• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.27 no.1
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• pp.51-62
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• 2021

Background: The purpose of this study was conducted to investigate the effects of the ankle mobilization with movement (MWM) technique on ankle dorsiflexion range of motion (ROM), balance, and gait in patients who underwent total knee replacement (TKR). Methods: Thirty patients with knee osteoarthritis were recruited and randomly divided into two groups: the experimental group (EG; n=15) and the control group (CG; n=15). For five days a week for 3 weeks, participants in the EG were treated with the ankle MWM technique and traditional total knee replacement (TKR) exercise, and those in the CG only performed traditional TKR exercises. The dorsiflexion ROM, balance, and gait of the patients were before and after exercise. Results: Balance system SD was used compare changes in dynamic balance. Patients in the EG group showed statistically significant differences after the intervention (p<.05). In addition, there was a statistically significant difference in dynamic balance between the EG and CG groups after the intervention (p<.05). STT-IBS was used to compare changes in velocity, step length, stride length, and ankle dorsiflexion ROM. Patients in the EG group showed statistically significant differences after the intervention (p<.05). In addition, there was a statistically significant difference in the velocity, step length, stride length, and ankle dorsiflexion ROM between the EC and CG groups after the intervention (p<.05). Conclusion: Our results showed that applying the ankle MWM technique with traditional TKR exercises improved ankle dorsiflexion ROM, dynamic balance, and gait in patients.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.27 no.2
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• pp.55-67
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• 2021

Background: This study aimed to use the muscle energy technique (MET) with total knee replacement (TKR) during the chronic phase in a clinical setting and confirm its effects on the knee extensor strength and ROM, balance, and walking ability. Methods: A total of 20 female patients who underwent TKR 1~4 years ago were assigned to two groups (Control: Q setting exercise+general physical therapy, n=10; Exp: MET+general physical therapy, n=10). Interventions were performed three times a week for 4 weeks. The strength of the knee extensor was evaluated using an aneroid sphygmomanometer, and ROM was evaluated using degrees at the end range on active knee flexion. The main balance outcomes were evaluated using two standard scale (TSS) and timed up and go (TUG) test, whereas the walking ability was evaluated using the 10 meter walk test (10MWT). Results: Analysis showed that both groups had significant increases in strength, ROM, TSS, TUG, and 10MWT. Differences in all variables were significant between the control and Exp groups at the post-intervention evaluation (p<.05). However, no significant difference was observed in strength and TUG. Conclusion: Results of this study demonstrated that MET would help improve the strength, ROM, balance, and walking ability of patients with chronic TKR who want to enhance their abilities and performance in activities of daily living.

• Journal of Korean Medicine Rehabilitation
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• v.29 no.3
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• pp.51-60
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• 2019

Objectives Osteoarthritis is hard to manage with both conventional and Korean medicine treatment. The core outcome set (COS) to demonstrate the effectiveness of Korean medicine treatment has not been established yet. We aimed to present preliminary data of COS by performing a literature review on the evaluation indices used in existing clinical research. Methods We examined the literature from 2000 to 2017 in two Korean electronic databases (Korea citation index and oriental medicine advanced searching integrated system) by searching for the following 3 terms 'total knee replacement (Korean)', 'total knee replacement,' and 'knee surgery.' We found 333 articles; among them, 50 duplicates were removed. Finally, we selected 160 articles after complete screening. We then extracted measured indices and clinical outcomes from the selected articles and categorized the relevant criteria. Results According to this study, the hospital for special surgery and knee society, range of movement angle, cross leg, Berg balance scale and balance ability, muscle strength, 6 minutes walking test, visual analogue scale, self-efficacy, the 12-item and 36-item short form survey and self-rated health status are the most commonly used outcomes of knee. Conclusions This study found that the several categories after total knee replacement (TKR) are being evaluated in the literature, and we were able to verify the most frequently used evaluation indices in these categories. The results of this study will be used to establish evaluation indices for the treatment of TKR in the future using Korean medicine.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.24 no.1
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• pp.77-83
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• 2018

