The Dervan protocol: A new improved rehabilitation protocol for faster recovery of knee replacement surgery

Abstract

Introduction: Osteoarthritis is a progressive disorder of joints caused by gradual loss of cartilage most commonly occurring at knee joint in Indian population. Post-operative physiotherapy is one of the most important pre requisite for further recovery. Traditionally only forward walking is studied, practiced in all rehabilitation protocols. Drawing clues from Yoga and martial arts we have studied the effect of backward walking in post operative rehabilitation of knee replacement patients. Changing basic approach of Rehabilitation has been done for the first time in our knowledge. Materials & Methods: This study was done in Walawalkar Rural Hospital and research centre, Dervan, Ratnagiri, Maharashtra. This was a randomized control study. 34 postoperative Patients were randomized into 2 groups. Pre-Operative and Post-Operative assessment was done with VAS score and Modified Oxford Knee Score at the end of 2 weeks. Results: Backward walking group shows 64.4% additional improvement in post-operative Modified Oxford knee score over forward walking group. There is significant improvement in pain score (VAS) in backward walking group at the end of 2 weeks. Discussion: The above results conclude that backward walking reduces significantly the impact force upon contact, foot contact pattern and lower extremity kinematic pattern. Range of Motion at the knee joint is reduced during backward walking incorporating a nearly isometric pattern following contact compared to a more stressful eccentric loading in the traditional forward walk rehab protocol. This can be especially advantageous for rehabilitation of knee joint surgeries along with better proprioception highlighting beneficial effects of backward walking like strengthening of Anti-gravity muscles, Quadriceps loading, Stretching of Post Capsule.

Dervan simultaneous surgical protocol complete relief of lower limb neuralgic & arthritic pain

“…Site of pain The newly described Dervan Rim Sign was an important tool to note non bone on bone medial compartment arthritis and explain cause of non-bone on bone contact arthritic pain [7] . Counselling, planning & explaining surgical protocol, Rehabilitation as per the Dervan Protocol [8] . Surgical Protocol was planned as per symptoms, evaluation & Radiological imaging [9] .…”

“…Patients are mobilized within 7-8 hours of the surgery as per The Dervan mobilization protocol [8] .…”