• Physical Therapy Rehabilitation Science
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• v.8 no.1
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• pp.8-14
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• 2019

Objective: Degenerative knee arthritis is the most common disease that occurs in older people. Constriction-induced movement therapy (CIMT) has been reported to be as an effective treatment for the impairments, such as asymmetric weight-bearing and reduced balance that occurs after receiving a total knee replacement (TKR). Game-based rehabilitation training for persons with TKR is interesting and provides a variety of feedback. Design: Randomized controlled trial. Methods: Thirty-six subjects with TKR were randomly assigned to either the CIMT game training (n=12), general game training (n=12), or the control (n=12) group. Each group underwent twelve sessions (30 min/d, 3 d/wk for 4 weeks). In the CIMT game training group, the application of CIMT adjusted the weight of the pressure delivered from the two boards used in Wii games. In the general game training group, the game was played without adjusting the weight of pressure. The game training used the Wii Fit's Ski Slalom application. Subjects were assessed with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Activities-specific Balance Confidence (ABC) Scale. Results: All three groups showed significant improvements in pain, stiffness and physical function, total WOMAC scores, and ABC scores after the intervention (p<0.05). Significant differences were observed in physical function, total WOMAC scores, and ABC scores of the CIMT game training group compared with the other groups (p<0.05). Conclusions: The CIMT game training and general game training exhibited improvements on stiffness, but the CIMT game training exhibited a larger effect on lower extremity function and balance confidence levels.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.26 no.1
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• pp.1-8
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• 2020

Background: The aim of this study was to conduct an Otago exercise program with total knee replacement patient (TKR) in a clinical setting and ascertain its effects on balance, walking ability and falls efficacy. Methods: The participating subjects were 30 people who had been diagnosed with TKR. They were assigned to two groups (Exp; Otago exercise and general physical therapy, n=15; Con; balance exercise and general physical therapy, n=15), and the exercises were conducted for three sessions per week for four weeks. The main balance outcomes were evaluated using the timed up and go test (TUG), while walking ability was evaluated using the 10m walk test (10MWT), direction change ability was measured using the figure 8 of walk test (F8WT), and the decrease of fear was evaluated using the modified falls efficacy scale (MFES). Results: In the analysis results, the Exp group showed significant increases in TUG, 10MWT, and F8WT within the both groups. There were significant differences in all variables between the Exp group and the Con group at the post-intervention evaluation, but there was no significant difference between the groups with respect to the TUG. Conclusion: The results of this study demonstrated that Otago exercise would be useful to improve balance and walking for TKR patients who want to improve their abilities and activities of daily living.

• The Journal of the Society of Stroke on Korean Medicine
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• v.14 no.1
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• pp.102-106
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• 2013

■ Objectives The purpose of the this study was to investigate organization change(pennation angle) of lower extremity muscle in elderly with knee osteoarthritis through ultrasonic image. Also, we examined organizational change of muscle was by influenced after total knee replacement(TKR). ■ Methods Rectus femoris image was taken at 50% of the distance between the anterior superior iliac spine and the superior border of the patella. Vastus medialis image was taken at the most distal insertion level of vastus medialis on the medial border of the patella. measurements included the most distal insertion level of the vastus medialis on the medial border of the patella. ■ Results Change of pennation angle in rectus femoris showed decrease from 5.11° in preoperation to 4.29° in 1 week after operation. Change of pennation angle in vastus medialis showed decrease from 6.94° in preoperation to 5.76° in 1 week after operation. ■ Conclusion We consider decrease of pennation angle after total knee replacement in this study was casued by organizational change of muscle and this pennation angle was influenced force created by muscle. Therefore, we thinks that this pennation angle through ultrasonic image will be available to plane individual muscle exercise program and to confirm muscle mass by muscle strength training.

