58% of all 74 patients included in the study. Multivariate analysis of the ACL with meniscus repair subgroup revealed that each 1-month delay in DS treatment was associated with a 5-fold increased risk of undergoing a LOA (P=0.007). Thirty-six (63%) patients with flexion deficit avoided need for surgery, whereas 26 (51%) patients with extension deficits avoided surgery. CONCLUSIONS Our data suggest that DS is an effective method to increase knee ROM and reduce the need for subsequent MUA/LOA in the pediatric and adolescent patient with arthrofibrosis after an index knee surgery. LEVEL OF EVIDENCE Level IV-retrospective case series.
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18
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Coulter C, Perriman DM, Neeman TM, Smith PN, Scarvell JM. Supervised or Unsupervised Rehabilitation After Total Hip Replacement Provides Similar Improvements for Patients: A Randomized Controlled Trial. Arch Phys Med Rehabil 2017; 98:2253-2264. [DOI: 10.1016/j.apmr.2017.03.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 02/24/2017] [Accepted: 03/10/2017] [Indexed: 10/19/2022]
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19
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Tedesco D, Gori D, Desai KR, Asch S, Carroll IR, Curtin C, McDonald KM, Fantini MP, Hernandez-Boussard T. Drug-Free Interventions to Reduce Pain or Opioid Consumption After Total Knee Arthroplasty: A Systematic Review and Meta-analysis. JAMA Surg 2017; 152:e172872. [PMID: 28813550 DOI: 10.1001/jamasurg.2017.2872] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Importance There is increased interest in nonpharmacological treatments to reduce pain after total knee arthroplasty. Yet, little consensus supports the effectiveness of these interventions. Objective To systematically review and meta-analyze evidence of nonpharmacological interventions for postoperative pain management after total knee arthroplasty. Data Sources Database searches of MEDLINE (PubMed), EMBASE (OVID), Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, Web of Science (ISI database), Physiotherapy Evidence (PEDRO) database, and ClinicalTrials.gov for the period between January 1946 and April 2016. Study Selection Randomized clinical trials comparing nonpharmacological interventions with other interventions in combination with standard care were included. Data Extraction and Synthesis Two reviewers independently extracted the data from selected articles using a standardized form and assessed the risk of bias. A random-effects model was used for the analyses. Main Outcomes and Measures Postoperative pain and consumption of opioids and analgesics. Results Of 5509 studies, 39 randomized clinical trials were included in the meta-analysis (2391 patients). The most commonly performed interventions included continuous passive motion, preoperative exercise, cryotherapy, electrotherapy, and acupuncture. Moderate-certainty evidence showed that electrotherapy reduced the use of opioids (mean difference, -3.50; 95% CI, -5.90 to -1.10 morphine equivalents in milligrams per kilogram per 48 hours; P = .004; I2 = 17%) and that acupuncture delayed opioid use (mean difference, 46.17; 95% CI, 20.84 to 71.50 minutes to the first patient-controlled analgesia; P < .001; I2 = 19%). There was low-certainty evidence that acupuncture improved pain (mean difference, -1.14; 95% CI, -1.90 to -0.38 on a visual analog scale at 2 days; P = .003; I2 = 0%). Very low-certainty evidence showed that cryotherapy was associated with a reduction in opioid consumption (mean difference, -0.13; 95% CI, -0.26 to -0.01 morphine equivalents in milligrams per kilogram per 48 hours; P = .03; I2 = 86%) and in pain improvement (mean difference, -0.51; 95% CI, -1.00 to -0.02 on the visual analog scale; P < .05; I2 = 62%). Low-certainty or very low-certainty evidence showed that continuous passive motion and preoperative exercise had no pain improvement and reduction in opioid consumption: for continuous passive motion, the mean differences were -0.05 (95% CI, -0.35 to 0.25) on the visual analog scale (P = .74; I2 = 52%) and 6.58 (95% CI, -6.33 to 19.49) opioid consumption at 1 and 2 weeks (P = .32, I2 = 87%), and for preoperative exercise, the mean difference was -0.14 (95% CI, -1.11 to 0.84) on the Western Ontario and McMaster Universities Arthritis Index Scale (P = .78, I2 = 65%). Conclusions and Relevance In this meta-analysis, electrotherapy and acupuncture after total knee arthroplasty were associated with reduced and delayed opioid consumption.
