Short-Term Effects of Isometric Quadriceps Muscle Exercise with Auditory and Visual Feedback on Pain, Physical Function, and Performance after Total Knee Arthroplasty: A Randomized Controlled Trial

AbstractSevere acute pain after total knee arthroplasty (TKA) may cause delay in muscle strength and functional recovery, and it is a risk factor for chronic postoperative pain. Although pharmacological approaches are the typical firstline to treat acute pain; recently, nonpharmacological approaches such as exercise have been increasingly applied. The purpose of this investigation was to evaluate the effects of a rehabilitation program involving isometric quadriceps exercise with auditory and visual feedback to improve the short-term outcome after TKA. Sixty-two patients, planning a primary unilateral TKA, were randomly assigned to either an intervention group (n = 31) involving isometric quadriceps exercise with auditory and visual feedback in usual rehabilitation after TKA or a control group (n = 31) involving a standardized program for TKA. Patients in the intervention group performed the isometric quadriceps muscle exercise using the Quadriceps Training Machine from 2 to 14 days after TKA instead of the traditional quadriceps sets. Pain intensity, isometric knee extension strength, range of motion, timed up and go test (TUG), 10-m gait speed, 6-minute walking distance, the Western Ontario and McMaster University Osteoarthritis index (WOMAC), the hospital anxiety and depression scale, and the pain catastrophizing scale were assessed before TKA (baseline) and 1 to 3 weeks after TKA. Pain intensity significantly decreased in the intervention group than in the control group at 1 (p = 0.005), 2 (p = 0.002), and 3 (p = 0.010) weeks after TKA. Greater improvements in TUG (p = 0.036), 10-m gait speed (p = 0.047), WOMAC total score (p = 0.017), pain (p = 0.010), and function (p = 0.028) 3 weeks after TKA were observed in the intervention group. These results suggest that isometric quadriceps exercises with auditory and visual feedback provided early knee pain relief, possibly leading to better improvements in physical performance, and patient's perception of physical function in the early stages of postoperative TKA. Further studies should investigate whether this short-term effect is sustainable.

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The Effect of Preoperative Video Based Pain Training on Postoperative Pain and Analgesic Use in Patients Undergoing Total Knee Arthroplasty: A Non-randomized Control Group Intervention Study

Clinical Nursing Research ◽

10.1177/1054773820983361 ◽

2020 ◽

pp. 105477382098336

Author(s):

Ceyda Su Gündüz ◽

Nurcan Çalişkan

Keyword(s):

Total Knee Arthroplasty ◽

Postoperative Pain ◽

Knee Arthroplasty ◽

Group Intervention ◽

Intervention Study ◽

Intervention Group ◽

Control Group ◽

Total Knee ◽

Randomized Control ◽

Analgesic Use

This non-randomized control group intervention study was conducted to determine the effect of preoperative video based pain training on postoperative pain and analgesic use in patients undergoing total knee arthroplasty. During the study, the patients in the control ( n = 40) received routine care and the patients in the intervention group ( n = 40) received video based pain training. İt was determined that the mean postoperative pain scores of the intervention group were significantly lower and their pain management was better compared to the control group ( p < .05). The intervention group was found to use significantly less paracetamol on operation day compared to the control group ( p < .05). The intervention group was determined to benefit from non-pharmacological methods more than the control group did ( p < .05). Providing video based pain training to patients undergoing total knee arthroplasty is recommended since it reduces postoperative pain levels and increases the use of non-pharmacological pain control methods.

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Patelloplasty with and without circumpatellar denervation in reducing anterior knee pain in primary total knee arthroplasty: a comparative prospective study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20200046 ◽

2020 ◽

Vol 6 (2) ◽

pp. 270

Author(s):

Sandeep Kumar Kanugula ◽

Mallesh Rathod ◽

Venugopal S. M.

