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Chen G, Yu D, Wang Y, Ma Z, Bi M, Lu L, Zhang S, Liu J, Chen H, Shen H, Zhang H, Luo X, Si Y, Zhang P. A Prospective Randomized Controlled Trial Assessing the Impact of Preoperative Combined with Postoperative Progressive Resistance Training on Muscle Strength, Gait, Balance and Function in Patients Undergoing Total Hip Arthroplasty. Clin Interv Aging 2024; 19:745-760. [PMID: 38736563 PMCID: PMC11088839 DOI: 10.2147/cia.s453117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/19/2024] [Indexed: 05/14/2024] Open
Abstract
Purpose The aim of this study is to investigate the effects of a preoperative combined with postoperative moderate-intensity progressive resistance training (PRT) of the operative side in patients with hip osteoarthritis (HOA) who are undergoing total hip arthroplasty (THA). The study seeks to evaluate the impact of this combined intervention on muscle strength, gait, balance, and hip joint function in a controlled, measurable, and objective manner. Additionally, the study aims to compare the outcomes of this combined intervention with those of preoperative or postoperative muscle strength training conducted in isolation. Methods A total of 90 patients with HOA scheduled for unilateral primary THA were randomly assigned to three groups: Pre group (preoperative PRT), Post group (postoperative PRT), and Pre& Post group (preoperative combined with postoperative PRT) focusing on hip flexion, extension, adduction, and abduction of operated side. Muscle strength, gait parameters, balance, and hip function were assessed at specific time points during a 12-month follow-up period. Results All three groups showed significant improvements in muscle strength, with the Pre& Post group demonstrating the most pronounced and sustained gains. Gait velocity and cadence were significantly improved in the Pre& Post group at 1-month and 3-month postoperative follow-ups compared to the other groups. Similarly, the Pre& Post group exhibited superior balance performance at 3-month and 12-month postoperative follow-ups. The Harris Hip Score also showed better outcomes in the Pre& Post group at all follow-up intervals. Conclusion Preoperative combined with postoperative moderate-intensity PRT in HOA patients undergoing THA led to superior improvements in muscle strength, gait, balance, and hip joint function compared to preoperative or postoperative PRT alone. This intervention shows significant promise in optimizing postoperative rehabilitation and enhancing patient outcomes following THA.
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Affiliation(s)
- Guo Chen
- Department of Geriatric Orthopedics(1), Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Duoduo Yu
- Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Yichen Wang
- Department of Geriatric Orthopedics(1), Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Zou Ma
- Department of Geriatric Orthopedics(1), Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Mengna Bi
- Department of Geriatric Orthopedics(1), Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Lisha Lu
- Department of Geriatric Orthopedics(1), Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Shangshang Zhang
- Department of Geriatric Orthopedics(1), Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Jiaxin Liu
- Department of Geriatric Orthopedics(1), Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Hu Chen
- Department of Geriatric Orthopedics(1), Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Hai Shen
- Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Huiwu Zhang
- Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Xiaobing Luo
- Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Yan Si
- Department of Geriatric Orthopedics(1), Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Peng Zhang
- Department of Geriatric Orthopedics(1), Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
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Chang HL, Hsu MF, Wong TH, Chung YC, Huang HL. Effects of a Hybrid Teaching Program on Lower Limb Muscle Strength, Knee Function, and Depression in Older Adults After Total Knee Replacement: A Randomized Controlled Trial. Res Gerontol Nurs 2024; 17:31-40. [PMID: 37738062 DOI: 10.3928/19404921-20230918-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
The aim of the current study was to evaluate the effects of a nurse-led hybrid teaching program on lower limb strength, knee function, and depression in older adults after total knee replacement (TKR). This was a single-blind, randomized controlled trial. Fifty-two patients who underwent TKR were randomly assigned to either the experimental group (EG; n = 26), which received routine care plus 16 weeks of home rehabilitation through a hybrid teaching program, or the control group (CG; n = 26), which received routine care only. The intervention included pre-discharge face-to-face education, video instructions to follow at home after discharge, and four monthly telephone-based follow ups during the 16 weeks post-surgery. After the 16-week intervention, participants in the EG exhibited improved quadriceps strength, hamstring strength, and Knee Injury and Osteoarthritis Outcome Score (KOOS) compared to those in the CG. Generalized estimating equation analyses revealed a significant group-by-time interaction effect on quadriceps strength, overall KOOS score, and Geriatric Depression Scale-Short Form score. Findings suggest that a nurse-led hybrid teaching program enhances physical and psychological function after TKR when compared to routine care. This hybrid teaching program, involving exercise and postoperative education, proves to be a feasible and cost-effective intervention for improving outcomes in older adults following TKR. Health care teams should consider it as a viable home rehabilitation option for older adults who undergo TKR. [Research in Gerontological Nursing, 17(1), 31-40.].