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Affiliation(s)
- Dario Tedesco
- Department of Medicine, Stanford University, Stanford, California.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Davide Gori
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Karishma R Desai
- Department of Medicine, Stanford University, Stanford, California
| | - Steven Asch
- Department of Medicine, Stanford University, Stanford, California.,Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Ian R Carroll
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California
| | - Catherine Curtin
- Department of Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, California.,Department of Surgery, Stanford University, Stanford, California
| | | | - Maria P Fantini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Tina Hernandez-Boussard
- Department of Medicine, Stanford University, Stanford, California.,Department of Surgery, Stanford University, Stanford, California.,Department of Biomedical Data Science, Stanford University, California
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20
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The effect of total knee arthroplasty on patients' balance and incidence of falls: a systematic review. Knee Surg Sports Traumatol Arthrosc 2017; 25:3439-3451. [PMID: 27761627 PMCID: PMC5644701 DOI: 10.1007/s00167-016-4355-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 07/05/2016] [Indexed: 01/05/2023]
Abstract
PURPOSE Despite the high incidence of falls in patients with OA, few studies have explored whether falls risk is affected after patients undergo total knee arthroplasty (TKA). Therefore, the aim of this systematic review was to identify the extent of the effects of TKA on balance and incidence of falls by critically reviewing the available literature. METHODS A systematic review of published literature sources was conducted up to March 2014. All studies assessing balance and incidence of falls after TKA (without physiotherapeutic intervention) were included. The methodological quality of each study was reviewed using the Critical Appraisal Skill Programme tool. RESULTS Thirteen studies were included, comprising of ten cohort studies (Level II) and three studies with Level of evidence III. CONCLUSIONS Findings provide evidence that TKA improves significantly single-limb standing balance (~60%) and dynamic balance up to 1-year following surgery (Level of evidence II). Moreover, TKA influences positively fear of falling and incidence of falls by switching 54.2 % of pre-operative fallers to post-operative non-fallers (Level of evidence II-III). It is highlighted that knee extension strength, proprioception and symmetrization of postural strategies have not fully recovered post-TKA and influence balance performance. Clinically, these persistent deficits need to be mitigated by physiotherapy even before TKA takes place.
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21
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Nakanowatari T, Suzukamo Y, Izumi SI. The Effectiveness of Specific Exercise Approach or Modifiable Heel Lift in the Treatment of Functional Leg Length Discrepancy in Early Post-surgery Inpatients after Total Hip Arthroplasty: A Randomized Controlled Trial with a PROBE design. Phys Ther Res 2016; 19:39-49. [PMID: 28289580 DOI: 10.1298/ptr.e9892] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 08/23/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study investigated the effectiveness of a specific exercise approach (SEA) or modifiable heel lift (MHL) to improve functional leg length discrepancy (LLD) after total hip arthroplasty (THA). METHODS The study was a randomized controlled trial with a PROBE (prospective, randomized, open, blinded-endpoint) design trial. Patients (n=33) with both functional and perceived LLDs, 1 week after THA, were randomized to the SEA, MHL, or control groups. Patients in the SEA group performed 2 weeks of exercises to improve hip contracture and lumbar scoliosis. Patients in the MHL group used an insole-type heel lift to correct functional LLD. The control group received normal postoperative care, comprising standard rehabilitation after THA. The primary outcomes were functional LLD, measured by a block test, and patient-perceived LLD at 3 weeks after the surgery. Secondary outcomes included the visual analog scale (VAS) for pain, the Timed Up and Go (TUG) test, and the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) at 3 weeks after the surgery. RESULTS The functional LLDs (mean ± SD) for the SEA (3.3 ± 3.1 mm) and MHL (2.2 ± 2.1 mm) groups were significantly smaller than for the control group (6.4 ± 4.0 mm). The degree of patient-perceived LLD differed significantly between the SEA and the control groups (p=.005). CONCLUSIONS SEA and MHL use, during early post-operative recovery, can produce relevant changes in functional LLD after THA.
