scholarly journals Effects of balance training on functional outcomes after total knee arthroplasty: a systematic review and meta-analysis of randomized controlled studies

2020 ◽  
Author(s):  
Wang Chen ◽  
Zheng-Hao Hu ◽  
Jian-Ning Sun ◽  
Ye Zhang ◽  
Yu Zhang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Weighted Mean Difference ◽  
Body Height ◽  
Balance Training ◽  
Cochrane Library ◽  
Control Group ◽  
Randomized Controlled Studies ◽  
Total Knee

Abstract Background: Many previous studies have compared the effects of preoperative balance training and non-balance training on daily performance and knee functional outcomes after surgery, however, whether preoperative balance training is more beneficial to patients is still a big debate. Comparing the postoperative joint and daily function of balance training and non-balance training is the main purpose of our study.Methods: Cochrane library, Pubmed and Web of Science databases searched by us, and searched again before submitting our submission. This mete-analysis included 22 studies that directly compared postoperative performance and functional outcomes after training group (TG) and control group (CG). We used the software endnote X9 for data selection, and the software Review Manager 5.3 for data analysis to make funnel plots and forest plots.Results: The pooled data indicated that balance training significantly improved 2/6 MWT (2/6-min walk test) (weighted mean difference (WMD) = 25.17, 95% confidence interval (CI) 12.88 to 37.46, P < 0.0001), gait speed (WMD = 0.15, 95% CI 0.10 to 0.19, P < 0.00001), TUG (timed up and go) (WMD = 1.02, 95% CI 0.75 to 1.29, P < 0.00001), BBS (berg balance scale) (WMD = 1.79, 95% CI 0.50 to 3.08, P = 0.006), FHR (ratio of functional reach distance to body height) (WMD = 9.34, 95% CI 6.69 to 11.98, P < 0.00001), TCS (WMD = 1.20, 95% CI 0.86 to 1.53, P < 0.00001), early stage vitality (WMD = 14.41, 95% CI 13.53 to 15.30, P < 0.00001) and KOOS (Knee Injury and Osteoarthritis Score) sysptoms (WMD = 6.34, 95% CI 2.07 to 10.60, P = 0.004), middle stage function (WMD = 5.85, 95% CI 0.13 to 11.56, P = 0.04).Conclusion: Preoperative balance training improved partial postoperative daily performance and knee functional outcomes in patients with total knee arthroplasty.

scholarly journals The Effect of Comorbidities and Age on Functional Outcomes After Total Knee Arthroplasty in the Octogenarian: A Matched Cohort Study

2018 ◽  
Vol 9 ◽  
pp. 215145931876950 ◽  
Author(s):  
Eric Wei Liang Cher ◽  
Kae Sian Tay ◽  
Karen Zhang ◽  
Seang Beng Tan ◽  
Tet Sen Howe ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Oxford Knee Score ◽  
World Health ◽  
Control Group ◽  
Knee Score ◽  
Life Expectancy At Birth ◽  
Total Knee ◽  
The Impact

Introduction: According to the World Health Organization data repository, the average life expectancy at birth for Singapore in 2015 has risen to 83.4 years, and many octogenarians (OG) remain active socioeconomically. The aim of this study is to compare the improvement and the impact of comorbidities on functional recovery after total knee arthroplasty (TKA) between OG and their younger counterparts. Methods: This is a retrospective study of prospectively collected data from a single institution arthroplasty register. Between January 2006 and December 2011, 209 OG with primary knee osteoarthritis underwent TKA. Each OG (mean age 82 ± 2.1) was then carefully matched to a younger control group (YG, mean age 66 ± 4.5). Their postoperative outcomes measured include Oxford Knee Score (OKS), SF36-Physical Function (SF-PF), and knee society rating score comprising of Knee Score (KS) and Function Score (FS). Their respective degrees of improvement were compared and adjusted for their baseline comorbidities, measured using the Deyo-Charlson Comorbidity Index (D-CCI). Results: There were more comorbidities among the OG ( P < .05). Both groups saw the largest improvement ( P < .05) during the first 6 months. There was no statistical significance between their improvement for OKS, KS, and FS between baseline and 6 months and OKS, FS, and SF-PF between 6 and 24 months. Adjusted for D-CCI using linear regression, the above results remained largely unchanged. Discussion: In our study, both groups showed significant improvement across all functional outcomes, especially during the first 6 months. The improvement observed in OG at 6 and 24 months was comparable to that of YG, despite an overall higher baseline D-CCI. Conclusions: Total knee arthroplasty is a viable treatment option for the OG, offering good functional outcomes and results at 6 and 24 months when compared to their younger counterparts.

scholarly journals Effects of Preoperative Telerehabilitation on Muscle Strength, Range of Motion, and Functional Outcomes in Candidates for Total Knee Arthroplasty: A Single-Blind Randomized Controlled Trial

2021 ◽  
Vol 18 (11) ◽  
pp. 6071
Author(s):  
Jung-Ae An ◽  
Ho-Kwang Ryu ◽  
Suk-Joo Lyu ◽  
Hyuk-Jong Yi ◽  
Byoung-Hee Lee
Keyword(s):  
Total Knee Arthroplasty ◽  
Muscle Strength ◽  
Range Of Motion ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Peak Torque ◽  
Test Time ◽  
Control Group ◽  
Womac Pain ◽  
Total Knee