Keyword(s):

Total Knee Arthroplasty ◽

Knee Pain ◽

Knee Arthroplasty ◽

Anterior Knee Pain ◽

Intervention Group ◽

Control Group ◽

Significant Difference ◽

Total Knee ◽

Anterior Knee

Background: Anterior knee pain (AKP) following total knee arthroplasty (TKA) is one of the complication which cause dissatisfaction in patients. Incidence estimated to be 4-49%. The aim of our study is to know the efficacy of patelloplasty with circumpatellar denervation with diathermy in reducing AKP in primary TKA.Methods: A total of 130 unilateral TKAs’ are divided into 2 groups. Group I (control) includes 65 patients in which only patelloplasty was done. Group II (intervention) includes 65 patients in which both patelloplasty and circumpatellar denervation with diathermy was done and analysed. Mean follow up period was 18 months. Patients were assessed both preoperatively and postoperatively at final follow up.Results: The overall incidence of AKP at follow up (18 months) was 16.9%, with 7.7% in the intervention group and 26.1% in the control group (p<0.05). Western Ontario and McMaster Universities osteoarthritis index scores were significantly better in intervention group when compared to control group (28.71±3.948 vs 31.40±3.860). Better results were also found in knee society scores for intervention group compared to control group (166.57±7.941 vs 161.23±11.219); Feller patellar score of intervention group was significantly better when compared to control group (23.28±2.546 vs 20.69±3.729); the range of knee flexion was similar in both the groups (94.62±12.6 vs 93.54±10.7). In terms of pain referred by the patient at 72 hrs postoperatively, there was statistically significant difference observed according to visual analogue scale.Conclusions: There is statistically significant difference with respect to AKP in patients who have undergone patelloplasty with circumpatellar denervation using diathermy compared with patelloplasty alone.

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Effect of Dynamic Balance Exercises Based on Visual Feedback on Physical Function, Balance Ability, and Depression in Women after Bilateral Total Knee Arthroplasty: A Randomized Controlled Trial

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17093203 ◽

2020 ◽

Vol 17 (9) ◽

pp. 3203

Author(s):

Ju-Yeon Lee ◽

Jung-Hee Kim ◽

Byoung-Hee Lee

Keyword(s):

Total Knee Arthroplasty ◽

Physical Function ◽

Visual Feedback ◽

Knee Arthroplasty ◽

Dynamic Balance ◽

Control Group ◽

Balance Exercise ◽

Balance Exercises ◽

Balance Ability ◽

Total Knee

The aim of this study was to compare the effects of dynamic balance exercises with and without visual feedback on recovery from total knee arthroplasty. The participants were 30 women who underwent total knee arthroplasty more than one week before the study, and were randomly allocated into two groups. The average ages of the experimental and control groups were 70.13 and 69.00 years, respectively. The dynamic balance exercise with visual feedback (VF) group practiced dynamic balance exercises using a laser pointer for five 30-min sessions over a 4-week period. The dynamic balance exercise without visual feedback (control) group practiced dynamic balance exercises for five 30 min sessions over a 4 week period. The following clinical measures were used for assessing physical function, balance ability, and depression. Compared with the control group, the VF group showed significant improvements in the physical performance test, Western Ontario and McMaster Universities Arthritis Index (WOMAC), confidence ellipse area (CEA), path length (PL), average velocity (AV), and Timed Up and Go test (TUG test) (p < 0.05). Furthermore, the VF group showed significant improvements in all post-surgery outcome measures compared with the pre-surgery values (p < 0.05). The above results indicated that the dynamic balance exercises based on visual feedback improved physical function and balance ability in patients following total knee arthroplasty, suggesting the need for effective rehabilitation programs for patients with total knee arthroplasty.

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Effects of an Intervention to Improve Life-Space Mobility and Self-Efficacy in Patients following Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0038-1672199 ◽

2018 ◽

Vol 32 (10) ◽

pp. 966-971 ◽

Cited By ~ 2

Author(s):

Yoshinori Hiyama ◽

Tsukasa Kamitani ◽

Kazuaki Mori

Keyword(s):