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Affiliation(s)
- Tatsuya Nakanowatari
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine; Department of Physical Therapy, Yamagata Prefectural University of Health Sciences
| | - Yoshimi Suzukamo
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine
| | - Shin-Ichi Izumi
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine; Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Biomedical Engineering
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22
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A Comparative Study to Determine Functional and Clinical Outcome Differences Between Patients Receiving Outpatient Direct Physical Therapy Versus Home Physical Therapy Followed by Outpatient Physical Therapy After Total Knee Arthroplasty. Orthop Nurs 2016; 35:382-390. [DOI: 10.1097/nor.0000000000000295] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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Jäppinen AM, Hämäläinen H, Kettunen T, Piirainen A. Postoperative Patient Education in Physiotherapy after Hip Arthroplasty: Patients' Perspective. Musculoskeletal Care 2016; 15:150-157. [PMID: 27593372 DOI: 10.1002/msc.1153] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The objective of the present study was to explore postoperative patient education in physiotherapy from total hip arthroplasty (THA) patients' perspectives, which has been a little-studied area of research. The usefulness of rehabilitation protocols after THA has been debated over the years, and there are no clear guidelines for physiotherapy after THA METHODS: The data for the present qualitative study were collected from nine patients with THA by using individual interviews at the hospital after surgery. The interviews were audio-recorded and analysed by using a phenomenographic method RESULTS: Four different categories of postoperative patient education in physiotherapy after hip arthroplasty were produced: trust while in hospital; preparing for going home; managing at home; and regaining physical fitness. These categories were analysed through the following themes: moving; exercising; and interaction between the patient and the physiotherapist CONCLUSIONS: The postoperative patient education in physiotherapy was constructed hierarchically. According to patients' conceptions, the combination of moving and exercising elements that focused on recovery at home after the operation was essential. This requires a trusting relationship between the patient and the physiotherapist. Two critical aspects can be identified: (i) how the role of moving could shift towards preparing for going home and (ii) widening the perspective from preparing for going home to managing at home. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Anna-Maija Jäppinen
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.,Department of Internal Medicine and Rehabilitation, Helsinki University Hospital, Helsinki, Finland
| | - Harri Hämäläinen
- Department of Internal Medicine and Rehabilitation, Helsinki University Hospital, Helsinki, Finland
| | - Tarja Kettunen
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.,Unit of Primary Health Care, Central Finland Health Care District, Jyväskylä, Finland
| | - Arja Piirainen
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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24
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Hudáková Z, Zięba HR, Lizis P, Dvořáková V, Cetlová L, Friediger T, Kobza W. Evaluation of the effects of a physiotherapy program on quality of life in females after unilateral total knee arthroplasty: a prospective study. J Phys Ther Sci 2016; 28:1412-7. [PMID: 27313341 PMCID: PMC4905880 DOI: 10.1589/jpts.28.1412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 01/19/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Osteoarthritis is a chronic and degenerative joint disease and is considered to be one of the most common musculoskeletal disorders. This study evaluated the differences in the quality of life of females treated with supervised physiotherapy and a standardized home program after unilateral total knee arthroplasty. [Subjects and Methods] From January 2012 to May 2015, a total of 40 females were examined at the Central Military Hospital in Ruzomberk, Slovakia. Quality of life was assessed with the Short Form-36. Quality of life and intensity of pain after normal daily activity, according to the visual analog scale, were assessed before total knee arthroplasty, immediately after physiotherapy, 3 months after total knee arthroplasty, and 6 months after total knee arthroplasty. [Results] We found statistically significant improvement of the quality of life results and a decreased intensity of pain at each time point compared with before total knee arthroplasty. [Conclusions] The results of this study provide further evidence indicating that patients who undergo total knee arthroplasty for primary osteoarthritis of the knee can achieve a significant improvement in the quality of life by using supervised physiotherapy compared with a standardized home program.
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Affiliation(s)
- Zuzana Hudáková
- Department of Physiotherapy, Faculty of Health, Catholic University, Slovakia; Department of Health Studies, College of Polytechnics, Czech Republic
| | | | - Paweł Lizis
- Department of Education and Health Protection, Holycross College: 51 Mielczarskiego Str., 25-709 Kielce, Poland
| | - Vlasta Dvořáková
- Department of Health Studies, College of Polytechnics, Czech Republic
| | - Lada Cetlová
- Department of Health Studies, College of Polytechnics, Czech Republic
| | - Teresa Friediger
- Institute of Health Science, Podhale State Higher Vocational School, Poland
| | - Wojciech Kobza
- Physiotherapy Cabinet, Bielski College named after Tyszkiewicz, Poland
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Pereira LC, Jolles BM. The effect of end-of-range grade A+ knee mobilisation following acute primary total knee arthroplasty: A randomised controlled trial. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2015. [DOI: 10.12968/ijtr.2015.22.12.583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background/Aims: Although the number of total knee arthroplasty procedures being performed is increasing worldwide, the rehabilitation protocols following surgery are poorly studied in the literature. Research suggests that exercise therapy and joint mobilisation are recommended in the later stages of osteoarthritis. However, best practice for rehabilitation in the immediate postoperative period is yet to be determined. This prospective randomised controlled trial examined whether adding grade A+ joint mobilisation to the standard in-hospital rehabilitative approach would increase pain (based on recordings of pain intensity on the visual analogue scale) and improve range of motion in the knee. Methods: Participants (n=32; mean±SD age: 71.1± 8.9 years) undergoing primary total knee arthroplasty at a university hospital were randomly assigned to two equal groups. Measurements were recorded before surgery and on the first, third and seventh days following total knee arthroplasty. All participants received standard care postoperatively, with participants in the experimental group receiving additional grade A+ joint mobilisation for knee flexion and extension twice a day for 20 minutes using the JAS Knee system (Joint Active Systems®, Effingham, Illinois). Results: There were no statistically significant differences in visual analogue scale scores or range of motion in all measurements (p > 0.05). Increased range of motion at a faster pace was observed in the obese subgroup of patients (p = 0.016). Other factors such as age, body mass index, type of anaesthesia and implant model did not influence the final outcome. Conclusions: Early grade A+ joint mobilisation combined with the standard in-hospital rehabilitative approach is safe to be used during the post-acute phase of rehabilitation after total knee arthroplasty. Despite increasing trends in the obese subgroup of patients, adding grade A+ joint mobilisation to the standard protocol did not significantly improve overall range of motion. The results of this study and heterogeneities in the literature identify the need for further research and development in this area.