Background: The purpose of this study is to investigate that effect of manual therapy using pelvic compression belt on hip abductor strength and balance ability in total knee replacement (TKR) patients. Methods: The subjects consisted of twenty two post-TKR patients. Participants were randomly assigned to a pelvic belt group (n=11) and a placebo group (n=11). All participants underwent manual therapy including range of motion exercise, soft tissue mobilization around knee joint, strengthening exercise (Quad set, SLR, sidelying hip abduction, standing hamstring curls, sitting knee extension, step-up, wall slide to $45^{\circ}$ knee flexion). Manual therapy was executed five times a week for 2 weeks. Outcome measures included hip abductor strength by using Biodex system 4 pro, anterior to posterior balance, medial to lateral balance, total balance by using Biodex balance system SD. Results: After the completion of the manual therapy, hip abductor strength was showed statistically significant improvements in pelvic belt group (p<.05). Anterior to posterior balance, medial to lateral balance, total balance were showed statistically significant improvements in pelvic belt group and placebo group (p<.05). There was a statistically significant difference between the two groups in hip abductor strength and there was no statistically significant difference in balance. Conclusions: This results suggest that manual therapy using pelvic compression belt has could be used for selective muscle activation of the hip abductor muscle and has useful in hip abductor strength and balance ability in TKR patients.

• Journal of Korean Physical Therapy Science
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• v.17 no.1_2
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• pp.41-52
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• 2010

Purpose: The purpose of this study was to compare the effects of continuous passive motion(CPM) and continuous active motion(CAM) on proprioception of the knee after total knee replacement(TKR). Methods: Twenty patients with TKR were randomly allocated into two groups, the CPM group(n=10) and the CAM group(n=10). All subjects were evaluated for levels of pain, passive range of motion and angle reproduction of the knee. An angle reproduction test was used to assess the proprioceptive deficit. Two types of angle reproduction test were used: a passive angle reproduction(PAR) test and an active angle reproduction(AAR) test. The relevant examinations were performed before and after intervention(on the 5th day and the 10th day). The statistical significance were calculated using a t-test and a one-way repeated ANOVA. Results: A pre-intervention significant difference was not found between the two groups. Significantly better results were before and after the intervention at 10 days, for the PAR(flexion direction) test; however, only in the CAM group. There were no significant difference, either before or after the intervention, for the AAR test(flexion and extension direction) in both group. Both groups experienced similar levels of pain and passive range of knee motion before and after the intervention. Conclusion: This study revealed that CAM was a better effect to restore position sense of the knee joint after TKR.

• YAKHAK HOEJI
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• v.52 no.2
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• pp.101-110
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• 2008

Total Knee Replacement (TKR) surgery is one of the invasive procedures for patients with late-stage knee joint disorders. In the present study, economic efficiency was compared between uses of the 2nd and 3rd generation cephalosporins for the prophylaxis before and after the surgery using frequency analysis in terms of various factors such as medication costs, the number of days of antibiotic use and hospitalization due to TKR surgery. The results showed that the 3rd generation cephalosporins did not reduce the infection rate and total medication costs, but rather raised antibiotic cost in comparison with the 2nd ones. A frequent use of the 3rd ones is closely related to emergence of resistant bacterial strains. Therefore, we suggest that unnecessary prescriptions for the broad spectrum antibiotics should be avoided.

• Physical Therapy Rehabilitation Science
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• v.8 no.3
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• pp.170-174
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• 2019

Objective: The objective of this study was to investigate the differences in the quality of life between two groups of patients who received or did not receive total knee replacement (TKR) surgery after being diagnosed with knee osteoarthritis (OA), and to investigate changes in the quality of life for persons who had TKR surgery. Design: Cross-sectional study. Methods: The subjects were randomized into a surgery group (n=70) and a non-surgery group (n=65). Subjects were selected from individuals diagnosed with knee OA from Himchan Hospital in Seoul, South Korea. Their sex, age, weight, height, body mass index, unilateral or bilateral, and quality of life were evaluated. Changes in the quality of life was measured using the Short Form-36 Health Survey (SF-36). Seventy out of 135 patients had TKR surgery, and their quality of life was evaluated at 6 months and 12 months after the surgery. Results: SF-36 scores were significantly improved at 6 months and 12 months after the surgery compared to the scores before the surgery (p<0.05). Also, the comparison between 6 and 12 months after surgery showed that the Vitality and Social Function scores in the SF-36 were significantly increased (p<0.05). Conclusions: The findings of this study showed that TKR surgery has a positive effect on the quality of life for persons with knee OA as a therapeutic intervention.

