Target range of motion for rehabilitation after total knee arthroplasty

Mutsuzaki, Hirotaka; Takeuchi, Ryoko; Mataki, Yuki; Wadano, Yasuyoshi

doi:10.2185/jrm.2923

Cited by 47 publications

(34 citation statements)

References 22 publications

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“…Regarding knee ROM outcomes, the results of knee flexion at 6 months in both groups were comparable to those reported in other studies (97º to 116º) [ 37 ], while active knee extension values were much lower than those found in the literature [ 37 , 41 , 42 ]. This latter difference could be a result of the more demanding position used to measure knee extension—sitting as compared to lying supine—which ultimately hampered direct comparison of the results.…”

Section: Discussionsupporting

confidence: 85%

Medium-Term Outcomes of Digital Versus Conventional Home-Based Rehabilitation After Total Knee Arthroplasty: Prospective, Parallel-Group Feasibility Study

Correia¹,

Nogueira²,

Magalhães³

et al. 2019

JMIR Rehabil Assist Technol

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BackgroundPhysical rehabilitation is recommended after total knee arthroplasty (TKA). With the expected increase in TKA over the next few decades, it is important to find new ways of delivering cost-effective interventions. Technological interventions have been developed with this intent, but only preliminary evidence exists regarding their validity, with short follow-up times.ObjectiveThis study aimed to present the follow-up results of a feasibility study comparing two different home-based programs after TKA: conventional face-to-face sessions and a digital intervention performed through the use of an artificial intelligence-powered biofeedback system under remote clinical monitoring.MethodsThe digital intervention uses a motion tracker allowing 3D movement quantification, a mobile app and a Web portal. This study presents the results of the previous single-center, prospective, parallel-group, feasibility study including an 8-week active treatment stage and further assessments at 3 and 6 months post-TKA. Primary outcome was the Timed Up and Go score, and secondary outcomes were the Knee Osteoarthritis Outcome Scale (KOOS) score and knee range of motion.ResultsA total of 59 patients completed the study (30 in the digital intervention group and 29 in the conventional rehabilitation group) and follow-up assessments. During the active treatment stage, patients in the digital intervention group demonstrated high engagement and satisfaction levels, with an 82% retention rate. Both groups attained clinically relevant improvements from baseline to 6 months post-TKA. At the end of the 8-week program, clinical outcomes were superior in the digital intervention group. At the 3- and 6-month assessments, the outcomes remained superior for the Timed Up and Go score (P<.001) and all KOOS subscale scores (at 3 months, P<.001 overall; at 6 months, KOOS Symptoms: P=.006, Pain: P=.002, Activities of Daily Living: P=.001, Sports: P=.003, and Quality of Life: P=.001). There was progressive convergence between both groups in terms of the knee range of motion, which remained higher for standing flexion in the digital intervention group than the conventional group at 6 months (P=.01). For the primary outcome, at 6 months, the median difference between groups was 4.87 seconds (95% CI 1.85-7.47), in favor of the digital intervention group.ConclusionsThe present study demonstrates that this novel digital intervention for independent home-based rehabilitation after TKA is feasible, engaging, and capable of maximizing clinical outcomes in comparison to conventional rehabilitation in the short and medium term; in addition, this intervention is far less demanding in terms of human resources.Trial RegistrationClinicalTrials.gov NCT03047252; https://clinicaltrials.gov/ct2/show/NCT03047252

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Section: Discussionsupporting

confidence: 85%

Medium-Term Outcomes of Digital Versus Conventional Home-Based Rehabilitation After Total Knee Arthroplasty: Prospective, Parallel-Group Feasibility Study

Correia¹,

Nogueira²,

Magalhães³

et al. 2019

JMIR Rehabil Assist Technol

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“…Improvement in extension lag at week 2 implies recovery of knee extension, possibly through a potential neuromuscular mechanism [ 8 , 35 ], and might have led to an improvement in the knee extension torque in the HAL group than in the control group, which was observed at weeks 8. In a case report where a HAL-SJ was applied after TKA [ 26 ], the authors suggested that improvement in the extension lag was brought about by the HAL-SJ-mediated promotion of muscle and nerve function in the quadriceps muscle. Due to the assistance during knee motion, the extension lag during walking decreased, and it was believed that the increase in step length led to an improvement in walking speed.…”

Section: Discussionmentioning

confidence: 99%

“…The surgical procedure was similar to that described in our previous report [ 26 ]. Under general anesthesia, a midline skin incision was made, and a medial parapatellar approach was used.…”