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Affiliation(s)
- Luis C Pereira
- Physiotherapist, University Hospital of Lausanne, Swiizerland
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Siebens HC, Sharkey P, Aronow HU, Deutscher D, Roberts P, Munin MC, Radnay CS, Horn SD. Variation in Rehabilitation Treatment Patterns for Hip Fracture Treated With Arthroplasty. PM R 2015; 8:191-207. [PMID: 26226210 DOI: 10.1016/j.pmrj.2015.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 07/08/2015] [Accepted: 07/13/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Recommendations for health care redesign often advocate for comparative effectiveness research that is patient-centered. For patients who require rehabilitation services, a first step in this research process is to understand current practices for specific patient groups. OBJECTIVE To document in detail the physical and occupational therapy treatment activities for inpatient hip fracture rehabilitation among 3 patient subgroups distinguished by their early rate of functional recovery between time of surgery to rehabilitation admission. DESIGN Multicenter prospective observational cohort, practice-based evidence, study. SETTING Seven skilled nursing facilities and 11 inpatient rehabilitation facilities across the United States. PARTICIPANTS A total of 226 patients with hip fractures treated with hip arthroplasty. METHODS Comparisons of physical and occupational therapy treatment activities among 3 groups with different initial recovery trajectory (IRT) rates (slower, moderate, faster). MAIN OUTCOME MEASURE(S) Percent of patients in each IRT group exposed to each physical and occupational therapy activity (exposure), and mean minutes per week for each activity (intensity). RESULTS The number of patients exposed to different physical or occupational therapy activities varied within the entire sample. More specifically, among the 3 IRT groups, significant differences in exposure occurred for 44% of physical therapy activities and 39% of occupational therapy activities. More patients in the slower recovery group, IRT 1, received basic activities of daily living treatments and more patients in the faster recovery group, IRT 3, received advanced activities. The moderate recovery group, IRT 2, had some treatments similar to IRT 1 group and others similar to IRT 3 group. CONCLUSIONS Analyses of practice-based evidence on inpatient rehabilitation of hip fracture patients treated with arthroplasty identified differences in therapy activities among three patient groups classified by IRT rates. These results may enhance physiatrists', other physicians', and rehabilitation teams' understanding of inpatient rehabilitation for these patients and help design future comparative effectiveness research.
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Affiliation(s)
- Hilary C Siebens
- Siebens Patient Care Communications, 13601 Del Monte Dr, Suite 47A, Seal Beach, CA 90740(∗).
