Prothèse unicompartimentale — Soins post-opératoires et rééducation

Abstract

This work reports postoperative and rehabilitation care provided by 11 teams-the same who attended the round table conference on “Unicompartmental knee prostheses”-. Drug prescription: An anticoagulant is prescribed for 10 days to 3 weeks. A preoperative perfusion of heparin is performed in the operated limb by one team -provided there is a pneumatic tourniquet (the rate of postoperative phlebitis has gone down from 50 to 6%). A course of antiflammatory and antalgic treatment is instituted by infusion for a few days and after this period, at the request of the patient. Postoperative splints: They are widely used. They have an antalgic role (for a 3 to 5 days period). Return to walking can be promoted. The use of postoperative splints must be limited since leads to a limited range of flexion and a loss of function schema. Elastic retention: They are used in two-third of cases. Weight-bearing: On the 2nd or 3rd day, instructions for weight-bearing are as follows:- bearing as completely as possible, - bearing 1/10 to 1/3 of body weight, - taking into account liabilities specific for each individual. Car driving is allowed since crutchers are no longer necessary. Range of knee motion: The goal is to achieve a range of 90° on the 21st day. Rehabilitation program: The selection of techniques will depend upon the clinical progress. Firstly, rehabilitation will be supervised by an independent physiotherapist in clinic and then in his private consulting room. This type of patient is seldom referred to rehabilitation centers. Recovery of strength will occur on weight-bearing and will be promoted by excitomotor electrotherapy. Physiotherapists will promote gait training, proprioception and return to previous function. Risks of complications include stiffness and loss of motor power. An early return to walking and normal function combined with an appropriate rehabilitation program should optimize surgical results.