Total Knee Arthroplasty ◽

Confidence Interval ◽

Knee Arthroplasty ◽

Self Efficacy ◽

Intervention Group ◽

Mean Difference ◽

Control Group ◽

Life Space ◽

Patient Reported ◽

Total Knee

AbstractLife-space mobility describes the spatial areas through which an individual moves, and the frequency and need for assistance. Although patients with knee osteoarthritis (OA) have shown restricted life-space mobility, total knee arthroplasty (TKA) does not improve it beyond preoperative levels. Life-space mobility after TKA was influenced by self-efficacy for walking tasks; thus, an intervention to improve self-efficacy for walking tasks may contribute to better life-space mobility. We provided a walking event including several walking tasks as the intervention. We assessed the effect of the walking event on life-space mobility and self-efficacy for walking tasks in patients following TKA. In this nonrandomized controlled trial, patients who underwent primary TKA were recruited. After recruitment, patients who could not participate in the walking event due to scheduling conflicts were included in the control group. The walking event consisted of 3.5 km of walking course and included walking tasks as follows: crossing at the crosswalk, walking up- and downstairs without a railing, walking along dirt roads, and walking up and down a slope. The primary outcome was life-space mobility measured using Life-Space Assessment (LSA) and self-efficacy for walking tasks measured using the modified Gait Efficacy Scale (mGES). We enrolled 104 patients, of whom 36 were assigned to the intervention group and participated in the walking event. Participants in the intervention group had significantly better LSA score (adjusted mean difference between groups: 13.9; 95% confidence interval: 12.4–15.5; p < 0.001) and mGES score (adjusted mean difference between groups: 13.8; 95% confidence interval: 12.4–15.1; p < 0.001) than the control group even after adjusting for age, gender, body mass index, elapsed time from surgery, the severity of knee OA of nonoperated limb, and patient-reported functional outcome. The walking event including various walking tasks improved life-space mobility and self-efficacy in patients following TKA. It is important to design a program that can improve self-efficacy for walking tasks through mastery experiences to improve life-space mobility after TKA.

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The Effects of Programmed Cryotherapy and Continuous Passive Motion in Patients after Computer-Assisted Total Knee Arthroplasty: A prospective, randomized controlled trial

10.21203/rs.3.rs-19897/v1 ◽

2020 ◽

Author(s):

Mei-Chu Chen ◽

Chiu-Chu Lin ◽

Jih-Yang Ko ◽

Feng-Chih Kuo

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Controlled Trial ◽

Intervention Group ◽

Continuous Passive Motion ◽

Control Group ◽

Computer Assisted ◽

Passive Motion ◽

Significant Difference ◽

Total Knee

Abstract Background: Cryotherapy and continuous passive motion (CPM) are commonly used for conventional total knee arthroplasty (TKA) to reduce postoperative pain and increase of the range of motion (ROM). However, this postoperative nursing intervention remains elusive for patients undergoing computer-assisted total knee arthroplasty (CAS-TKA) Methods: A prospective, randomized controlled trial with a purposive sampling method was utilized. Sixty patients scheduled for a unilateral CAS-TKA at a medical center were randomly assigned to the intervention group (n=30) and control group (n=30). The intervention group applied programed cryotherapy and CPM within one hour while returning to the ward on the day of surgery, while the control group did not. Data were analyzed using mixed models to compare numeric rating scale (NRS) for pain, ROM, and swelling at postoperative day (POD) 4. Results: There was no significant difference in the NRS score between the groups ( p = 0.168). The intervention group had significantly higher ROM than the control group (98 degrees vs. 91 degrees, p = 0.004) at POD 4. Although no significant difference in joint swelling was found between groups ( p = 0.157), the intervention group had lower mean joint swelling (32.2 cm) than the control group (33.9 cm). Conclusions: Programmed cryotherapy and continuous passive motion can improve the range of motion after CAS-TKA. It should be incorporated into the daily nursing plan for patients undergoing CAS-TKA.

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A new educational method before total knee arthroplasty to be applied in developing countries: a randomized controlled trial

10.21203/rs.3.rs-29921/v1 ◽

2020 ◽

Author(s):

Marco Antonio Percope de Andrade ◽

Guilherme Moreira Abreu e Silva ◽

Tulio Vinicius Oliveira Campos ◽

David Guen Kasuya Barbosa ◽

Danilo Silva Leite ◽

...

Keyword(s):

Developing Countries ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Positive Impact ◽

Intervention Group ◽

Public Hospitals ◽

Control Group ◽

Educational Method ◽

Walk Ability ◽

Total Knee

Abstract Background In developing countries, the illiteracy index is high in public hospitals. We describe a method in which patients are instructed before total knee arthroplasty (TKA) in a differentiated way without the necessity of reading any self-orientation. Methods To improve patient education before TKA we developed a multidisciplinary method in which an orthopedic surgeon, a nurse and a physiotherapist give the patients a differentiated orientation with specific lectures regarding the pre, intra and post-operative issues in a prospective case-control study of 79 consecutive patients undergoing primary TKA. Twenty-nine patients received the standard verbal education (control group) and 38 patients received the differentiated education (intervention group). The patients were evaluated during at least six months. Results After a 6-month follow-up period, SF-36 and WOMAC forms, VAS and range of motion improved significantly in both groups. ROM was better in the intervention group (mean and SD − 106.9 ± 5.7 versus 92.5 ± 12.1 degrees, p = 0.02). Moreover, walk ability (more than 400 meters) was improved in the intervention group compared with control group (97.4% versus 72.4%, p = 0.003). In the intervention and control groups, respectively, 10.5% and 31% of patients reported the need of some walking device (p = 0.03). Conclusions A differentiated educational program with a multidisciplinary team had a positive impact on functional outcomes, improving ROM and walk ability of patients undergoing TKA in a short-term evaluation.