• The Journal of Korean Physical Therapy
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• v.20 no.2
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• pp.11-17
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• 2008

Purpose: This study examined the application of electric stimulation to the auricle acupoint (frequency 2 Hz, stimulation level: noxious) with 30 elderly people over 65 years that received treatment in a rural hospital to determine the influence of pain, gait and balance in the aged with knee joint disease. Methods: The subjects were divided into three groups; the degenerative joint diseases (DJD) group (1 male, 9 females), the total knee replacement (TKR) group (1 male, 9 females) and the control group (1 male, 9 females). Auricualr electrical stimulation (AES) was applied with low frequency, high intensity transcutaneous electrical nerve stimulation for 10 seconds per each point. Results: 1. For the change of pain according to AES, there was interaction in the resting period (p<0.001) and gait (p<0.001) and pain of the DJD group and TKR group was decreased. 2. The range of motion (ROM) of the knee joint showed a significant difference in interaction for each group of elderly people (p<0.001) and the ROM for the DJD group and TKR group of elderly people was increased. 3. In the analysis of gait speed changes, there was a significant difference in interaction for each group of elderly people (p<0.001) and for gait speed in the DJD group and TKR group of elderly people. 4. It was found in the change of static balance that there was a significant difference in interaction for each group of elderly people (p<0.01) and balance capacity in the DJD group and TKR group of elderly people was increased. Conclusion: The aged with knee joint disease have pain, and a decreased function of gait and balance. AES was an excellent treatment for control of pain, and an excellent treatment to enhanced joint functions. AES was useful for improving gait and balance due to decreased pain.

• Journal of Life Science
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• v.14 no.3
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• pp.484-489
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• 2004

Artificial joint replacement is one of the major surgical advances of the 21th century. The primary purpose of a TKA (Total Knee Arthroplasty) is to restore normal knee Auction. Therefore, ideally, a TKA should: (a) maintain the natural leverage of the knee joint muscles to ensure generating adequate knee muscle moments to accomplish daily tasks such as rising from a chair or climbing stairs;(b) allow the same range of motion as an complete knee; and (c) provide adequate knee joint stability. Four individuals (2 peoples after surgery one year and 2 peoples after surgery three years) participated in this study. All they were prescreened for health and functional status by the same surgeon who performed the operations. Two days of accommodation practice occurred prior to the actual strength testing. The isometric strength (KIN-COM III) of the quadriceps and hamstring were measured at 60$^\circ$ and 30$^\circ$ of knee flexion, respectively. During isokinetic concentric testing, the range of motion was between 10$^\circ$ to 80$^\circ$ of knee flexion (stand-to-sit) and extension (sit-to-stand). for a given test, the trial exhibiting maximum torque was analyzed. A 16-channel MYOPACTM EMG system (Run Technologies, Inc.) was used to collect the differential input surface electromyographic (EMG) signals of the vastus medialis (VM), vastus lateralis(VL), rectus femoris (RF) during sit-to-stand and stand-to-sit tests. Disposable electrodes (Blue SensorTM, Medicotest, Inc.) were used to collect the EMG signals. The results were as follows; 1. Less maximum concentric (16% and 21% less for 1 yew man and 3 years mm, respectively) and isometric (12% and 29%, respectively) quadriceps torque for both participants. 2.14% less maximum hamstrings concentric torque for 1 year man but 16% greater torque for 3 years mm. However, 1 year man had similar hamstring isometric peak torque for both knees. 3. Less quadriceps co-contraction by 1 year man except for the VM at 10$^\circ$-20$^\circ$ and 30$^\circ$-50$^\circ$ range of knee flexion.

• Journal of Biomedical Engineering Research
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• v.28 no.1
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• pp.108-116
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• 2007

Recently, it has been reported that the posterior stabilized implant, which is clinically used for the total knee replacement (TKR), may have failure risk such as wear or fracture by the contact pressure and stress on the tibial post. The purpose of this study is to investigate the influence of the mal alignment of the posterior stabilized implant on the tibial post by estimating the distributions of contact pressure and von-Mises stress on a tibial post and to analyze the failure risk of the tibial post. Finite element models of a knee joint and an implant were developed from 1mm slices of CT images and 3D CAD software, respectively. The contact pressure and the von-Mises stress applying on the implant were analyzed by the finite element analysis in the neutral alignment as well as the 8 malalignment cases (3 and 5 degrees of valgus and varus angulations, and 2 and 4 degrees of anterior and posterior tilts). Loading condition at the 40% of one whole gait cycle such as 2000N of compressive load, 25N of anterior-posterior load, and 6.5Nm of torque was applied to the TKR models. Both the maximum contact pressure and the maximum von-Mises stress were concentrated on the anterior-medial region of the tibial post regardless of the malalignment, and their magnitudes increased as the degree of the malalignment increased. From present result, it is shown that the malalignment of the implant can influence on the failure risk of the tibial post.