• The Korean Journal of Pain
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• v.21 no.3
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• pp.211-216
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• 2008

Background: Postoperative pain after bilateral total knee replacement (TKR) is expected to be more severe than unilateral TKR. Intravenous patient-controlled analgesia (IV PCA) is less effective than other methods of pain management especially immediately after an operation even though it is an easily controlled method for managing pain. This study was designed to evaluate the effect of femoral nerve blocks combined with IV PCA after bilateral TKR for postoperative pain control. Methods: The patients in group I (n = 20) were given only IV PCA with morphine and group II (n = 20) were given bilateral femoral nerve blocks with 12 ml of 0.25% bupivacaine and epinephrine 1 : 400,000 before extubation followed by an IV PCA. Main outcome measures included numerical rating pain score, cumulative opioid consumption, hourly dose during each time interval, and side effects. Results: The pain score in group II was significantly lower than that in group I immediately after recovery of awareness and at 3, 6, 12 hours postoperatively. Cumulative opioid consumption was significantly decreased in group II during the first 48 hours postoperatively. The hourly dose in group II was also significantly lower than that in group I until 12 hours postoperatively. There was no difference in side effects between the groups. Conclusions: We concluded that bilateral femoral nerve blocks improve analgesia and decrease morphine use during IV PCA after bilateral TKR.

• The Journal of Korean Physical Therapy
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• v.25 no.2
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• pp.81-87
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• 2013

Purpose: The purpose of the current study was to examine the effects of electromyography (EMG)-biofeedback training on lower extremity muscle activity and balance of patients with total knee replacement (TKR). Methods: Subjects were randomly allocated to two groups: experimental and control group. Subjects in the experimental group (n=10) were provided with quadriceps setting exercise by EMG-biofeedback (QSE+BF) and those in the control group were provided with QSE. Subjects in both groups were provided with the respective training programs for 20 minutes per session, five times per week, for a period of six weeks. To test significance, data analysis was performed using repeated-ANOVAs. Results: Statistically significant differences in muscle activity of the rectus femoris muscle and the vastus lateralis, and dynamic balance ability were observed in the experimental group, compared with the control group. In comparison of the muscle activity of the rectus femoris muscle and the vastus lateralis, and dynamic balance ability between different training periods within the groups, both groups showed statistically significant differences. Conclusion: EMG-biofeedback training is effective in improving lower extremity muscle activity and balance ability of patients with TKR, and should be effective in patients with other diseases.

• Physical Therapy Rehabilitation Science
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• v.11 no.1
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• pp.16-23
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• 2022

Objective: This study aimed to investigate the effect of adding hip abductor strengthening to conventional rehabilitation on muscle strength and physical function following total knee replacement (TKR) for knee osteoarthritis. Design: Randomized controlled trial Methods: Thirty-five participants were randomly allocated to exercise groups I (n=18) and II (n=17). Group I underwent hip abductor training and conventional rehabilitation for 30 min per day, 5 days per week for 4 weeks. Group II underwent conventional rehabilitation for 30 min per day, 5 days per week for 4 weeks. The participants in both groups also received continuous passive motion therapy for 15 min per day, 5 days per week for 4 weeks. To investigate the effect of the intervention, the Biodex dynamometer was used to measure the peak torque of both knee extensors and hip abductors. This study used the Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS) to assess physical function, as well as the figure-of-8 walk test (F8W) and the stair climb test (SCT). Results: According to the interventions, exercise groups I and II showed significantly improved muscle strength and KOS-ADLS, F8W, and SCT scores (p<0.001). Compared with that of exercise group II, exercise group I showed significantly improved hip abductor strength (p<0.001) and KOS-ADLS, F8W, and SCT scores (p<0.05). Conclusions: The results of this study indicate that the combination of hip abductor strengthening and conventional rehabilitation is an effective exercise method to increase hip abductor muscle strength and physical function after TKR.