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Hawke LJ, Shields N, Dowsey MM, Choong PFM, Taylor NF. Does a consumer co-designed infographic increase knowledge of physical activity after total knee joint replacement? A randomised controlled trial. Musculoskeletal Care 2023; 21:1497-1506. [PMID: 37817390 DOI: 10.1002/msc.1827] [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: 09/14/2023] [Accepted: 09/16/2023] [Indexed: 10/12/2023]
Abstract
PURPOSE To determine if a consumer co-designed infographic increased knowledge of physical activity and self-efficacy for exercise after total knee joint replacement surgery. METHODS Forty-four adults with primary knee joint replacement surgery were recruited from a public and a private hospital in Melbourne, Australia. Participants were randomly allocated to an experimental or control group. The experimental group received a consumer co-designed infographic. All participants received usual care. Primary outcome measures were knowledge of physical activity and self-efficacy for exercise. Outcomes were administered at baseline, week 1 and week 6. Semi-structured interviews with experimental group participants explored the acceptability, implementation and efficacy of the infographic. RESULTS There were no between-group differences for knowledge of physical activity at week 1 (MD -0.02 units, 95% CI -0.9 to 0.9) or week 6 (MD 0.01 units, 95% CI -0.9 to 0.9). Self-efficacy for exercise increased at week 1 (MD 14.2 units, 95% CI 2.9-25.4) but was not sustained. Qualitative data showed that the infographic was embraced by some participants but not by others. CONCLUSIONS A consumer co-designed infographic did not improve knowledge of physical activity but may have had a short-term positive effect on self-efficacy for exercise after knee joint replacement. Trial registration ACTRN12621000910808.
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Affiliation(s)
- Lyndon J Hawke
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, Australia
- University of Melbourne Department of Surgery, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Nora Shields
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Michelle M Dowsey
- University of Melbourne Department of Surgery, St. Vincent's Hospital, Melbourne, Victoria, Australia
- Department of Orthopaedics, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Peter F M Choong
- University of Melbourne Department of Surgery, St. Vincent's Hospital, Melbourne, Victoria, Australia
- Department of Orthopaedics, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, Australia
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Pitaro NL, Herrera MM, Alasadi H, Shah KC, Kiani SN, Stern BZ, Zubizarreta N, Chen DD, Hayden BL, Poeran J, Moucha CS. Sleep Disturbance Trends in the Short-Term Postoperative Period for Patients Undergoing Total Joint Arthroplasty. J Am Acad Orthop Surg 2023; 31:e859-e867. [PMID: 37523691 DOI: 10.5435/jaaos-d-23-00059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/21/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Patients undergoing total joint arthroplasty (TJA) often experience preoperative/postoperative sleep disturbances. Although sleep quality generally improves > 6 months after surgery, patterns of sleep in the short-term postoperative period are poorly understood. This study sought to (1) characterize sleep disturbance patterns over the 3-month postoperative period and (2) investigate clinical and sociodemographic factors associated with 3-month changes in sleep. METHODS This retrospective analysis of prospectively collected data included 104 primary elective TJA patients. Patients were administered the PROMIS Sleep Disturbance questionnaire preoperatively and at 2 weeks, 6 weeks, and 3 months postoperatively. Median sleep scores were compared between time points using Wilcoxon signed-rank tests, stratified by preoperative sleep impairment. A multivariable logistic regression model identified factors associated with 3-month clinically improved sleep. RESULTS The percentage of patients reporting sleep within normal limits increased over time: 54.8% preoperatively and 58.0%, 62.5%, and 71.8% at 2 weeks, 6 weeks, and 3 months post-TJA, respectively. Patients with normal preoperative sleep experienced a transient 4.7-point worsening of sleep at 2 weeks ( P = 0.003). For patients with moderate/severe preoperative sleep impairment, sleep significantly improved by 5.4 points at 2 weeks ( P = 0.002), with improvement sustained at 3 months. In multivariable analysis, patients undergoing total hip arthroplasty (versus knee; OR: 3.47, 95% CI: 1.06 to 11.32, P = 0.039) and those with worse preoperative sleep scores (OR: 1.13, 95% CI: 1.04 to 1.23, P = 0.003) were more likely to achieve clinically improved sleep from preoperatively to 3 months postoperatively. DISCUSSION Patients experience differing patterns in postoperative sleep changes based on preoperative sleep disturbance. Hip arthroplasty patients are also more likely to experience clinically improved sleep by 3 months compared with knee arthroplasty patients. These results may be used to counsel patients on postoperative expectations and identify patients at greater risk of impaired postoperative sleep. STUDY DESIGN Retrospective analysis of prospectively collected data.
