The effects of preoperative rehabilitation on pain and functional outcome after total knee arthroplasty: a meta-analysis of randomized controlled trials

Su, Wei; Zhou, Yang; Qiu, Hailing; Wu, Hui

doi:10.1186/s13018-022-03066-9

Cited by 17 publications

(14 citation statements)

References 38 publications

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“…Compared with the P group (placebo), the IVSPAS group had significantly better rehabilitation parameters, including active range of knee flexion on POD3, muscle power on POD2 and POD3, walking distance on the first 3 PODs, and EMS and QoR scores on POD1. These improvements in rehabilitation and recovery parameters may have contributed to the higher percentage of patients who were discharged home in the IVSPAS group than in the P group, which has also been found in previous studies [25][26][27][28] . IVS was also demonstrated to be superior to placebo in reducing pain.…”

Section: Discussionsupporting

confidence: 78%

Pain Relief After Total Knee Arthroplasty with Intravenous and Periarticular Corticosteroid

Chan

Mak

et al. 2023

Journal of Bone and Joint Surgery

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Background:Total knee arthroplasty (TKA) is a cost-effective procedure, but it is also associated with substantial postoperative pain. The present study aimed to compare pain relief and functional recovery after TKA among groups that received intravenous corticosteroids, periarticular corticosteroids, or a combination of both.Methods:This randomized, double-blinded clinical trial in a local institution in Hong Kong recruited 178 patients who underwent primary unilateral TKA. Six of these patients were excluded because of changes in surgical technique; 4, because of their hepatitis B status; 2, because of a history of peptic ulcer; and 2, because they declined to participate in the study. Patients were randomized 1:1:1:1 to receive placebo (P), intravenous corticosteroids (IVS), periarticular corticosteroids (PAS), or a combination of intravenous and periarticular corticosteroids (IVSPAS).Results:The pain scores at rest were significantly lower in the IVSPAS group than in the P group over the first 48 hours (p = 0.034) and 72 hours (p = 0.043) postoperatively. The pain scores during movement were also significantly lower in the IVS and IVSPAS groups than in the P group over the first 24, 48, and 72 hours (p ≤ 0.023 for all). The flexion range of the operatively treated knee was significantly better in the IVSPAS group than in the P group on postoperative day 3 (p = 0.027). Quadriceps power was also greater in the IVSPAS group than in the P group on postoperative days 2 (p = 0.005) and 3 (p = 0.007). Patients in the IVSPAS group were able to walk significantly further than patients in the P group in the first 3 postoperative days (p ≤ 0.003). Patients in the IVSPAS group also had a higher score on the Elderly Mobility Scale than those in the P group (p = 0.036).Conclusions:IVS and IVSPAS yielded similar pain relief, but IVSPAS yielded a larger number of rehabilitation parameters that were significantly better than those in the P group. This study provides new insights into pain management and postoperative rehabilitation following TKA.Level of Evidence:Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionsupporting

confidence: 78%

Pain Relief After Total Knee Arthroplasty with Intravenous and Periarticular Corticosteroid

Chan

Mak

et al. 2023

Journal of Bone and Joint Surgery

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“…In recent years, the practice of prehabilitation has started gaining traction within the field of orthopedics. However, there remains a lack of consensus regarding its ability to expedite patient recovery ( 44 , 45 ). In the future, standard nursing procedures for preoperative rehabilitation should be explored for patients undergoing cervical spine surgery.…”

Section: Discussionmentioning

confidence: 99%

Assessing multidisciplinary follow-up pattern efficiency and cost in follow-up care for patients in cervical spondylosis surgery: a non-randomized controlled study

Fu,

Xie,

et al. 2024

Front. Med.

