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

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.

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

2020 ◽  
Author(s):  
Yasutaka Kondo ◽  
Yoshihiro Yoshida ◽  
Takashi Iioka ◽  
Hideki Kataoka ◽  
Junya Sakamoto ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Visual Feedback ◽  
Knee Arthroplasty ◽  
Acute Pain ◽  
Intervention Group ◽  
Quadriceps Muscle ◽  
Control Group ◽  
Muscle Exercise ◽  
Short Term ◽  
Total Knee

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.

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

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

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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.<strong></strong></p><p class="abstract"><strong>Results:</strong> 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&lt;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.</p><p class="abstract"><strong>Conclusions:</strong> There is statistically significant difference with respect to AKP in patients who have undergone patelloplasty with circumpatellar denervation using diathermy compared with patelloplasty alone.</p><p> </p>

scholarly journals Synergistic Effect of a Prolonged Combination Course of Tranexamic Acid and Dexamethasone Involving High Initial Doses in Total Knee Arthroplasty: A Randomized Controlled Trial

2021 ◽  
Author(s):  
Hong Xu ◽  
Jinwei Xie ◽  
Jingli Yang ◽  
Zeyu Huang ◽  
Duan Wang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Pain ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Inflammatory Markers ◽  
Knee Function ◽  
Control Group ◽  
Group A ◽  
Total Knee ◽  
Secondary Outcomes

AbstractThe optimal regimes of tranexamic acid (TXA) and dexamethasone (DXM) in total knee arthroplasty (TKA) are still uncertain. The aim of this study was to assess the efficacy and safety of a prolonged course of intravenous TXA and DXM involving a high initial dose in TKA. Patients who underwent primary TKA at our center were randomized to receive one of four regimes: control (group A), prolonged course of TXA (B), prolonged course of DXM (C), or the combination of a prolonged course of TXA and DXM (D). The four groups were compared in primary outcomes (fibrinolytic and inflammatory markers, knee function, postoperative pain levels, and consumption of opioids) and secondary outcomes (blood loss, maximal drop in hemoglobin, coagulation, fasting blood glucose, and complications). A total of 162 patients were enrolled. On postoperative days 2 and 3, fibrinolytic markers were lower in groups B and D than in groups A and C; inflammatory markers were lower in groups C and D than in groups A and B. Inflammatory markers were lower in group B than in group A on postoperative day 3. Postoperative pain levels and oxycodone consumption were lower, and knee function was better in groups C and D. The four groups did not differ in any of the secondary outcomes. A prolonged course of intravenous TXA and DXM involving high initial doses can effectively inhibit postoperative fibrinolytic and inflammatory responses, reduce pain, and improve knee function after TKA.

scholarly journals Effectiveness of Periarticular Infiltration of the Knee during Total Knee Arthroplasty for Postoperative Pain Management

2021 ◽  
Vol 3 (2) ◽  
pp. 24-28
Author(s):  
Bibhuti Nath Mishra ◽  
Joydeep Banerjee Chowdhury ◽  
Rajeev Raman ◽  
Dipmalya Chakraborty ◽  
Tanmoy Karmakar
Keyword(s):  
Total Knee Arthroplasty ◽  
Pain Management ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Postoperative Pain Management ◽  
Control Group ◽  
Periarticular Injection ◽  
Combination Drugs ◽  
Total Knee ◽  
Periarticular Infiltration

Background: Different treatment regimens of analgesia, nerve blocks and epidurals are used for pain relief in Total Knee Arthroplasty (TKA). Local infiltration analgesia (LIA) is one of the modalities in which a cocktail combination of different medicines is infiltrated locally into the capsule, surrounding tissues or intraarticular joint space. This study aims to analyze the effectiveness of periarticular injection of combination drugs (Bupivacaine, Ketorolac and Morphine) during TKA for postoperative pain management. Methods: Total of 150 patients who underwent primary unilateral TKA were randomly categorized into 2 groups (75 each). Group A (control group) didn’t receive intraoperative periarticular injection but Group-B received the intraoperative injection of combined local analgesics and anaesthetics (Bupivacaine, Ketorolac and Morphine). Pain following surgery at 0, 1, and 2 postoperative days were recorded with visual analogue scale (VAS) whereas Knee Society Score was used to evaluate the pain and function pre-operative and 3 months’ post-operative. Statistical analysis was done using SPSS software. Results: Patients receiving periarticular infiltration of combination drugs intraoperatively had lower VAS for postoperative pain (p < 0.001) and this group also showed reduced need of analgesia postoperatively. Conclusions: Periarticular infiltration of knee during Total Knee Arthroplasty is effective in management of postoperative pain Keywords: Periarticular; Total Knee Arthroplasty; combination drugs; postoperative pain

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

2018 ◽  
Vol 32 (10) ◽  
pp. 966-971 ◽  
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.

