Journal of the Korean Orthopaedic Association (대한정형외과학회지)

Korean Orthopaedic Association (대한정형외과학회)
권호 표지
DOI QR코드

DOI QR Code

Treatment Methods for Functional Recovery after Total Knee Arthroplasty

슬관절 전치환술 후 기능 회복을 위한 치료법

  • Kim, Young-mo (Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine) ;
  • Joo, Yong-bum (Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine) ;
  • Park, Il-young (Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine)
  • 김영모 (충남대학교 의과대학 정형외과학교실, 충남대학교병원 정형외과) ;
  • 주용범 (충남대학교 의과대학 정형외과학교실, 충남대학교병원 정형외과) ;
  • 박일영 (충남대학교 의과대학 정형외과학교실, 충남대학교병원 정형외과)
  • Received : 2019.06.25
  • Accepted : 2019.08.09
  • Published : 2020.04.30
⟨ Previous Next ⟩

Abstract

Total knee arthroplasty is performed widely in degenerative arthritis of the knee joint, and the frequency of use is increasing. Efforts should be made to achieve functional recovery, such as returning to daily life, and the recovery of strength and range of motion after surgery. The procedure should be approached from a range of perspectives, such as patient factors, surgical technique and rehabilitation. The patient's age, degree of obesity, sex, and strength of the quadriceps muscle can affect the functional recovery after surgery. In addition, the patient's mental state, such as expectation value and satisfaction, can also have an effect. For functional recovery, patient education, pain control, and strengthening of the quadriceps muscle can be performed prior to surgery. Postoperative physiotherapy, such as icing and compression, transcutaneous electrical nerve stimulation therapy, neuromuscular electrical stimulation therapy, low frequency low intensity magnetic field therapy, strengthening of quadriceps muscle, and range of motion exercise can also be applied. In recent years, hydrotherapy, which restores the strength and balance of the leg, is being performed increasingly. These treatments are not only performed shortly after surgery, but are also performed continuously. In addition, the surgeon should apply it appropriately considering the patient's condition, compliance, and social and psychological conditions.

슬관절의 퇴행성 관절염에서 슬관절 전치환술은 널리 시행되고 있고 그 빈도도 점점 증가되고 있다. 수술 후 일상생활로의 복귀, 근력 및 운동범위의 회복 등 기능 회복을 위한 노력이 이루어져야 하고 이는 환자 요인, 수술 술기 및 재활 등 다양한 관점에서 접근해야 한다. 환자의 연령이나 비만의 정도, 성별, 대퇴사두근의 근력 등이 수술 후 기능 회복에 영향을 줄 수 있고 환자의 기대치나 만족도 같은 정신적인 상태도 영향을 준다. 기능 회복을 위하여 수술 전부터 환자교육 및 통증 조절, 대퇴사두근 근력의 강화 같은 치료를 시행할 수 있다. 수술 후 냉찜질 및 압박, 경피적 전기 신경 자극 치료, 신경근육 전기 자극 치료, 저주파 저강도 자기장 치료, 대퇴사두근의 근력운동, 관절범위 운동과 같은 물리치료도 적용할 수 있다. 최근에는 수중에서 근력과 균형감각을 회복시키는 수 치료도 점점 시행되는 추세이다. 이런 기능 회복을 위한 치료들은 수술 후 단기적으로만 시행될게 아니라 장기적으로 꾸준히 시행되는 것이 중요하며 술자는 환자의 상태나, 순응도, 사회적, 심리적 상황 등을 고려하여 적절히 적용하여야 한다.