| | - Phoebe Sharkey
- Department of Information Systems and Operations Management, Loyola University Maryland, Baltimore, MD(†)
| | | | | | | | - Michael C Munin
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA(#)
| | - Craig S Radnay
- Insall Scott Kelly Institute for Orthopaedics and Sports Medicine, New York, NY(∗∗)
| | - Susan D Horn
- Institute for Clinical Outcomes Research, Salt Lake City, UT(§)
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Are Harris hip scores and gait mechanics related before and after THA? Clin Orthop Relat Res 2014; 472:3452-61. [PMID: 25138471 PMCID: PMC4182402 DOI: 10.1007/s11999-014-3886-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 08/06/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Discordance between subjective and objective functional measures hinders the development of new ways to improve THA outcomes. QUESTIONS/PURPOSES We asked if (1) any kinematic or kinetic gait variables are correlated with preoperative Harris hip scores (HHS), (2) any kinematic or kinetic gait variables are correlated with postoperative HHS, and (3) pre- to postoperative changes in any kinematic or kinetic gait variables are associated with the change in HHS? METHODS For this retrospective study, an institutional review board-approved data repository that included all individuals who participated in motion analysis research studies was used to identify subjects evaluated before (n=161) and at least 6 months after primary unilateral THA (n=156). Selected kinematic (sagittal plane dynamic hip ROM and kinetic (peak external moments about the hip in the sagittal, frontal, and transverse planes) gait variables were collected at subjects' self-selected normal walking speeds. We used first-order partial correlations to identify relationships between HHS and gait variables, controlling for the influence of speed. RESULTS Preoperative HHS correlated with hip ROM (R|speed=0.260; p<0.001) and the peak extension moment (R|speed=0.164; p=0.038), postoperative HHS correlated with the peak internal rotation moment (R|speed=0.178; p=0.034), and change in HHS correlated with change in hip ROM (R|speed=0.288; p=0.001) and peak external rotation moment (R|speed=0.291; p=0.002). Similar associations were seen when the HHS pain and function were analyzed separately. CONCLUSIONS This study identified relationships between a common clinical outcome measure and specific, modifiable gait adaptations that can persist after THA-ROM and transverse plane gait moments. Addressing these aspects of gait dysfunction through focused rehabilitation could be a new strategy for improving clinical outcomes. Prospective studies are needed to evaluate this concept. LEVEL OF EVIDENCE Level III, diagnostic study. See the Instructions for Authors for a complete description of levels of evidence.
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Monaghan B, Cusack T. Effectiveness of delayed rehabilitation programmes in patients following total hip replacement. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x13y.0000000114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Brueilly KE, Pabian PS, Straut LC, Freve LA, Kolber MJ. Factors contributing to rehabilitation outcomes following hip arthroplasty. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x12y.0000000027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Gurcay E, Ozturk EA, Erdem T, Gurcay AG, Cakci A. Heterotopic ossification as rare complication of hemiplegia following stroke: two cases. Brain Inj 2013; 27:1727-31. [PMID: 24088051 DOI: 10.3109/02699052.2013.831123] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Heterotopic ossification (HO), characterized by new bone formation in the periarticular regions of large joints, is frequently seen after spinal cord injury, traumatic brain injury, burn and trauma. It is a rare complication of hemiplegia following stroke, with a reported incidence of 1% or less. CASE REPORTS This study reports two unusual presentations of HO: (1) A 56-year-old male with a history of atrial fibrillation on warfarin developed sudden-onset left hemiplegia. Eight months after the event, he was diagnosed with HO of the hip joint including both the affected and unaffected sides. (2) A 55-year-old female with left hemiplegia due to subarachnoid bleeding developed HO on the left hip joint 7 months later. In both cases, spasticity around the hip muscle groups, especially hip flexors, adductors and knee extensors, and limited range of motion accompanied by pain were present. X-ray and pelvic computed tomography revealed HO around the hip joints. After 4 weeks of inpatient rehabilitation, the ranges of hip joint motion improved, without exceeding 10° in the direction of flexion and rotations, and ambulation levels were wheelchair-bound for the first case and dependent on a cane for the second case. CONCLUSIONS Considering the presented cases, it is suggested that HO should be kept in mind in the differential diagnosis in stroke patients presenting with spontaneous joint pain or limitation. The clinical importance of HO development on both the affected and unaffected sides in post-stroke hemiplegia is emphasized, since it may worsen the patient's functional status.
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Affiliation(s)
- Eda Gurcay
- Department of Physical Therapy and Rehabilitation, Ministry of Health Ankara Diskapi Yildirim Beyazit Education and Research Hospital , Ankara , Turkey and
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Brueilly KE, Schoenfeld BJ, Darbouze MR, Kolber MJ. Postrehabilitation Exercise Considerations Following Hip Arthroplasty. Strength Cond J 2013. [DOI: 10.1519/ssc.0b013e31828a0049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Wallace DF, Emmett SR, Kang KK, Chahal GS, Hiskens R, Balasubramanian S, McGuinness K, Parsons H, Achten J, Costa ML. The safety of peri-articular local anaesthetic injection for patients undergoing total knee replacement with autologous blood transfusion: a randomised trial. ACTA ACUST UNITED AC 2013. [PMID: 23188903 DOI: 10.1302/0301-620x.94b12.29357] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Intra-operative, peri-articular injection of local anaesthesia is an increasingly popular way of controlling pain following total knee replacement. At the same time, the problems associated with allogenic blood transfusion have led to interest in alternative methods for managing blood loss after total knee replacement, including the use of auto-transfusion of fluid from the patient's surgical drain. It is safe to combine peri-articular infiltration with auto-transfusion from the drain. We performed a randomised clinical trial to compare the concentration of local anaesthetic in the blood and in the fluid collected in the knee drain in patients having either a peri-articular injection or a femoral nerve block. Clinically relevant concentrations of local anaesthetic were found in the fluid from the drains of patients having peri-articular injections (4.92 μg/ml (sd 3.151)). However, none of the patients having femoral nerve blockade had detectable levels. None of the patients in either group had clinically relevant concentrations of local anaesthetic in their blood after re-transfusion. The evidence from this study suggests that it is safe to use peri-articular injection in combination with auto-transfusion of blood from peri-articular drains during knee replacement surgery.