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Affiliation(s)
- Nicholas L Pitaro
- From the Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY (Pitaro, Herrera, Alasadi, Shah, Kiani, Stern, Zubizarreta, Chen, Hayden, Poeran, and Moucha), the Department of Population Health Science and Policy, Institute for Health Care Delivery Science, Icahn School of Medicine at Mount Sinai (Stern, Zubizarreta and Poeran), and the Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (Poeran)
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Terao Y, Hosaka N, Otobe Y, Suzuki M, Kojima I, Yoshizawa K, Yamada M, Nakayama Y, Abo M. The impact of preoperative muscle strength on postoperative walking ability in patients undergoing total knee arthroplasty. Int J Rehabil Res 2023; 46:157-162. [PMID: 36867015 DOI: 10.1097/mrr.0000000000000572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Although knee extensor muscle strength is strongly associated with postoperative walking ability (PWA) in patients undergoing total knee arthroplasty (TKA), few studies have considered the impact of both knee extensor and flexor muscle strength. This study aimed to determine whether operative side knee flexor and extensor muscle strength before surgery affects the PWA of patients who undergo TKA while accounting for potential covariates. This multicenter retrospective cohort study involved four university hospitals, and patients who underwent unilateral primary TKA were included. The outcome measure was the 5-m maximum walking speed test (MWS), which was completed 12 weeks postoperatively. Muscle strength was measured as the maximum isometric muscle strength required for knee flexor and extensor. Three multiple regression models with a progressively larger number of variables were developed to determine the predictors of 5-m MWS at 12 weeks post-TKA surgery. One hundred thirty-one patients who underwent TKA were enrolled in the study (men, 23.7%; mean age, 73.4 ± 6.9 years). Age, sex, operative side knee flexor muscle strength before surgery, Japanese Orthopaedic Association knee score, and preoperative walking ability were significantly associated with PWA in the final model of the multiple regression analysis ( R2 = 0.35). The current findings suggest that the operative side knee flexor muscle strength before surgery is a robust modifiable predictor of improved PWA. We believe that further validation is needed to determine the causal relationship between preoperative muscle strength and PWA.
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Affiliation(s)
- Yusuke Terao
- Department of Rehabilitation Medicine, The Jikei University School of Medicine Hospital
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo
| | - Naoki Hosaka
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo
| | - Yuhei Otobe
- Department of Rehabilitation Science, Physical Therapy Course, School of Medicine, Osaka Metropolitan University, Osaka
| | - Mizue Suzuki
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo
| | - Iwao Kojima
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo
| | - Kazuya Yoshizawa
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo
| | | | - Yasuhide Nakayama
- Department of Rehabilitation Medicine, The Jikei University School of Medicine Hospital
| | - Masahiro Abo
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
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Ren R, Spaan J, Jordan A, Shafiro A, Su EP. Novel Use of an Accelerometer to Assess Load Asymmetry Over Time After Hip Resurfacing Arthroplasty. J Arthroplasty 2023:S0883-5403(23)00356-X. [PMID: 37068566 DOI: 10.1016/j.arth.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 04/05/2023] [Accepted: 04/08/2023] [Indexed: 04/19/2023] Open
Abstract
INTRODUCTION There is limited knowledge regarding usage of wearable technology to guide return to sport after hip resurfacing arthroplasty (HRA). This study evaluated the use of accelerometers to identify when symmetry is restored between operative and non-operative limbs. METHODS A total of 26 primary HRA patients performed five validated physical tests before, 3 and 6 months after HRA: broad jump, double leg vertical jump (DLVJ), hop test, lateral single leg jump (LSLJ), and vertical single leg jump (VSLJ). Impact load and average intensity data (g-force units) were collected using accelerometers. Strength data (pounds (lbs.)) for internal and external rotation was collected with a dynamometer. Univariate and correlation analyses analyzed interlimb asymmetries. RESULTS At pre-operation, there were significant impact load asymmetries for DLVJ (P=.008), hop test (P=.021), and LSLJ (P=.003), and intensity asymmetry for DLVJ (P=.010) and LSLJ (P=.003). At 3 months, there was impact load asymmetry for DLVJ (P=.005) and LSLJ (P=.005), and intensity asymmetry for broad jump (P=.020), hop test (P=.042), and LSLJ (P=.005). There were significant strength asymmetries at pre- and 3 months post-operation for internal (P=.013) and external rotation (P=.037). All significant asymmetries indicated the non-operative leg had greater output. No significant asymmetries were found for any exercises at 6 months post-operation. An increase in Harris Hip Score was significantly associated with a decrease in impact asymmetry (rs = -0.269, P=.006). DISCUSSION AND CONCLUSION Impact loads and strength reach interlimb symmetry at 6 months post-HRA. Wearable accelerometers provide useful metrics to distinguish limb asymmetries for recovery monitoring.