Keywords

References

  1. Park HR, Cho SK, Im SG, et al. Treatment patterns of knee osteoarthritis patients in Korea. Korean J Intern Med. 2019;34:1145-53. https://doi.org/10.3904/kjim.2017.304
  2. Health Insurance Review & Assessment Service. 100 disease statistics in living. Wonju: Health Insurance Review & Assessment Service; 2018 Mar. Report No.: GOOOFJ1-2018-20. 215p.
  3. Franklin PD, Li W, Ayers DC. The Chitranjan Ranawat award: functional outcome after total knee replacement varies with patient attributes. Clin Orthop Relat Res. 2008;466:2597-604. https://doi.org/10.1007/s11999-008-0428-8
  4. Kennedy JW, Johnston L, Cochrane L, Boscainos PJ. Total knee arthroplasty in the elderly: does age affect pain, function or complications? Clin Orthop Relat Res. 2013;471:1964-9. https://doi.org/10.1007/s11999-013-2803-3
  5. Belmar CJ, Barth P, Lonner JH, Lotke PA. Total knee arthroplasty in patients 90 years of age and older. J Arthroplasty. 1999;14:911-4. https://doi.org/10.1016/S0883-5403(99)90002-5
  6. Xu S, Chen JY, Lo NN, et al. The influence of obesity on functional outcome and quality of life after total knee arthroplasty: a ten-year follow-up study. Bone Joint J. 2018;100-B:579-83. https://doi.org/10.1302/0301-620X.100B5.BJJ-2017-1263.R1
  7. Rodriguez-Merchan EC. Review article: outcome of total knee arthroplasty in obese patients. J Orthop Surg (Hong Kong). 2015;23:107-10. https://doi.org/10.1177/230949901502300124
  8. Cho WS, Park JH, Kim JM, Hwang WY, Nam TS. Factors affecting range of motion after total knee arthroplasty. J Korean Orthop Assoc. 2003;38:683-8. https://doi.org/10.4055/jkoa.2003.38.7.683
  9. MacDonald SJ, Charron KD, Bourne RB, Naudie DD, McCalden RW, Rorabeck CH. The john insall award: gender-specific total knee replacement: prospectively collected clinical outcomes. Clin Orthop Relat Res. 2008;466:2612-6. https://doi.org/10.1007/s11999-008-0430-1
  10. McClelland JA, Zeni JA, Snyder-Mackler L. Functional recovery from total knee replacement is different between males and females. Paper presented at: 57th Annual Meeting of the Orthopaedic Research Society; 2011 Jan 13-16; Long Beach, USA.
  11. Hoogeboom TJ, van Meeteren NLU, Schank K, Kim RH, Miner T, Stevens-Lapsley JE. Risk factors for delayed inpatient functional recovery after total knee arthroplasty. BioMed Res Int. 2015;2015:167643 https://doi.org/10.1155/2015/167643
  12. Mizner RL, Petterson SC, Stevens JE, Axe MJ, Snyder-Mackler L. Preoperative quadriceps strength predicts functional ability one year after total knee arthroplasty. J Rheumatol. 2005;32:1533-9.
  13. Ayers DC, Li W, Oatis C, Rosal MC, Franklin PD. Patient-reported outcomes after total knee replacement vary on the basis of preoperative coexisting disease in the lumbar spine and other nonoperatively treated joints: the need for a musculoskeletal comorbidity index. J Bone Joint Surg Am. 2013;95:1833-7. https://doi.org/10.2106/JBJS.L.01007
  14. Harris IA, Harris AM, Naylor JM, Adie S, Mittal R, Dao AT. Discordance between patient and surgeon satisfaction after total joint arthroplasty. J Arthroplasty. 2013;28:722-7. https://doi.org/10.1016/j.arth.2012.07.044
  15. Ghomrawi HM, Franco Ferrando N, Mandl LA, Do H, Noor N, Gonzalez Della Valle A. How often are patient and surgeon recovery expectations for total joint arthroplasty aligned? results of a pilot study. HSS J. 2011;7:229-34. https://doi.org/10.1007/s11420-011-9203-6
  16. Noble PC, Fuller-Lafreniere S, Meftah M, Dwyer MK. Challenges in outcome measurement: discrepancies between patient and provider definitions of success. Clin Orthop Relat Res. 2013;471:3437-45. https://doi.org/10.1007/s11999-013-3198-x
  17. Duivenvoorden T, Vissers MM, Verhaar JA, et al. Anxiety and depressive symptoms before and after total hip and knee arthroplasty: a prospective multicentre study. Osteoarthritis Cartilage. 2013;21:1834-40. https://doi.org/10.1016/j.joca.2013.08.022