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The Effect of Early Hip-strengthening on Physical Function in Patients With Unilateral Total Knee Arthroplasty

Journal of Arak University of Medical Sciences ◽

10.32598/jams.23.6.6045.1 ◽

2021 ◽

Vol 23 (6) ◽

pp. 912-925

Author(s):

Mojgan Moaref Khanli ◽

◽

Mohammad Akbari ◽

Ali Amiri ◽

◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Outcome Measures ◽

Knee Arthroplasty ◽

Intervention Group ◽

Control Group ◽

Rehabilitation Programs ◽

Hip Muscle ◽

Strengthening Exercises ◽

Total Knee ◽

Hip Strengthening

Background and Aim: Conventional post-operative rehabilitation programs focus on quadriceps strengthening and knee range of motion. However, hip muscle weakness is evident in patients with knee osteoarthritis. The present trial study aimed to investigate the effects of adding early hip muscle strengthening exercises to conventional rehabilitation programs on pain, Range of Motion (RoM), Quality of Life (QoL), and physical function in patients with unilateral Total Knee Arthroplasty (TKA). Methods & Materials: The intervention was initiated from the second day after surgery and continued for 10 sessions, 3 times a week on 24 participants in the control and intervention groups. Both research groups received Transcutaneous Electrical Neural Stimulation (TENS) and Infra-Red (IR), followed by exercises. The control group performed knee extensor and flexor strengthening and RoM exercises. The intervention group conducted hip-strengthening exercises in addition. Outcome measures included pain, knee flexion, and extension RoM, and QoL using the 36-Item Short Form Survey (SF-36), Timed Up and Go (TUG) test, Step Test, Six-Minute Walk Test (6MWT), and Hip and Knee Muscle Strength test. Ethical Considerations: This research was approved by the Research Ethics Committee of Iran University of Medical Sciences (IR.IUMS.REC.1396.9511340012) and it was registered in the Clinical Trial Registration Center (Code: IRCT 20150314021459N6). Results: All outcome measures improved in both research groups. The improvement in the scores of pain (P=0.03), knee extension RoM (P=0.007), and TUG test (P=0.033) were significantly higher in the intervention group, compared to the control group. The strength of knee flexors (P=0.023), hip flexors (P=0.040), hip extensors (P=0.028), hip adductors (P=0.040), and hip external rotators (P=0.047) significantly improved higher in the intervention group. Conclusion: According to the present research results, both treatment approaches were effective on patients with unilateral total knee arthroplasty. Considering the better result of some of the outcome measures in the intervention group, the addition of hip strengthening exercises to knee exercises can be useful.

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The Effects of Immediate Programmed Cryotherapy and Continuous Passive Motion in Patients after Computer-Assisted Total Knee Arthroplasty: A prospective, randomized controlled trial

10.21203/rs.3.rs-19897/v2 ◽

2020 ◽

Author(s):

Mei-Chu Chen ◽

Chiu-Chu Lin ◽

Jih-Yang Ko ◽

Feng-Chih Kuo

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Intervention Group ◽

Nursing Intervention ◽

Continuous Passive Motion ◽

Control Group ◽

Computer Assisted ◽

Passive Motion ◽

Significant Difference ◽

Total Knee

Abstract Background: The postoperative nursing intervention with immediate cryotherapy and continuous passive motion (CPM) remains elusive regarding the postoperative pain and range of motion (ROM) for patients undergoing computer-assisted total knee arthroplasty (CAS-TKA).Methods: A prospective, randomized controlled trial with a purposive sampling method was utilized. Sixty patients scheduled for a unilateral CAS-TKA at a medical center were randomly assigned to the intervention group (n=30) and control group (n=30). The intervention group applied programed cryotherapy and CPM within one hour while returning to the ward on the day of surgery, while the control group did not. Data were analyzed using mixed models to compare the numeric rating scale (NRS) for pain, ROM, and swelling at postoperative day (POD) 4.Results: There was no significant difference in the NRS score between the groups (p = 0.168). The intervention group had significantly higher ROM than the control group (98 degrees vs. 91 degrees, p = 0.004) at POD 4. Although no significant difference in joint swelling was found between groups (p = 0.157), the intervention group had lower mean joint swelling (32.2 cm) than the control group (33.9 cm).Conclusions: Immediate programmed cryotherapy and continuous passive motion could help to improve ROM quickly after CAS-TKA. It should be incorporated into the daily nursing plan for patients undergoing CAS-TKA.Keywords: Postoperative nursing intervention, total knee arthroplasty, continuous passive motion, cryotherapy, computer-assistedTrial registration: ClinicalTrials.gov: NCT04136431. Registered 23 October 2019 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04136431

