Knee-Extension Training with a Single-Joint Hybrid Assistive Limb during the Early Postoperative Period after Total Knee Arthroplasty in a Patient with Osteoarthritis

Abstract

The knee range of motion is an important outcome of total knee arthroplasty (TKA). According to previous studies, the knee range of motion temporarily decreases for approximately 1 month after TKA due to postoperative pain and quadriceps dysfunction following surgical invasion into the knee extensor mechanism. We describe our experience with a knee-extension training program based on a single-joint hybrid assistive limb (HAL-SJ, Cyberdyne Inc., Tsukuba, Japan) during the acute recovery phase after TKA. HAL-SJ is a wearable robot suit that facilitates the voluntary control of knee joint motion. A 76-year-old man underwent HAL-SJ-based knee-extension training, which enabled him to perform knee function training during the acute phase after TKA without causing increased pain. Thus, he regained the ability to fully extend his knee postoperatively. HAL-SJ-based knee-extension training can be used as a novel post-TKA rehabilitation modality.

Robotic device-assisted knee extension training during the early postoperative period after opening wedge high tibial osteotomy: a case report

“…We previously reported the case of a patient who underwent three sessions of knee extension training using the HAL-SJ as part of the inpatient acute rehabilitation program after TKA, and we also found in that case that HAL-SJ-assisted training was safe and feasible [ 7 ]. In the present application of HAL-SJ training following OWHTO, the patient’s knee pain increased after three of the six sessions (sessions 1, 3, and 5), but the intervention was not stopped because of the increase in pain, and the patient completed all six training sessions.…”

“…The HAL-SJ treatment program was divided into five phases [ 7 ]. Phase 1 consisted of preoperative observation from the day of hospital admission until the day of surgery.…”

“…For this purpose, it is desirable to develop new rehabilitation intervention strategies that can be implemented during the early postoperative period without increasing anterior knee pain. Our previous case report described knee joint extension training using the single-joint hybrid assistive limb device (HAL-SJ; Cyberdyne Inc., Tsukuba, Japan) to provide rehabilitation treatment targeted to improving knee joint function after TKA [ 7 ]. In this previously described case, we obtained immediate improvement of the extension lag (EL) without increasing knee pain [ 7 ].…”

“…Our previous case report described knee joint extension training using the single-joint hybrid assistive limb device (HAL-SJ; Cyberdyne Inc., Tsukuba, Japan) to provide rehabilitation treatment targeted to improving knee joint function after TKA [ 7 ]. In this previously described case, we obtained immediate improvement of the extension lag (EL) without increasing knee pain [ 7 ]. The HAL-SJ is a wearable robotic device that facilitates the voluntary control of knee joint motion.…”

Shoulder motion assistance using a single-joint Hybrid Assistive Limb® robot: Evaluation of its safety and validity in healthy adults

“…The HAL is very compact and has been successfully used for active ROM support after knee joint replacement surgery. 12 Based on this evidence, the single-joint HAL could facilitate shoulder movement. However, to assist with shoulder flexion-extension, the proximal arm of the robot would need to be affixed to the trunk, which is difficult to achieve reliably.…”