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Affiliation(s)
- D F Wallace
- University Hospitals Coventry and Warwickshire NHS Trust, University Hospital, Clifford Bridge Road, Coventry CV2 2DX, UK
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Renaud A, Lavigne M, Vendittoli PA. Periprosthetic joint infections at a teaching hospital in 1990-2007. Can J Surg 2013; 55:394-400. [PMID: 22992404 DOI: 10.1503/cjs.033610] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Periprosthetic joint infections (PJIs) are major complications associated with high costs and substantial morbidity. We sought to evaluate hip and knee arthroplasty infection rates at our hospital, compare them in periods before and after implementation of measures to reduce PJIs (1990-2002 and 2003-2007) and identify associated risk factors. METHODS We retrospectively reviewed records of patients who received primary hip or knee total joint prostheses at our centre between Jan. 1, 1990, and Dec. 31, 2007, and were readmitted for the treatment of infection related to their surgery. We also reviewed data from a prospective surveillance protocol of total hip (THA) and knee arthroplasty (TKA) infections that started in November 2005. We ascertained the annual rates of deep, superficial and hematogenous infections. RESULTS During the periods studied, 2403 THAs and 1220 TKAs were performed. For THA, the average rates of deep, superficial and hematogenous infections were 2.0%, 0.8% and 0.3%, respectively. For TKA, the rates were 1.6%, 0.7% and 0.2%, respectively. Of 106 infected joints, 84 (79.2%) presented risk factors for infection. Efforts to reduce the infection rate at our institution began in 2003. We achieved a 44% decrease in the deep infection rate for THA (2.5% v. 1.4%; p = 0.06) and a 45% decrease for TKA (2.0% v. 1.1%, p = 0.20) between the periods studied. CONCLUSION Knowing the actual infection rate associated with different procedures in specific settings is essential to identify unexpected problems and seek solutions to improve patient care. Although we do not know what specific improvements were successful, we were able to decrease our infection rates to levels comparable to those reported by similar care centres.
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Affiliation(s)
- Alexandre Renaud
- Centre de recherche Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Que
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Abstract
Rheumatoid arthritis is often accompanied by massive destruction of the smaller and larger joints even with early therapy using antirheumatic drugs. In these cases total joint arthroplasty is the only surgical option, especially for the knee and hip joint. Knowledge of the specific disease-related postoperative characteristics is a prerequisite for the successful treatment of patients with rheumatoid arthritis. As dislocation of the arthroplastic joint does not occur more often in rheumatoid arthritis, the risk of periprosthetic infection is increased due to the use of biologicals. Therefore, a perioperative optimization is obligatory. In order to facilitate independence in daily living physiotherapy in combination with aids such as arthritis crutches, gripping pliers or raised toilet seat need to be started as soon as possible after surgical treatment. To achieve this goal it is recommended to refer patients with inflammatory arthritis to inpatient rehabilitation facilities. With respect to the specific postoperative treatment after joint replacement the long-term results are comparable with those from patients with primary osteoarthritis.
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Affiliation(s)
- S Seitz
- Klinik für Orthopädie und Orthopädische Rheumatologie, Klinikum Bad Bramstedt, Oskar-Alexander Str. 26, 24576, Bad Bramstedt, Deutschland.