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Affiliation(s)
- Renee Ren
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, United States.
| | - Jonathan Spaan
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, United States
| | - Andrew Jordan
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, United States
| | - Alexander Shafiro
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, United States
| | - Edwin P Su
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, United States
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Hill AM, Ross-Adjie G, McPhail SM, Jacques MBiostat A, Bulsara M, Cranfield A, Etherton-Beer C, Azlan Mn NR, Powell SJ, Hardisty G, Monterosso L. Incidence and Associated Risk Factors for Falls in Older Adults After Elective Total Knee Replacement Surgery: A Prospective Cohort Study. Am J Phys Med Rehabil 2022; 101:454-459. [PMID: 34292196 DOI: 10.1097/phm.0000000000001848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to determine the incidence and associated risk factors for falls in older adults in the 12 mos after elective, primary total knee replacement surgery. DESIGN A prospective observational cohort of older adults undergoing total knee replacement were followed. Baseline measurements included risk factors of history of falls, using a gait aid and number of medications. Falls data were recorded after discharge for 12 mos alongside patient reported outcomes (Oxford Knee Score). Analyses used logistic and negative binomial regression modeling. RESULTS There were 267 participants (mean age = 70 [6.7] yrs) enrolled. Participants who fell (n = 102 [40.6%]) reported 200 falls in the 12 mos after surgery. The incidence of falls was 2.4 falls per 1000 patient days in the 12 mos after surgery, with the highest incidence (2.6 falls per 1000 patient days) in month 1. Risk factors for falling were a history of falls (adjusted odds ratio = 2.41, 95% confidence interval = 1.35-4.31) and number of central nervous system acting medications taken before surgery (adjusted odds ratio = 1.66, 95% confidence interval = 1.25-2.21). Using a walking aid at baseline was associated with falls after discharge (adjusted incident rate ratio = 2.38, 95% confidence interval = 1.57-3.60). CONCLUSIONS Older adults experience a high incidence of falls after elective total knee replacement. Further research that investigates falls prevention after total knee replacement is required.
