Neuromuscular electrical stimulation allows a slightly better functional recovery after total knee arthroplasty, especially in the first period, with more evident benefits in patients with a severe lack of muscular activation. Nevertheless, there is no difference at medium-long term.
This review focuses on the validity and the effectiveness of rehabilitation techniques and physical therapies before and after total knee arthroplasty (TKA). The intent is to drive surgeons and rehabilitation specialists in the choice of the strategies for the treatment after TKA. The Data sources were MEDLINE, PubMed, CINAHL, EMBASE, and PsychINFO databases using the selected key words. Three authors independently selected studies for review using as criteria English, adults, any clinical population, and intervention for. Among several published studies of rehabilitation after TKA, only a few were based on scientific evidence. Moreover, many studies were heterogeneous and included different outcomes and evaluations. There is consensus that a complete and specific rehabilitation post-operative programme is effective in reducing the length of hospitalisation and the incidence of early complications. However, it is not clear what "complete and specific rehabilitation" may mean: the real efficacy of every specific treatment (continuous passive motion, cryotherapy, magneto therapy, neuro muscular electrical stimulation, whole body vibration, hydrotherapy, pre-operative physiotherapy) is still questionable, and often related to the experience of the authors. In conclusion, patients undergoing physiotherapy obtain a better and faster outcome achievement than non-treated patients; however, evidence-based treatments, protocols and clinical trials are recommended.
Total knee arthroplasty ensures patients a safe recover of function and pain relief. It is performed on millions of patients worldwide. Nevertheless, in a certain percentage of case there is an unexplainable persistence of pain in presence of a well-performed surgery. This is called mystery knee or persistent postsurgical pain (PPSP) and the surgical treatment is difficult since the factors to correct are unknown. Radiofrequencies are used for the treatment of chronic nervous pain and also in some cases of osteoarthritis. They function with well-demonstrated and safe physical and microbiological processes. Therefore, the idea to apply radiofrequencies on one or several nervous braches of the knee (superolateral, superomedia, middle, inferolateral (recurrent), inferomedial and lateral retinacular) is quite interesting and can provide pain relief for this particular group of patients. The procedure is safe and not permanent and can be repeated if necessary. There are not many studies on this topic, but the first results report good outcomes. Costs may be an issue, but once the patient has no pain, the rehabilitation is more effective and the surgery con is postponed or deleted. This review discusses the basis of PPSP after knee surgery, the biological mechanism of action of the radiofrequencies and the clinical application after total knee arthroplasty.
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