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Outcomes and Weight-bearing Status During Rehabilitation After Arthroplasty for Hip Fractures. PM R 2012; 4:548-55. [DOI: 10.1016/j.pmrj.2012.05.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 05/01/2012] [Accepted: 05/08/2012] [Indexed: 11/15/2022]
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Aronow HU, Sharkey P, Siebens HC, Horn SD, Smout RJ, DeJong G, Munin MC, Radnay CS. Initial Recovery Trajectories Among Patients With Hip Fracture: A Conceptual Approach to Exploring Comparative Effectiveness in Postacute Care. PM R 2012; 4:264-72. [DOI: 10.1016/j.pmrj.2011.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 09/20/2011] [Accepted: 10/05/2011] [Indexed: 11/16/2022]
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Häkkinen A, Borg H, Kautiainen H, Anttila E, Häkkinen K, Ylinen J, Kiviranta I. Muscle strength and range of movement deficits 1 year after hip resurfacing surgery using posterior approach. Disabil Rehabil 2010; 32:483-91. [DOI: 10.3109/09638280903171451] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Chandrasekaran S, Ariaretnam SK, Tsung J, Dickison D. Early mobilization after total knee replacement reduces the incidence of deep venous thrombosis. ANZ J Surg 2009; 79:526-9. [DOI: 10.1111/j.1445-2197.2009.04982.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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LISKA WILLIAMD, DOYLE NANCYD. Canine Total Knee Replacement: Surgical Technique and One-Year Outcome. Vet Surg 2009; 38:568-82. [DOI: 10.1111/j.1532-950x.2009.00531.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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40
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McGrath MS, Mont MA, Siddiqui JA, Baker E, Bhave A. Evaluation of a custom device for the treatment of flexion contractures after total knee arthroplasty. Clin Orthop Relat Res 2009; 467:1485-92. [PMID: 19333671 PMCID: PMC2674191 DOI: 10.1007/s11999-009-0804-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Accepted: 03/09/2009] [Indexed: 01/31/2023]
Abstract
UNLABELLED Knee flexion contractures can severely impair function after total knee arthroplasties. We evaluated the use of a custom-molded knee device to treat 47 patients who had knee flexion contractures (mean, 22 degrees; range, 10 degrees-40 degrees) after primary or revision total knee arthroplasties and who had failed conventional therapeutic methods. The device was used for 30 to 45 minutes per session two to three times per day in conjunction with standard physical therapy modalities two to three times per week. Twenty-seven of 29 patients who underwent primary total knee arthroplasty and 13 of 18 patients who underwent revisions achieved full extension after a mean treatment time of 9 weeks (range, 6-16 weeks). Full knee extension was maintained at a minimum followup of 18 months (mean, 24 months; range, 18-36 months). The mean Knee Society knee and functional scores improved from 50 points and 34 points to 91 points and 89 points, respectively. This protocol had comparable rates of improvement in knee extension with less treatment time when compared with other nonoperative treatments reported in the literature. The custom knee device may be a useful adjunct to a physical therapy regimen for knee flexion contractures after total knee arthroplasty. LEVEL OF EVIDENCE Level IV, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Mike S. McGrath
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215 USA
| | - Michael A. Mont
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215 USA
| | - Junaed A. Siddiqui
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215 USA
| | - Erin Baker
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215 USA
| | - Anil Bhave
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215 USA
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Harmer AR, Naylor JM, Crosbie J, Russell T. Land-based versus water-based rehabilitation following total knee replacement: A randomized, single-blind trial. ACTA ACUST UNITED AC 2009; 61:184-91. [DOI: 10.1002/art.24420] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Franz JR, Riley PO, Dicharry J, Allaire PE, Kerrigan DC. Gait synchronized force modulation during the stance period of one limb achieved by an active partial body weight support system. J Biomech 2008; 41:3116-20. [PMID: 18986653 DOI: 10.1016/j.jbiomech.2008.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Revised: 09/03/2008] [Accepted: 09/13/2008] [Indexed: 11/19/2022]
Abstract
Our purpose was to demonstrate the ability of an actively controlled partial body weight support (PBWS) system to provide gait synchronized support during the stance period of a single lower extremity while examining the affect of such a support condition on gait asymmetry. Using an instrumented treadmill and a motion capture system, we compared gait parameters of twelve healthy elderly subjects (age 65-80 years) during unsupported walking to those while walking with 20% body weight support provided during only the stance period of the right limb. Specifically, we examined peak three-dimensional ground reaction force (GRF) data and the symmetry of lower extremity sagittal plane joint angles and of time and distance parameters. A reduction in all three GRF components was observed for the supported limb during modulated support. Reductions observed in the vertical GRF were comparable to the desired 20% support level. Additionally, GRF components examined for the unsupported limb during modulated support were consistently similar to those measured during unsupported walking. Modulated support caused statistically significant increases in asymmetry for knee flexion during stance (increased 5.9%), hip flexion during late swing (increased 9.1%), and the duration of single limb support (increased 2.8%). However, the observed increases were similar or considerably less than the natural variability in the asymmetry of these parameters during unsupported walking. The ability of the active PBWS device to provide unilateral support may offer new and possibly improved applications of PBWS rehabilitation for patients with unilateral walking deficits such as hemiparesis or orthopaedic injury.