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Affiliation(s)
- Anne-Marie Hill
- From the School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia (A-MH, AJ); Institute for Health Research, The University of Notre Dame Australia, Fremantle, Australia (A-MH, MB); School of Nursing and Midwifery, The University of Notre Dame Australia, Fremantle, Australia (GR-A, LM); Australian Centre for Health Services Innovation and Centre of Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia (SMM); Clinical Informatics Directorate, Metro South Health, Brisbane, Australia (SMM); Centre for Nursing and Midwifery Research, St John of God Hospital, Murdoch, Australia (AC, NRA, S-JP, LM); WA Centre for Health and Ageing, University of Western Australia, Perth, Australia (CE-B); Faculty of Health and Medical Sciences: Surgery, University of Western Australia, Perth, Australia (GH); Western Orthopaedic Clinic, St John of God Hospital Murdoch and Hollywood, Perth, Australia (GH); School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia (LM); and Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Murdoch, Australia (LM)
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Zhang LK, Zhu FB, Gao HH, Zhang L, Quan RF. Is intraoperative corticosteroid a good choice for postoperative pain relief in total joint arthroplasty? A meta-analysis of 11 randomized controlled trials. Medicine (Baltimore) 2021; 100:e27468. [PMID: 34622874 PMCID: PMC8500626 DOI: 10.1097/md.0000000000027468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 09/18/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Effective postoperative analgesia is of great significance for postoperative rehabilitation. This meta-analysis aimed to investigate the efficacy of corticosteroid on pain following total joint arthroplasty. METHOD PubMed (1996-December 2020), Embase (1996-December 2020), and the Cochrane Library (CENTRAL, December 2020) were searched and a total of 11 randomized controlled trials met our inclusion criteria. RESULTS Eleven randomized controlled trials met the inclusion criteria. Pooled data indicated the corticosteroid group was effective compared to the control group in terms of the visual analogue scale at rest (P < .05) and movement (P < .05), the total morphine equivalent consumption (P < .05), and the length of stay (P < .05), without increasing the risk of periprosthetic joint infection (P = .74) and the length of stay (P = .32). CONCLUSIONS Compared to the control group, intraoperative corticosteroid was benefit to the pain management in total joint arthroplasty.
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Affiliation(s)
- Lu-kai Zhang
- Department of Orthopaedics, Xiaoshan Traditional Chinese Medical Hospital, Hangzhou, Zhejiang Province, People's Republic of China
- Department of Orthopedics, Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Fang-bing Zhu
- Department of Orthopaedics, Xiaoshan Traditional Chinese Medical Hospital, Hangzhou, Zhejiang Province, People's Republic of China
- Department of Orthopedics, Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Huan-huan Gao
- Department of Orthopaedics, Xiaoshan Traditional Chinese Medical Hospital, Hangzhou, Zhejiang Province, People's Republic of China
- Department of Orthopedics, Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Lei Zhang
- Department of Orthopaedics, Xiaoshan Traditional Chinese Medical Hospital, Hangzhou, Zhejiang Province, People's Republic of China
- Department of Orthopedics, Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Ren-fu Quan
- Department of Orthopaedics, Xiaoshan Traditional Chinese Medical Hospital, Hangzhou, Zhejiang Province, People's Republic of China
- Department of Orthopedics, Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, People's Republic of China
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Przkora R, Sibille K, Victor S, Meroney M, Leeuwenburgh C, Gardner A, Vasilopoulos T, Parvataneni HK. Blood flow restriction exercise to attenuate postoperative loss of function after total knee replacement: a randomized pilot study. Eur J Transl Myol 2021; 31. [PMID: 34459574 PMCID: PMC8495367 DOI: 10.4081/ejtm.2021.9932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/16/2021] [Indexed: 11/22/2022] Open
Abstract
Aging well is directly associated with a healthy lifestyle. The focus of this paper is to relate that attenuation of postoperative loss of muscle function after a total knee arthroplasty (TKA) is an important consideration. Because patients usually do not tolerate standard high-resistance exercise in the preoperative or postoperative period, they often experience a decline in strength and function. Therefore, we tested the feasibility and acceptability of an alternative low-resistance exercise protocol with blood flow restriction (BFR) using a tourniquet in the preoperative period for patients awaiting TKA. We recruited patients undergoing a TKA and randomized six to the BFR exercise for 4 weeks prior to surgery and four to standard of care (no exercise). We measured physical function using the Short Physical Performance Battery (SPPB), the 6-Minute Walk Test (6MWT), leg strength (peak torque), and pain (numerical pain score) 4 to 5 weeks preoperatively and 2 weeks postoperatively. The clinical management, e.g., anesthetic management, did not differ between groups. No complications were observed. Our findings demonstrate the feasibility and acceptability of the BFR intervention. Although preliminary and not powered for comparison, the BFR group demonstrated less decline in SPPB following surgery (−2.2, 95%CI:−4.4,0.1) compared to the no exercise group (−4.8, 95%CI:−7.8,−1.7). No differences were noted for the 6MWT, leg strength, and pain measurements. We conclude that preoperative low-resistance exercise using the BFR is feasible and acceptable, and this test warrants investigation as an intervention to potentially attenuate the postoperative loss of physical function after TKA.