  18. Matsuda S, Kawahara S, Okazaki K, Tashiro Y, Iwamoto Y. Postoperative alignment and ROM affect patient satisfaction after TKA. Clin Orthop Relat Res. 2013;471:127-33. https://doi.org/10.1007/s11999-012-2533-y
  19. Fischer HB, Simanski CJ, Sharp C, et al. A procedure-specific systematic review and consensus recommendations for postoperative analgesia following total knee arthroplasty. Anaesthesia. 2008;63:1105-23. https://doi.org/10.1111/j.1365-2044.2008.05565.x
  20. Harsten A, Kehlet H, Toksvig-Larsen S. Recovery after total intravenous general anaesthesia or spinal anaesthesia for total knee arthroplasty: a randomized trial. Br J Anaesth. 2013;111:391-9. https://doi.org/10.1093/bja/aet104
  21. Luring C, Beckmann J, Haibock P, Perlick L, Grifka J, Tingart M. Minimal invasive and computer assisted total knee replacement compared with the conventional technique: a prospective, randomised trial. Knee Surg Sports Traumatol Arthrosc. 2008;16:928-34. https://doi.org/10.1007/s00167-008-0582-2
  22. Choi YJ, Ra HJ. Patient satisfaction after total knee arthroplasty. Knee Surg Relat Res. 2016;28:1-15. https://doi.org/10.5792/ksrr.2016.28.1.1
  23. Holm B, Kristensen MT, Myhrmann L, et al. The role of pain for early rehabilitation in fast track total knee arthroplasty. Disabil Rehabil. 2010;32:300-6. https://doi.org/10.3109/09638280903095965
  24. Halaszynski TM, Juda R, Silverman DG. Optimizing postoperative outcomes with efficient preoperative assessment and management. Crit Care Med. 2004;32:S76-86. https://doi.org/10.1097/01.CCM.0000122046.30687.5C
  25. Cheville A, Chen A, Oster G, McGarry L, Narcessian E. A randomized trial of controlled-release oxycodone during inpatient rehabilitation following unilateral total knee arthroplasty. J Bone Joint Surg Am. 2001;83:572-6.
  26. Ong CK, Lirk P, Seymour RA, Jenkins BJ. The efficacy of preemptive analgesia for acute postoperative pain management: a meta-analysis. Anesth Analg. 2005;100:757-73. https://doi.org/10.1213/01.ANE.0000144428.98767.0E
  27. Sharma S, Iorio R, Specht LM, Davies-Lepie S, Healy WL. Complications of femoral nerve block for total knee arthroplasty. Clin Orthop Relat Res. 2010;468:135-40. https://doi.org/10.1007/s11999-009-1025-1
  28. Kandasami M, Kinninmonth AW, Sarungi M, Baines J, Scott NB. Femoral nerve block for total knee replacement - a word of caution. Knee. 2009;16:98-100. https://doi.org/10.1016/j.knee.2008.10.007
  29. Koh IJ, Kang YG, Chang CB, Do SH, Seong SC, Kim TK. Does periarticular injection have additional pain relieving effects during contemporary multimodal pain control protocols for TKA?: a randomised, controlled study. Knee. 2012;19:253-9. https://doi.org/10.1016/j.knee.2011.03.007
  30. Koh IJ, Kang YG, Chang CB, et al. Additional pain relieving effect of intraoperative periarticular injections after simultaneous bilateral TKA: a randomized, controlled study. Knee Surg Sports Traumatol Arthrosc. 2010;18:916-22. https://doi.org/10.1007/s00167-010-1051-2
  31. Korean Knee Society. Guidelines for the management of postoperative pain after total knee arthroplasty. Knee Surg Relat Res. 2012;24:201-7. https://doi.org/10.5792/ksrr.2012.24.4.201
  32. Mistry JB, Elmallah RD, Bhave A, et al. Rehabilitative guidelines after total knee arthroplasty: a review. J Knee Surg. 2016;29:201-17. https://doi.org/10.1055/s-0036-1579670
  33. Li J, Song Y. Transcutaneous electrical nerve stimulation for postoperative pain control after total knee arthroplasty: a meta-analysis of randomized controlled trials. Medicine (Baltimore). 2017;96:e8036. https://doi.org/10.1097/MD.0000000000008036
  34. Rakel BA, Zimmerman MB, Geasland K, et al. Transcutaneous electrical nerve stimulation for the control of pain during rehabilitation after total knee arthroplasty: a randomized, blinded, placebo-controlled trial. Pain. 2014;155:2599-611. https://doi.org/10.1016/j.pain.2014.09.025
  35. Angulo DL, Colwell CW. Use of postoperative TENS and continuous passive motion following total knee replacement. J Orthop Sports Phys Ther. 1990;11:599-604. https://doi.org/10.2519/jospt.1990.11.12.599
