scholarly journals A pilot study of aquatic prehabilitation in adults with knee osteoarthritis undergoing total knee arthroplasty – short term outcome

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Sunghye Kim ◽  
Fang-Chi Hsu ◽  
Leanne Groban ◽  
Jeff Williamson ◽  
Stephen Messier
Keyword(s):  
Physical Function ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Exercise Intervention ◽  
Assessment Tool ◽  
Short Form ◽  
Aquatic Exercise ◽  
Water Exercise ◽  
Mobility Assessment ◽  
Total Knee

Abstract Background Knee osteoarthritis (KOA) is increasingly more prevalent and significant number of patients require knee arthroplasty. Although knee arthroplasty is generally successful, it takes months to recover physical function. Preoperative physical function is known to predict postoperative outcomes and exercise can improve preoperative physical function. However, patients with KOA have difficulty exercise on land due to pain and stiffness, while water exercise can be better tolerated. We hypothesized that preoperative water exercise to improve preoperative physical function will improve postoperative outcomes after total knee arthroplasty (TKA). Methods We enrolled 43 participants who were scheduled for elective TKA in 4–8 weeks and scored at or below 50th percentile in mobility assessment tool-sf (MAT-sf). All enrolled participants were assessed on 1) clinical osteoarthritis symptom severity using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), 2) physical function using Short Physical Performance Battery (SPPB), 3) self-reported mobility using Mobility Assessment Tool-short form (MAT-sf), 4) depression using Geriatric Depression Scale-short form (GDS-sf), 5) cognitive function using Montreal Cognitive Assessment (MoCA). Blood samples for high-sensitivity-C-reactive protein (hs-CRP), tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) were stored at − 80 °C then all samples were analyzed together. All the enrolled participants were randomly assigned to the aquatic exercise intervention (AEI) or usual care group. Sixty minute sessions of AEI was conducted three times a week for 4–8 weeks. Participants in both groups were evaluated within 1 week before their scheduled surgery, as well as 4 weeks after the surgery. Results The mean age was 67.1 (±6.2), 44% were female, 74% were White. There is no statistically significant difference in combined outcome of any complication, unscheduled ER visit, and disposition to nursing home or rehab facility by AEI. However, AEI was associated with more favorable outcomes: WOMAC scores (p < 0.01), chair-stand (p = 0.019), MAT-sf as well as improved depression (p = 0.043) and cognition (p = 0.008). Conclusion 4–8 weeks of aquatic exercise intervention resulted in improved functional outcomes as well as improved depression and cognition in elderly patients undergoing TKA. A larger study is warranted to explore the role of water exercise in clinical and functional outcomes of TKA.

scholarly journals A Randomized Clinical Trial of Prehabilitation Using Aquatic Exercise in Older Adults with Knee Osteoarthritis Undergoing Total Knee Arthroplasty

2020 ◽  
Author(s):  
Sunghye Kim ◽  
Fang-Chi Hsu ◽  
Leanne Groban ◽  
Jeff Williamson ◽  
Stephen Messier
Keyword(s):  
Clinical Trial ◽  
Physical Function ◽  
Functional Outcomes ◽  
Exercise Intervention ◽  
Assessment Tool ◽  
Short Form ◽  
Aquatic Exercise ◽  
Water Exercise ◽  
Mobility Assessment ◽  
Total Knee

Abstract Background: With an aging population, knee osteoarthritis (KOA) is increasingly more prevalent. A significant number of patients with advanced KOA require total knee arthroplasty (TKA). Preoperative physical function predicts postoperative outcomes. We hypothesized that preoperative water exercise to improve preoperative physical function will improve postoperative outcomes after TKA.Methods: We conducted a randomized controlled trial in 43 participants who were scheduled for TKA and scored at or below 50th percentile in mobility assessment tool-sf (MAT-sf). All enrolled participants were assessed on 1) clinical osteoarthritis symptom severity using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), 2) physical function using Short Physical Performance Battery (SPPB), 3) self-reported mobility using Mobility Assessment Tool-short form (MAT-sf), 4) depression using Geriatric Depression Scale-short form (GDS-sf), 5) cognitive function using Montreal Cognitive Assessment (MoCA). High-sensitivity-C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) levels were analyzed. Participants were randomly assigned to the aquatic exercise intervention (AEI) or usual care group. The AEI was conducted three times a week for 4-8 weeks, with each session lasting for 60 minutes. Participants in both groups were evaluated within one week before their scheduled surgery, as well as 4 weeks after the surgery. Logistic regressions were used to examine the associations between the intervention and unfavorable outcomes.Results: The mean age was 67.1 (±6.2), 44% were female, 74% were White. There is no statistically significant difference in combined outcome of any complication, unscheduled ER visit, and disposition to nursing home or rehab facility by AEI. However, AEI was associated with more favorable functional outcomes including WOMAC scores, chair-stand, MAT-sf, as better mood and cognition and lower blood pressure in multivariable analyses.Conclusion: 4-8 weeks of aquatic exercise intervention resulted in improved functional outcomes in patients undergoing TKA. A larger study is warranted to explore the role of water exercise in clinical and functional outcomes of TKA.Trial registration: This clinical trial was registered at ClinicalTrials.gov with ClinicalTrials.gov Identifier of NCT02773745. The date of registration was March 16th 2016. The URL of the trial registry record is https://www.clinicaltrials.gov/ct2/show/NCT02773745?term=water&recrs=e&cond=Osteoarthritis%2C+Knee&cntry=US&draw=2&rank=2.