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Affiliation(s)
- Rene Przkora
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida.
| | - Kimberly Sibille
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA; Department of Aging and Geriatric Research, University of Florida College of Medicine, Gainesville, Florida.
| | - Sandra Victor
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida.
| | - Matthew Meroney
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida.
| | - Christiaan Leeuwenburgh
- Department of Aging and Geriatric Research, University of Florida College of Medicine, Gainesville, Florida, USA; Department of Anatomy and Cell Biology, University of Florida College of Medicine, Gainesville, Florida.
| | - Anna Gardner
- Department of Applied Physiology and Kinesiology, University of Florida College of Health and Human Performance, Gainesville, Florida.
| | - Terrie Vasilopoulos
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA; Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, Florida.
| | - Hari K Parvataneni
- Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, Florida.
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Hawke LJ, Taylor NF, Dowsey MM, Choong PFM, Shields N. In the dark about physical activity - exploring patient perceptions of physical activity after elective total knee joint replacement: a qualitative study. Arthritis Care Res (Hoboken) 2021; 74:965-974. [PMID: 34057314 DOI: 10.1002/acr.24718] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/06/2021] [Accepted: 05/25/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The study aimed to explore patient perceptions of and motivations for physical activity after total knee joint replacement. METHODS Participants were purposively sampled after completing a public outpatient rehabilitation exercise group. Semi-structured interviews were completed with 22 participants (mean age 70 years, 45% women) 6 to 12 months after total knee joint replacement. Interviews were audiotaped and transcribed verbatim. Themes were identified by an inductive and iterative process of data analysis. RESULTS The main theme to emerge was participants were in the dark about physical activity. Participants were typically not familiar with physical activity guidelines and had difficulty distinguishing between low and moderate-intensity physical activity. Three subthemes were identified: (1) people prioritise participation in meaningful life situations after total knee joint replacement; (2) rehabilitation was perceived to not explicitly address moderate-intensity physical activity levels; and (3) other health and social reasons replaced knee osteoarthritis as barriers to physical activity. CONCLUSION Limited understanding of physical activity recommendations, prioritisation of participation in meaningful life situations, rehabilitation that was impairment focused and other health and social reasons appeared to contribute to low levels of moderate-intensity physical activity for adults after knee joint replacement. Addressing being in the dark about physical activity may be an important first step to increase the effectiveness of behavioural interventions designed to promote physical activity after total knee joint replacement.
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Affiliation(s)
- Lyndon J Hawke
- La Trobe University, Bundoora, and Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
| | - Nicholas F Taylor
- La Trobe University, Bundoora, and Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
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Przkora R, Sibille K, Victor S, Meroney M, Leeuwenburgh C, Gardner A, Vasilopoulos T, Parvataneni HK. Assessing the feasibility of using the short physical performance battery to measure function in the immediate postoperative period after total knee replacement. Eur J Transl Myol 2021; 31. [PMID: 33840178 PMCID: PMC8274223 DOI: 10.4081/ejtm.2021.9673] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/01/2021] [Indexed: 12/27/2022] Open
Abstract
Measurements of physical function after total knee arthroplasty (TKA) are uncertain and require investments for special equipment, space, and staff. Therefore, we evaluated the Short Physical Performance Battery (SPPB) 4 to 6 weeks preoperatively and 2 weeks following TKA as this test battery addresses lower extremity strength, coordination, and balance, without additional special investments. For context, we also employed the Six-Minute Walk test (6MWT) and peak torque knee extension. Our analysis consisted of three women and one man, with average ages of 68.3±3.9 years. Patients showed a decrease in all functional measurements: SPPB (mean change: -4.8±1.9, 44% decrease), 6MWT (-0.37±.21 m/s, 34% decrease), and peak torque (-11.8±8.8°/s, 68% decrease). Our findings suggest the SPPB is feasible and can be integrated easily in daily clinical practice.
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Affiliation(s)
- Rene Przkora
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida.
| | - Kimberly Sibille
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida; Department of Aging and Geriatric Research, University of Florida College of Medicine, Gainesville, Florida.
| | - Sandra Victor
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida.
| | - Matthew Meroney
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida.
| | - Christiaan Leeuwenburgh
- Department of Aging and Geriatric Research, University of Florida College of Medicine, Gainesville, Florida; Department of Anatomy and Cell Biology, University of Florida College of Medicine, Gainesville, Florida.
| | - Anna Gardner
- Department of Applied Physiology and Kinesiology, University of Florida College of Health and Human Performance, Gainesville, Florida.
| | | | - Hari K Parvataneni
- Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, Florida.
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