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

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.

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

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.

Using pharmacogenetics to structure individual pain management protocols in total knee arthroplasty

2020 ◽  
Vol 102-B (6_Supple_A) ◽  
pp. 73-78
Author(s):  
William G. Hamilton ◽  
Jeanine M. Gargiulo ◽  
Nancy L. Parks
Keyword(s):  
Total Knee Arthroplasty ◽  
Side Effects ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Genetic Variants ◽  
Control Group ◽  
Ongoing Research ◽  
Pain Scores ◽  
Pain Medications ◽  
Total Knee

Aims The purpose of this study was to use pharmacogenetics to determine the frequency of genetic variants in our total knee arthroplasty (TKA) patients that could affect postoperative pain medications. Pharmacogenetic testing evaluates patient DNA to determine if a drug is expected to have a normal clinical effect, heightened effect, or no effect at all on the patient. It also predicts whether patients are likely to experience side effects from medicine. We further sought to determine if changing the multimodal programme based on these results would improve pain control or reduce side effects. Methods In this pilot study, buccal samples were collected from 31 primary TKA patients. Pharmacogenetics testing examined genetic variants in genes OPRM1, CYP1A2, CYP2B6, CYP2C19, CYP3A4, CYP2C9, and CYP2D6. These genes affect the pharmacodynamics and pharmacokinetics of non-steroidal anti-inflammatory drugs and opioids. We examined the frequency of genetic variants to any of the medications we prescribed including celecoxib, hydrocodone, and tramadol. Patients were randomized to one of two groups: the control group received the standard postoperative pain regimen, and the study group received a customized regimen based on the pharmacogenetic results. For the first ten postoperative days, patients recorded pain scores, medication, and side effects. Results Genetic variants involving one or more medications in the multimodal pain protocol occurred in 13 of the 31 patients (42%). In total, eight patients (26%) had variants affecting more than one of the medications. For the 25 patients who recorded pain and medication logs, the mean pain levels and morphine equivalents (MEQs) consumed in the first ten days were higher in the control group than in the custom-guided group (p = 0.019 for pain and p = 0.655 for MEQ). Conclusion Overall, 42% of patients had a variant involving one of the pain medications prescribed in our perioperative pain program for TKA. Ongoing research will help determine if using these data to modify a patient’s medication will improve outcomes. Cite this article: Bone Joint J 2020;102-B(6 Supple A):73–78.

scholarly journals App-based rehabilitation program after total knee arthroplasty: a randomized controlled trial

2021 ◽  
Author(s):  
Henrik C. Bäcker ◽  
Chia H. Wu ◽  
Matthias R. G. Schulz ◽  
Thomas Sanjay Weber-Spickschen ◽  
Carsten Perka ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Randomized Control Trial ◽  
Control Group ◽  
Prospective Randomized Control Trial ◽  
Long Term Study ◽  
Total Knee ◽  
Randomized Control

Abstract Introduction New app-based programs for postoperative rehabilitation have been developed, but no long-term study has been published to date. Thus, a prospective randomized control trial with 2-year follow-up was performed to evaluate the effectiveness of app-based rehabilitation (GenuSport) compared to a control group after total knee arthroplasty (TKA). Methods Between April and October 2016, 60 patients were enrolled in the study. Twenty-five patients were lost to follow-up, leaving 35 patients undergoing TKA for inclusion. In this group, twenty patients received app-based exercise program and 15 were randomized to the control group. The mean age was 64.37 ± 9.32 years with a mean follow-up of 23.51 ± 1.63 months. Patients in the app group underwent an app-based knee training starting on the day of surgery; whereas, patients in the control group underwent regular physiotherapy. Functional outcome scores using the Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Society Score (KSS) and VAS of pain were analyzed. Results In the short term, significant differences between the app group and control group in time of 10-m walk (19.66 ± 7.80 vs. 27.08 ± 15.46 s; p = 0.029), VAS pain at rest and activity (2.65 ± 0.82 vs. 3.57 ± 1.58, respectively 4.03 ± 1.26 vs. 5.05 ± 1.21; p < 0.05) were observed. In the long term, a variety of different tendencies was found, highest in KSS Function with 76.32 ± 16.49 (app group) vs. 67.67 ± 16.57 (control group) (p = 0.130). Additionally, patients in the app group required less painkillers (10.0% vs. 26.7%) and more likely to participate in sports (65.0% vs. 53.3%). Conclusions An app-based knee trainer is a promising tool in improving functional outcomes such as KSS function score and VAS after TKA. Level of evidence Level II, prospective randomized control trial.

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

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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