No Difference in Functional Outcomes after Total Knee Arthroplasty with or without Pinless Navigation

2017 ◽  
Vol 31 (07) ◽  
pp. 649-653 ◽  
Author(s):  
Jerry Chen ◽  
Hwei Chong ◽  
Hee Pang ◽  
Darren Tay ◽  
Shi-Lu Chia ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Short Form ◽  
Oxford Knee Score ◽  
Navigation Group ◽  
Total Knee ◽  
Lost To Follow Up ◽  
Pinless Navigation

AbstractThis study aims to investigate the functional outcomes of pinless navigation (BrainLAB VectorVision Knee 2.5 navigation system; Munich, Germany) as an intraoperative alignment guide in total knee arthroplasty (TKA). A prospective, 24-month follow-up study of 100 patients who were scheduled and randomized into two groups, the pinless navigation and conventional surgery, was conducted. All TKAs were performed with the surgical aim of achieving neutral coronal alignment with the 180-degree mechanical axis. The outcomes measured in this study were Oxford Knee Score (OKS), Knee Society Score (KSS), Short Form-36 (SF-36), and range of motion (ROM). At 24-month postoperatively, four and two patients were lost to follow-up from the pinless navigation group and conventional group, respectively. There were no significant differences in absolute scores of the OKS, KSS, and ROM, as well as changes from preoperative baseline, between pinless navigation and conventional groups at both 6 and 24 months postoperatively. Pinless navigation results in comparable functional outcomes as conventional TKA at 6 and 24 months postoperatively.

scholarly journals A randomized controlled trial comparing functional outcomes for navigated kinematically aligned total knee arthroplasty versus navigated mechanically aligned total knee arthroplasty

2021 ◽  
Vol 2 (11) ◽  
pp. 945-950
Author(s):  
Vilas Narayan Sadekar ◽  
Sandeep Datir ◽  
Victoria Allgar ◽  
Hemant Sharma
Keyword(s):  
Total Knee Arthroplasty ◽  
Randomized Controlled Trial ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Short Form ◽  
Controlled Trial ◽  
Oxford Knee Score ◽  
Secondary Outcome ◽  
Randomized Controlled ◽  
Total Knee

Aims Nearly 99,000 total knee arthroplasties (TKAs) are performed in UK annually. Despite plenty of research, the satisfaction rate of this surgery is around 80%. One of the important intraoperative factors affecting the outcome is alignment. The relationship between joint obliquity and functional outcomes is not well understood. Therefore, a study is required to investigate and compare the effects of two types of alignment (mechanical and kinematic) on functional outcomes and range of motion. Methods The aim of the study is to compare navigated kinematically aligned TKAs (KA TKAs) with navigated mechanically aligned TKA (MA TKA) in terms of function and ROM. We aim to recruit a total of 96 patients in the trial. The patients will be recruited from clinics of various consultants working in the trust after screening them for eligibility criteria and obtaining their informed consent to participate in this study. Randomization will be done prior to surgery by a software. The primary outcome measure will be the Knee injury and Osteoarthritis Outcome Score The secondary outcome measures include Oxford Knee Score, ROM, EuroQol five-dimension questionnaire, EuroQol visual analogue scale, 12-Item Short-Form Health Survey (SF-12), and Forgotten Joint Score. The scores will be calculated preoperatively and then at six weeks, six months, and one year after surgery. The scores will undergo a statistical analysis. Discussion There is no clear evidence on the best alignment for a knee arthroplasty. This randomized controlled trial will test the null hypothesis that navigated KA TKAs do not perform better than navigated MA TKAs. Cite this article: Bone Jt Open 2021;2(11):945–950.