  36. Gotlin RS, Hershkowitz S, Juris PM, Gonzalez EG, Scott WN, Insall JN. Electrical stimulation effect on extensor lag and length of hospital stay after total knee arthroplasty. Arch Phys Med Rehabil. 1994;75:957-9. https://doi.org/10.1016/0003-9993(94)90671-8
  37. Stevens-Lapsley JE, Balter JE, Wolfe P, Eckhoff DG, Kohrt WM. Early neuromuscular electrical stimulation to improve quadriceps muscle strength after total knee arthroplasty: a randomized controlled trial. Phys Ther. 2012;92:210-26. https://doi.org/10.2522/ptj.20110124
  38. Petterson SC, Mizner RL, Stevens JE, et al. Improved function from progressive strengthening interventions after total knee arthroplasty: a randomized clinical trial with an imbedded prospective cohort. Arthritis Rheum. 2009;61:174-83. https://doi.org/10.1002/art.24167
  39. Levine M, McElroy K, Stakich V, Cicco J. Comparing conventional physical therapy rehabilitation with neuromuscular electrical stimulation after TKA. Orthopedics. 2013;36:e319-24.
  40. Adravanti P, Nicoletti S, Setti S, Ampollini A, de Girolamo L. Effect of pulsed electromagnetic field therapy in patients undergoing total knee arthroplasty: a randomised controlled trial. Int Orthop. 2014;38:397-403. https://doi.org/10.1007/s00264-013-2216-7
  41. Moretti B, Notarnicola A, Moretti L, et al. I-ONE therapy in patients undergoing total knee arthroplasty: a prospective, randomized and controlled study. BMC Musculoskelet Disord. 2012;13:88. https://doi.org/10.1186/1471-2474-13-88
  42. van Leeuwen DM, de Ruiter CJ, Nolte PA, de Haan A. Preoperative strength training for elderly patients awaiting total knee arthroplasty. Rehabil Res Pract. 2014;2014:462750.
  43. Skoffer B, Maribo T, Mechlenburg I, Hansen PM, Soballe K, Dalgas U. Efficacy of preoperative progressive resistance training on postoperative outcomes in patients undergoing total knee arthroplasty. Arthritis Care Res (Hoboken). 2016;68:1239-51. https://doi.org/10.1002/acr.22825
  44. Sheppard MS, Westlake SM, McQuarrie A. Continuous passive motion - where are we now? Physiotherapy Canada. 1995;47:36-9.
  45. Brosseau L, Milne S, Wells G, et al. Efficacy of continuous passive motion following total knee arthroplasty: a metaanalysis. J Rheumatol. 2004;31:2251-64.
  46. Woog L, Vandeput C. [Interet de l'utilisation precoce de la mobilisation passive continue apres une prothese totale de genou: comparaison de deux protocoles de reeducation]. Kinesither Rev. 2008;8:38-43. French.
  47. Liao CD, Huang YC, Lin LF, et al. Continuous passive motion and its effects on knee flexion after total knee arthroplasty in patients with knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2016;24:2578-86. https://doi.org/10.1007/s00167-015-3754-x
  48. Johnson DP. The effect of continuous passive motion on wound-healing and joint mobility after knee arthroplasty. J Bone Joint Surg Am. 1990;72:421-6. https://doi.org/10.2106/00004623-199072030-00016
  49. Valtonen A, Poyhonen T, Sipila S, Heinonen A. Effects of aquatic resistance training on mobility limitation and lower-limb impairments after knee replacement. Arch Phys Med Rehabil. 2010;91:833-9. https://doi.org/10.1016/j.apmr.2010.03.002
  50. Rahmann AE, Brauer SG, Nitz JC. A specific inpatient aquatic physiotherapy program improves strength after total hip or knee replacement surgery: a randomized controlled trial. Arch Phys Med Rehabil. 2009;90:745-55. https://doi.org/10.1016/j.apmr.2008.12.011
  51. Liao CD, Liou TH, Huang YY, Huang YC. Effects of balance training on functional outcome after total knee replacement in patients with knee osteoarthritis: a randomized controlled trial. Clin Rehabil. 2013;27:697-709. https://doi.org/10.1177/0269215513476722
  52. Jogi P, Overend TJ, Spaulding SJ, Zecevic A, Kramer JF. Effectiveness of balance exercises in the acute post-operative phase following total hip and knee arthroplasty: A randomized clinical trial. SAGE Open Med. 2015;3:2050312115570769.