Section: Methodsmentioning

confidence: 99%

Training with Hybrid Assistive Limb for walking function after total knee arthroplasty

et al. 2018

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BackgroundThe Hybrid Assistive Limb (HAL, CYBERDYNE) is a wearable robot that provides assistance to patients while walking, standing, and performing leg movements based on the intended movement of the wearer. We aimed to assess the effect of HAL training on the walking ability, range of motion (ROM), and muscle strength of patients after total knee arthroplasty (TKA) for osteoarthritis and rheumatoid arthritis, and to compare the functional status after HAL training to the conventional training methods after surgery.MethodsNine patients (10 knees) underwent HAL training (mean age 74.1 ± 5.7 years; height 150.4 ± 6.5 cm; weight 61.2 ± 8.9 kg), whereas 10 patients (11 knees) underwent conventional rehabilitation (mean age 78.4 ± 8.0 years; height 150.5 ± 10.0 cm; weight 59.1 ± 9.8 kg). Patients underwent HAL training during 10 to 12 (average 14.4 min a session) sessions over a 4-week period, 1 week after TKA. There was no significant difference in the total physical therapy time including HAL training between the HAL and control groups. Gait speed, step length, ROM, and muscle strength were evaluated.ResultsThe nine patients completed the HAL training sessions without adverse events. The walking speed and step length in the self-selected walking speed condition, and the walking speed in the maximum walking speed condition were greater in the HAL group than in the control group at 4 and 8 weeks (P < 0.05). The step length in the maximum walking speed condition was greater in the HAL group than in the control group at 2, 4, and 8 weeks (P < 0.05). The extension lag and knee pain were lower in the HAL group than in the control group at 2 weeks (P < 0.05). The muscle strength of knee extension in the HAL group was greater than that in the control group at 8 weeks (P < 0.05).ConclusionHAL training after TKA can improve the walking ability, ROM, and muscle strength compared to conventional physical therapy for up to 8 weeks after TKA. Since the recovery of walking ability was earlier in the HAL group than in the control group and adverse events were not observed in this pilot study, HAL training after TKA can be considered a safe and effective rehabilitation intervention.Trial registrationUMIN, UMIN000017623. Registered 19 May 2015

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“…Mutsuzaki et al concluded that post-operative flexion post 12 months of TKA was 113.6±15.3º in their study involving the replacement of 39 knee joints. 15 Anouchi et al showed that the post-operative flexion at 24 months was 107±10 º. This study enrolled 621 patients of whom 282 TKAs had a follow-up of 12 months and 86 have a follow-up of 24 months.…”

Section: Discussionmentioning

confidence: 97%

Increasing range of motion in total knee replacement using novel patellar resection technique

Suryavanshi¹

2020

Int Surg J

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Background: Total knee arthroplasty (TKA) is a surgical procedure designed to alleviate pain and improve function in patients suffering from osteoarthritis. Range of motion is one of the most important factors for patient satisfaction after total knee replacement. The purpose of this study was to assess the effectiveness of a new TKA technique involving patellar resection to enable increased flexion of the knee joint.Methods: Eighty-four patients suffering from osteoarthritis with an indication for conducting TKA underwent the novel procedure. Pre-operative and post-operative flexion measurements were assessed.Results: Mean age of patients participating in this study was 62 years. Males and females were 63% and 37 % of total population respectively. The mean pre-operative and post-operative flexion measurements were 97.39±3.33 º and 131.35±4.27 respectively. The mean in flexion measurements was improved by 33.95±5.30 º (p<0.05). The joint was kinematically stable during full flexion, mid-flexion, and extension.Conclusions: The novel patellar resection technique can be beneficial for the patients. They can able to follow their native lifestyle and perform their daily activities without any hindrance. The mean increase in the range of flexion was 33.95±5.30 º (ranged 30-35 º, p<0.05). This technique allowed patients to have a greater range of flexion as compared to standard and high flexion designs.

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Target range of motion for rehabilitation after total knee arthroplasty

Cited by 47 publications

References 22 publications

Medium-Term Outcomes of Digital Versus Conventional Home-Based Rehabilitation After Total Knee Arthroplasty: Prospective, Parallel-Group Feasibility Study

Medium-Term Outcomes of Digital Versus Conventional Home-Based Rehabilitation After Total Knee Arthroplasty: Prospective, Parallel-Group Feasibility Study

Training with Hybrid Assistive Limb for walking function after total knee arthroplasty

Increasing range of motion in total knee replacement using novel patellar resection technique

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