Comparing durability of water- and land-based exercise benefits among older adults in South Korea: A randomized controlled trial with 1-year follow-up

2021 ◽  
pp. 1-11
Author(s):  
Se Jun Oh ◽  
Sang Heon Lee
Keyword(s):  
Exercise Intervention ◽  
External Rotation ◽  
Short Form ◽  
Controlled Trial ◽  
Weight Bearing ◽  
Aquatic Exercise ◽  
Step Test ◽  
Sf 36 ◽  
Partial Weight

BACKGROUND: Aquatic exercise can improve strength, flexibility, and aerobic function while safely providing partial weight-bearing support through viscosity and buoyancy. OBJECTIVE: The aim of the present study was to compare the effects of water-based exercise with land-based exercise before and after a 10-week exercise intervention and again at one-year follow-up. METHODS: Eighty participants aged 65 years and older were randomly assigned to either a water- or a land-based 10-week exercise program. Assessment included the Senior Fitness Test (SFT), the Modified Falls-Efficacy Scale, and the 36-Item Short-Form Health Survey (SF-36). Hip and knee strength was also measured. All assessments were completed at three time points: pre- (T1), post- (T2), and at 1-year follow-up (T3). RESULTS: Significant differences were observed between the two groups on three parameters: the SFT timed up-and-go test; lower hip muscle strength in extension, adduction, and external rotation; and quality of life (QoL) measured by the SF-36 (p< 0.05). No significant differences were observed in the SFT chair stand test, dominant arm curl test, two-minute step test, chair sit-and-reach test, back scratch test, and Modified Falls-Efficacy Scale. CONCLUSION: Aquatic exercise provided greater improvement of physical health and QoL among older people than land-based exercise.

scholarly journals Acceptable Functional Outcomes and Patient Satisfaction Following Total Knee Arthroplasty in Asians with Severe Knee Stiffness: A Matched Analysis

2018 ◽  
Vol 10 (3) ◽  
pp. 337 ◽  
Author(s):  
Bryce W Polascik ◽  
Hamid Rahmatullah Bin Abd Razak ◽  
Hwei-Chi Chong ◽  
Ngai-Nung Lo ◽  
Seng-Jin Yeo
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Knee Stiffness ◽  
Total Knee

A Prospective Randomised Control Trial Comparing Functional with Mechanical Axis Alignment in Total Knee Arthroplasty: study protocol for an investigator initiated trial

2021 ◽  
Author(s):  
Richard Steer ◽  
Beth Tippett ◽  
R Nazim Khan ◽  
Dermot Collopy ◽  
Gavin Clark
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Medical Information ◽  
Randomised Control Trial ◽  
Computer Assisted ◽  
Patient Reported ◽  
Total Knee ◽  
Alternative Alignment

Abstract Background: A drive to improve functional outcomes for patients undergoing total knee arthroplasty (TKA) has led to alternative alignment being used. Functional alignment (FA) uses intraoperative soft tissue tension to determine the optimal position of the prosthesis within the patients soft tissue envelope. Angular limits for bone resections are followed to prevent long term prosthesis failure. This study will use the aid of robotic assistance to plan and implement the final prosthesis position. This method has yet to be compared to the traditional mechanically aligned (MA) knee in a randomised trial. Methods: A blinded randomised control trial with 100 patients will be undertaken via Perth Hip and Knee clinic. Fifty patients will undergo a MA TKA and fifty will undergo a FA TKA. Both alignment techniques will be balanced via computer assisted navigation to assess prosthetic gaps, being achieved via the initial bony resection and further soft tissue releases as required to achieve satisfactory balance. The primary outcome will be the forgotten joint score (FJS) two years after surgery, with secondary outcomes being other patient reported outcome measures, clinical functional assessment, radiographic position and complications. Other data that will be collected will be patient demography (Sex, Age, level of activity) and medical information (grade of knee injury, any other relevant medical information). The linear statistical model will be fitted to the response (FJS), including all the other variables as covariates. Discussion: Many surgeons are utilising alternative alignment techniques with a goal of achieving better functional outcomes for their patients. Currently MA TKA remains the gold standard with good outcomes and excellent longevity. There is no published RCTs comparing FA to MA yet and only two registered studies are planned or currently in progress. This study utilizes a FA technique which differs from the two studies. This study will help determine if FA TKA has superior functional results for patients.Trial registration: This trial has been registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) http://www.anzctr.org.au: U1111-1257-2291, registered 25th Jan 2021. It is also listed on www.clinicaltrials.gov: NCT04748510

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