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Affiliation(s)
- Jason R Franz
- Department of Physical Medicine and Rehabilitation, University of Virginia, 545 Ray C. Hunt Dr., Suite 240, P.O. Box 801004, Charlottesville, VA 22908, USA
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Gender and ethnic differences in rehabilitation outcomes after hip-replacement surgery. Am J Phys Med Rehabil 2008; 87:567-72. [PMID: 18574348 DOI: 10.1097/phm.0b013e31817c143a] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine gender and ethnic differences in functional status and living setting for patients after hip arthroplasty. DESIGN Retrospective cohort study of 69,793 patients receiving inpatient medical rehabilitation after hip arthroplasty included in the Uniform Data System for Medical Rehabilitation database for the period of 2002-2003. Primary measures included functional status as assessed by the FIM instrument and discharge living setting (home vs. not home). The sample included non-Hispanic white, non-Hispanic black, Hispanic, and Asian patients. RESULTS Multivariate regression models showed the greatest FIM instrument change scores from admission to discharge among non-Hispanic whites (mean [SE]: 23.42 [0.18]) and among women (mean [SE]: 22.79 [0.23]). Asians had the lowest mean change scores (mean [SE]: 22.00 [0.53]). Estimates from multivariate logistic models showed that being of nonwhite ethnicity was associated with higher odds of home discharge (black: OR [CI]: 1.23, CI 95% = 1.07, 1.41; Hispanic: OR [CI]: 1.51, CI 95% = 1.15-1.99). Compared with women, men had higher odds of home discharge (OR [CI]: 1.08, CI 95% = 1.01, 1.17). CONCLUSIONS The findings suggest that ethnic and gender disparities exist in postacute care outcomes for persons with hip arthroplasty.
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Bonutti PM, McGrath MS, Ulrich SD, McKenzie SA, Seyler TM, Mont MA. Static progressive stretch for the treatment of knee stiffness. Knee 2008; 15:272-6. [PMID: 18538574 DOI: 10.1016/j.knee.2008.04.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Revised: 03/27/2008] [Accepted: 04/11/2008] [Indexed: 02/02/2023]
Abstract
Persistent knee stiffness is common after knee arthroplasties, cruciate ligament repairs, and trauma. Static progressive stretch protocols have shown success in treating contractures of the elbow, ankle, and knee in case reports and small case series. This study evaluated static progressive stretch as a treatment method for patients who had refractory knee stiffness, and compared the outcomes to published results of other therapeutic modalities. Forty-one patients who had knee stiffness and who had not improved with conventional physical therapy modalities were treated with a patient-directed orthosis that utilized the principles of static progressive stretch. After a mean of 9 weeks of use (range, 3 to 27 weeks), the total arc of motion increased by a mean of 33 degrees (range, 0 to 85 degrees ). Forty of 41 patients had increased motion at a mean final follow-up time of 1 year (range, 6 months to 2 years), and 93% were satisfied with the results. The outcomes were comparable to other nonoperative treatments reported in the literature, but the results in the present study occurred in a shorter mean treatment time. An orthosis that utilizes the principles of static progressive stretch may be a successful treatment for improving the range of motion and satisfaction of patients who have knee contractures.
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Affiliation(s)
- Peter M Bonutti
- Bonutti Clinic, 1303 West Evergreen Avenue, Effingham, Illinois 62401, United States
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Westby MD, Kennedy D, Jones D, Jones A, Doyle-Waters MM, Backman C. Post-acute physiotherapy for primary total knee arthroplasty. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2008. [DOI: 10.1002/14651858.cd007099] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Marie D. Westby
- Mary Pack Arthritis Program; 895 West 10th Ave Vancouver BC Canada V5Z 1L7
| | - Deborah Kennedy
- Holland Orthopaedic and Arthritic Centre; Department of Rehabilitation; 43 Wellesley St East Toronto Ontario Canada M4Y 1H1
| | - Dina Jones
- West Virginia University; Department of Orthopaedics; One Medical Center Drive PO Box 9196 Morgantown West Virginia USA
| | - Anamaria Jones
- Arthritis Research Centre of Canada; 895 West 10th Avenue Vancouver BC Canada V5Z 1L7
| | - M. Madeleine Doyle-Waters
- Centre for Clinical Epidemiology and Evaluation; VGH Research Pavilion, Vancouver Coastal Health 810 West 10th Avenue Vancouver BC Canada V5Z 1L8
| | - Catherine Backman
- University of British Columbia; Department of Occupational Science and Occupational Therapy; T325-2211 Wesbrook Mall Vancouver BC Canada V6T 2B5
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Nožica-Radulović T, Erceg T, Manojlović S, Talić G, Lazović M. Effects of preoperative and early postoperative rehabilitation to duration of the treatment of patients with implanted total hip endoprosthesis. SCRIPTA MEDICA 2007. [DOI: 10.5937/scrimed0702087n] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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