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BackgroundThe use of multidisciplinary treatment programs in out-of-hospital healthcare is a new area of research. Little is known about the benefits of this method in the management of discharged patients undergoing cervical spondylosis surgery.ObjectiveThis study aimed to explore the effect of a contracted-based, multidisciplinary follow-up plan in patients after cervical spondylosis surgery.MethodsThis non-blinded non-randomized controlled study was conducted with 88 patients (44 in the intervention group, 44 in the control group). The clinical outcomes, including Neck Disability Index (NDI), pain score (VAS), Self-Efficacy for Managing Chronic Disease 6-item Scale (SECD-6), and 12-Item Short-Form Health Survey (SF-12) score were assessed at the time of discharge, 24–72 h, 1 month, and 3 months post-discharge. The complications, patient satisfaction, and economic indicators were assessed at the final follow-up (3 months).ResultsPatients who received contracted follow-up showed greater improvement in neck dysfunction at 24–72 h, 1 month, and 3 months after discharge compared to those who received routine follow-up (p < 0.001). At 1 month after discharge, the intervention group exhibited better self-efficacy (p = 0.001) and quality of life (p < 0.001) than the control group, and these improvements lasted for 3 months. The intervention group reported lower pain scores at 24–72 h and 1 month (p = 0.008; p = 0.026) compared to the control group. The incidence of complications was significantly lower in the intervention group (11.4%) compared to the control group (40.9%). The total satisfaction score was significant difference between the two groups (p < 0.001). Additionally, the intervention group had lower direct medical costs (p < 0.001), direct non-medical costs (p = 0.035), and total costs (p = 0.04) compared to the control group. However, there was no statistically significant difference in indirect costs between the two groups (p = 0.59).ConclusionA multidisciplinary contract follow-up plan has significant advantages regarding neck disability, self-efficacy, quality of life, postoperative complications, patient satisfaction, and direct costs compared with routine follow-up.

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“…In arthrofibrosis management, every effort should be made to prevent this complication. According to a metaanalysis of 19 randomized controlled trials (RCTs), preoperative rehabilitation used to improve strength and ROM before surgery significantly improved knee flexion after arthroplasty, but resulted in no differences in overall ROM or knee extension 120 . Other preventative measures may be robotic-assisted TKA, which has demonstrated superior softtissue protection that may ultimately minimize inflammation [121][122][123] .…”

Section: Nonpharmacological Prevention Strategiesmentioning

confidence: 99%

Arthrofibrosis After Total Knee Arthroplasty

Ramos,

Pasqualini,

Surace

et al. 2023

JBJS Reviews

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» Arthrofibrosis after total knee arthroplasty (TKA) is the new formation of excessive scar tissue that results in limited ROM, pain, and functional deficits.» The diagnosis of arthrofibrosis is based on the patient's history, clinical examination, absence of alternative diagnoses from diagnostic testing, and operative findings. Imaging is helpful in ruling out specific causes of stiffness after TKA. A biopsy is not indicated, and no biomarkers of arthrofibrosis exist.» Arthrofibrosis pathophysiology is multifactorial and related to aberrant activation and proliferation of myofibroblasts that primarily deposit type I collagen in response to a proinflammatory environment. Transforming growth factor-beta signaling is the best established pathway involved in arthrofibrosis after TKA.» Management includes both nonoperative and operative modalities. Physical therapy is most used while revision arthroplasty is typically reserved as a last resort. Additional investigation into specific pathophysiologic mechanisms can better inform targeted therapeutics.

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The effects of preoperative rehabilitation on pain and functional outcome after total knee arthroplasty: a meta-analysis of randomized controlled trials

Cited by 17 publications

References 38 publications

Pain Relief After Total Knee Arthroplasty with Intravenous and Periarticular Corticosteroid

Pain Relief After Total Knee Arthroplasty with Intravenous and Periarticular Corticosteroid

Assessing multidisciplinary follow-up pattern efficiency and cost in follow-up care for patients in cervical spondylosis surgery: a non-randomized controlled study

Arthrofibrosis After Total Knee Arthroplasty

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