Effect of an Innovative Biofeedback Insole on Patient Rehabilitation after Total Knee Arthroplasty

Edoardo Bori,Michele Merlini,Bernardo Innocenti,Gianluca Castellarin,Raffaella Riso,Giulia Bettinelli

doi:10.3390/app12052456

Abstract

Partial weight bearing is fundamental to rehabilitation in the early stages following lower limb surgery. However, it remains debated as to how to properly achieve partial weight bearing while avoiding complications from excessive or premature load. Of the devices currently on the market, instrumented insoles coupled with force-sensitive resistors (FSRs) are among the best options in today’s clinical practice. Still, although several of these systems have been developed in the last few years, only some have been validated, leaving insufficient information on their application in rehabilitation after total knee replacement (TKR). To address this research gap, we evaluated the performance of an innovative biofeedback insole system featuring an extremely low response time for real-time force feedback. We randomly recruited 30 patients who underwent total knee arthroplasty. All patients used the new programmable insole for partial weight bearing per post-operative rehabilitation protocol. Our results confirm their inability to perform a correct gait with low partial weight bearing (<30–50% of their bodyweight). Partial weight bearing with a correct gait in the post-operative period is not obtainable without a measuring system. This new biofeedback insole is thus one of the most indicated and can improve rehabilitation compliance, therefore allowing continual patient monitoring for faster discharge and fast-track rehabilitation.

Highlights

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Proper observation of patients’ weight bearing is difficult to attain after lower limb surgery as it is challenging to control their compliance with the recommended rehabilitation protocol in a domestic and active functional environment
In order for any possible confounding factors to be reduced, the patients were operated on by the same surgeon (G.C.) using the same surgical technique, which consists of an extra medullary guide (EMAS) already described in previously published papers [15,16], the same approach, and the same prosthesis (Genus mobile bearing knee with LS insert, Adler Ortho SpA, Cormano, Italy) [15–18]

Summary

Introduction

Proper observation of patients’ weight bearing is difficult to attain after lower limb surgery as it is challenging to control their compliance with the recommended rehabilitation protocol in a domestic and active functional environment. It is well known that after major lower limb surgery, such as total hip or knee arthroplasty, the load on the affected limb is at least always >30% of the patient’s bodyweight, leading to possible loosening or failure of the prostheses [1–6]. Any lower limb surgery (from the femur to the foot), either elective or traumatologic, is followed by a partial weight bearing (PWB) period on the treated limb, which has multiple aims widely described and analyzed in the literature [4]. The PWB period prevents prolonged discharge (non–weight bearing) and related complications on the operated limb [2–8]

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Conclusion