• Journal of the Korean Academy of Clinical Electrophysiology
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• v.11 no.1
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• pp.39-44
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• 2013

Purpose : The purpose of present study is to evaluate the joint angles of legs in the standing posture for six patients with unilateral knee osteoarthritis. Methods : The participants underwent unilateral total knee replacement. A motion analysis was used to measure the joint angles of the hip, knee, and ankle. The measurements were taken before the surgery, one week and two weeks after the surgery. Both sides of the legs were evaluated. Results : This result showed that after a certain healing period, both hip joint angles showed a significant difference while there was no significant difference in the knee and ankle joint angles. After surgery, the angle of ankle dorsiflexion was smaller on the operated side than the opposite side compared to the pre-surgery measurements. Conclusion : After surgery, the asymmetry in a standing position left unchanged due to contracture of the knee joint and tightness in the hamstring muscle. Therefore, when physiotherapists plan an initial exercise programs for TKR patients, it is essential to apply adequate exercises which consider the contracture of the leg joints.

• Research in Community and Public Health Nursing
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• v.28 no.4
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• pp.494-503
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• 2017

Purpose: This study is to grasp factors influencing the quality of life in older adults after total knee replacement. Methods: This study was conducted with 165 older adults who had TKR at four orthopedic hospitals in D city. Data were analyzed using one-way ANOVA, independent t-test, Pearson's correlation, and stepwise multiple linear regression with SPSS 19.0 software. Results: Pain and depression were negatively correlated with range of motion, social support, while sense of coherence was positively correlated with quality of life. Sense of coherence (43%, ${\beta}=.40$), pain (8%, ${\beta}=-.30$), and depression (3%, ${\beta}=-.20$) on the Physical Component Summary in the quality of life have significant explanatory power of 54%. Sense of coherence (49%, ${\beta}=.44$), social support (6%, ${\beta}=.25$), and depression (3%, ${\beta}=-.22$) on the Mental Component Summary in the quality of life have significant explanatory power of 58%. Conclusion: This study suggests developing a program to improve the quality of life in older adults who had TKR, considering factors such as sense of coherence.

• Archives of Reconstructive Microsurgery
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• v.23 no.2
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• pp.70-75
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• 2014

Purpose: Soft-tissue reconstruction in the knee area requires thin, pliable, and tough skin. The range of motion of the knee also acts as a limitation in using only local flaps for coverage. The author has successfully used various perforator flaps for soft tissue reconstruction around the knee while preserving its functional and cosmetic characteristics. Materials and Methods: Out of the twenty patients assessed from April 2009 to March 2011, seven received anterolateral thigh perforator flaps, four received medial sural perforator island flaps, four received lateral supragenicular perforaor perforator flaps, and five received medial genicular artery flaps. The age of the patients ranged from 44 to 79 and the size of the defects ranged from $4{\times}5cm$ to $17{\times}11cm$. Fifteen of the twenty patients had histories of total knee replacement (TKR) surgery. Results: There were no flap losses in any of the twenty patients assessed. Two patients showed partial losses in the distal area of the flap, but were treated through careful wound care. One patient presented with pedicle adhesion at the drainage site from a past TKR, but it did not hinder the flap survival. Primary closure at the donor site was possible in nine patients, while split skin graft was necessary for the other 13. Conclusion: In soft tissue reconstruction of the knee, various perforator flaps can be used depending on the condition of the preoperation scar, wound site, and size. It also proved to provide better functional and cosmetic results than in primary wound closure or skin grafts.

• Proceedings of the Korean Society of Precision Engineering Conference
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• 2006.05a
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• pp.185-186
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• 2006

Image Guided Surgery(IGS) system has been developed to provide exquisite and objective information to surgeons for surgical operation process. It is necessary that registration technique is important to match between 3D image model reconstructed from image modalities and the object operated by surgeon. Majority techniques of registration in IGS system have been used by recognizing fiducial markers placed on the object. However, this method has been criticized due to its invasive protocol inserting fiducial markers in patient's bone. Therefore, shape-based registration technique using geometric characteristics of the object has been invested to improve the limitation of IGS system. During Total Knee Replacement(TKR) operation, it is challenge to register with high accuracy by using shape-based registration because the area to acquire sample data from knee is limited. We have developed region-based 3D registration technique based on anatomical landmarks on the object and this registration algorithm was evaluated in femur model. It was found that region-based algorithm can improve the accuracy in 3D registration. We expect that this technique can efficiently improve the IGS system.