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Image-Free Handheld Robot for Total Knee Arthroplasty Improves Early Functional Recovery Compared with Conventional Total Knee Arthroplasty

10.21203/rs.3.rs-1048544/v1 ◽

2021 ◽

Author(s):

Kazu Matsumoto ◽

Hiroyasu Ogawa ◽

Hiroki Yoshioka ◽

Yutaka Nakamura ◽

Haruhiko Akiyama

Keyword(s):

Total Knee Arthroplasty ◽

Muscle Strength ◽

Functional Recovery ◽

Knee Arthroplasty ◽

Quadriceps Muscle ◽

Control Group ◽

Rescue Analgesia ◽

Implant Positioning ◽

Strength Recovery ◽

Total Knee

Abstract This study aimed to examine whether it is advantageous in robotic-assisted TKA (RA-TKA) compared with conventional TKA throughout a 14 postoperative days (PODs). A total of 113 knees (100 patients) were reviewed and divided into the control group (55 knees) and the RA-TKA group (58 knees). We assessed postoperative pain intensity using a visual analogue scale at rest (rVAS) and during movement (mVAS), evaluated lower extremity functional recovery through quadriceps muscle strength and knee range of motion (ROM), preoperatively and on PODs 3, 7, 10, and 14. We also assessed the rescue analgesia intake and postoperative implant coronal alignment. The mean rVAS and mVAS scores did not differ significantly between the two groups. Muscle strength recovery was significantly faster in the RA-TKA group than in the control group on every PODs. ROM recovery was better in the RA-TKA group than in the control group on POD 10. The amount of postoperative analgesia was significantly lower in the RA-TKA group than in the control group. Attainment of a β angle <2° significantly better in RA-TKA. This study demonstrated better functional recovery in RA-TKA, particularly for muscle strength and ROM. RA-TKA reduced rescue drug intake and provided better implant positioning.

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Providing Inpatient Mobilization with a Mobility Technician Constrains Cost in Primary Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0040-1718597 ◽

2020 ◽

Author(s):

Thomas A. Novack ◽

Christopher J. Mazzei ◽

Jay N. Patel ◽

Eileen B. Poletick ◽

Roberta D'Achille ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Care Pathway ◽

Primary Total Knee Arthroplasty ◽

Cost Savings ◽

Patient Discharge ◽

Control Group ◽

Study Group ◽

Bundled Payment ◽

Total Knee

AbstractSince the 2016 implementation of the comprehensive care for joint replacement (CJR) bundled payment model, our institutions have sought to decrease inpatient physical therapy (PT) costs by piloting a mobility technician program (MTP), where mobility technicians (MTs) ambulate postoperative total knee arthroplasty (TKA) patients under the supervision of nursing staff members. MTs are certified medical assistants given specialized gate and ambulation training by the PT department. The aim of this study was to examine the economic and clinical impact of MTs on the primary TKA postoperative pathway. We performed a retrospective review of TKA patients who underwent surgery at our institution between April 2018 and March 2019 and who were postoperatively ambulated by MTs. The control group included patients who had surgery during the same months of the prior year, preceding introduction of MTs to the floor. Inclusion criteria included: unilateral primary TKA for arthritic conditions and conversion to unilateral primary TKA from a previous knee surgery. Minitab Software (State College, PA) was used to perform the statistical analysis. There were 658 patients enrolled in the study group and 1,400 in the control group. The two groups shared similar demographics and an average age of 68 (p = 0.177). The median length of stay (LOS) was 2 days in both groups (p = 0.133) with 90.5% of patients in the study group discharged to home versus 81.5% of patients in the control group (p < 0.001). The ability of MTs to increase patient discharge to home without negatively impacting LOS suggest MTs are valuable both clinically to patients, and economically to the institution. Cost analysis highlighted the substantial cost savings that MTs may create in a bundled payment system. With the well-documented benefits of early ambulation following TKA, we demonstrate how MTs can be an asset to optimizing the care pathway of TKA patients.

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