This study aims to investigate the effect of a preoperative telerehabilitation (PT) program on muscle strength, knee range of motion (ROM), and functional outcomes in candidates for total knee arthroplasty (TKA). Sixty patients (all women, mean age 70.53 ± 2.7 years) scheduled for bilateral TKA participated in this study. The PT and preoperative patient education (PE) groups participated in a 3-week intensive exercise program (30 min/session, 2 times/day, 5 days/week), whereas the control group received the usual care before TKA. Quadriceps muscle strength, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), ROM of knee flexion, pain, and time up-and-go (TUG) test time were evaluated at 4 weeks preoperatively, post-interventionally, and 6 weeks after TKA. Significant differences were found in the time-by-group interaction for 60°/s extension peak torque [F(4, 100) = 2.499, p < 0.047, η2p = 0.91], 180°/s extension peak torque [F(4, 100) = 3.583, p < 0.009, η2p = 0.125], ROM [F(4, 100) = 4.689, p < 0.002, η2p = 0.158], TUG time [F(4, 100) = 7.252, p < 0.001, η2p = 0.225], WOMAC pain [F(4, 100) = 9.113, p < 0.001, η2p = 0.267], WOMAC functional outcome [F(4, 100) = 6.579, p < 0.001, η2p = 0.208], and WOMAC total score [F(4, 100) = 10.410, p < 0.001, η2p = 0.294]. The results of this study demonstrate the early benefits of a PT program in elderly female patients with end-stage osteoarthritis. The PT program improved muscle strength, ROM, and functional outcomes before TKA, which contributed to better functional recovery after TKA.

scholarly journals The role of perioperative intravenous low-dose dexamethasone in rapid recovery after total knee arthroplasty: a meta-analysis

2021 ◽  
Vol 49 (3) ◽  
pp. 030006052199822
Author(s):  
Youguang Zhuo ◽  
Rongguo Yu ◽  
Chunling Wu ◽  
Yuting Huang ◽  
Jie Ye ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Low Dose ◽  
Meta Analysis ◽  
Postoperative Nausea And Vomiting ◽  
Opioid Consumption ◽  
Cochrane Library ◽  
China National Knowledge Infrastructure ◽  
Postoperative Rehabilitation ◽  
Total Knee

Purpose The purpose of this meta-analysis was to evaluate the overall safety and effectiveness of perioperative intravenous dexamethasone to facilitate postoperative rehabilitation in patients after total knee arthroplasty (TKA). Methods A comprehensive literature search was performed using the Embase, PubMed, Cochrane Library, and China National Knowledge Infrastructure (CNKI) databases for relevant randomized controlled trials (RCTs) from inception to 2020. Methodological quality of the trials was assessed using the Cochrane Risk of Bias Tool, and the relevant data were extracted using a predefined data extraction form. Results Ten RCTs with 1100 knees were included. Our study showed a significant reduction in pain using a postoperative pain visual analog scale (VAS) at 24 hours and 48 hours, total opioid consumption at 24 hours and 48 hours, postoperative nausea and vomiting (PONV), active range of motion (ROM) limitation, and passive ROM limitation at 72 hours in dexamethasone-treated groups compared with controls. Conclusion Intravenous low-dose dexamethasone is potentially useful in the perioperative setting for reducing postsurgical immediate ROM limitations, pain, opioid consumption, and PONV. There are no data that directly attribute an increase in postoperative complications to intravenous dexamethasone. More high-quality studies are necessary to draw these conclusions.

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

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.

scholarly journals Reporting of post-operative rehabilitation interventions for Total knee arthroplasty: a scoping review

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Nora Bakaa ◽  
Lu Hsi Chen ◽  
Lisa Carlesso ◽  
Julie Richardson ◽  
Luciana Macedo
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Scoping Review ◽  
Literature Search ◽  
Exercise Adherence ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Quality Of Reporting ◽  
Exercise Interventions ◽  
Total Knee

Abstract Objective The aim of this study was to evaluate the completeness of reporting of exercise adherence and exercise interventions delivered as part of clinical trials of post-operative total knee replacement (TKA) rehabilitation. Design: Scoping review Literature search A literature search was conducted in PubMed, EMBASE, AMED, CINAHL, SPORTDiscus and Cochrane Library. Study selection criteria All randomized controlled trials (RCT) that examined post-operative exercise-based interventions for total knee arthroplasty were eligible for inclusion. Studies that were multifactorial or contained exercise interventions for both hip and knee arthroplasty were also included. Data synthesis The definition, type of measurement used and outcome for exercise adherence were collected and analyzed descreptively. Quality of reporting of exercise interventions were assessed using the Consensus for Exercise Reporting Tool (CERT) and the Cochrane Risk of Bias Tool. Results There were a total of 112 RCTs included in this review. The majority of RCTs (63%, n = 71) did not report exercise adherence. Only 23% (n = 15) of studies provided a definition of adherence. RCTs were of poor quality, with 85% (n = 95) of studies having high or unclear risk of bias. Reporting of exercise interventions was poor, with only 4 items (of 19) (21%) of the CERT adequately reported (88–99%), with other items not fulfilled on at least 60% of the RCTs. There were no RCTs that had fulfilled all the criteria for the CERT. Conclusion The RCTs included in this study poorly reported exercise adherence, as well as description of the post-operative TKA rehabilitation intervention. Future RCTs should use valid and reliable measures of adherence and a proper tool for reporting of exercise interventions (e.g., CERT, TiDER). Pre-registration OSF:https://osf.io/9ku8a/

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.

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