Early Postoperative Physiotherapy Research Articles

HPB SO25 - The impact of chest physiotherapy on post-operative recovery from open liver surgery: A quality improvement project

Abstract Background The incidence of postoperative pulmonary complications (PPCs) after open liver surgery is high. Risk factors include age, body mass index, ex- or current smoker, and chronic lung disease. Early postoperative chest physiotherapy (CP), an essential part of any enhanced recovery protocol (ERP), can reduce PPCs, length of stay and healthcare costs. This study evaluated the uptake of CP after open liver surgery and resultant outcomes, following a quality improvement (QI) intervention. Method The project design involved two audit cycles: cycle 1 (C1) and cycle 2 (C2), each of five months duration, of consecutive patients undergoing open liver surgery, before and after a QI intervention (intensive preoperative patient education, poster campaign, increased engagement with physiotherapists regarding the importance of timely CP. Patients undergoing laparoscopic resections were excluded. Outcome measures included whether patients received postoperative CP at all, if so on which post-operative day (POD), for what duration, patient location, incidence of PPCs, and the length of postoperative stay. Statistical analysis was performed using (r 4-4.1) software, using the Chi-squared or Fisher’s Exact test. Results Despite more smokers/ex-smokers in C1(24%) versus C2(8%,p=0.04), only 18/50(36%) C1 patients received CP on POD1, versus 20/36(57%) in C2(p=0.07). Sixteen(32%) C1 patients received no postoperative CP, versus 7(19%) in C2(p=0.19). There were non-significant decreases in PPCs in C2(8%), versus C1(20%)(p=0.13). Three of four patients developing pneumonia in C1, and both those in C2, had no POD1 CP. Wards with higher physiotherapist:patient ratios had more POD1 CP: in C1 12/19(63%)[6/31(20%), p=0.001], and C2 14/15(93%)[6/20(30%) p=0.0001]. Median hospital stay was unchanged (4 days). Conclusion This QI project shows that even with an established enhanced recovery programme, the provision of postoperative chest physiotherapy is not universal. However, it can be improved with an education programme for both healthcare workers and patients.

Analgesic effects of intraarticular anaesthetic lidocaine and methylprednisolone versus methylprednisolone alone following knee arthroscopy.

Knee arthroscopy is a widely practiced orthopaedic procedure known for its minimally invasive approach, allowing quicker recovery times and less postoperative discomfort than traditional open surgeries. However, managing postoperative pain remains a critical aspect of patient care and satisfaction. The main objective of this research is to examine the relationships between patient demographics (age, gender, BMI) and early postoperative outcomes, including pain, physiotherapy, and walking. Randomized data collection, clinical trial study of 2 groups of patients. The patients were split into lidocaine 1 % 16 ml + methylprednisolone 160 mg 4 ml) and (methylprednisolone only 160 mg 4 ml) groups. All patients in both groups were queried about age, gender, BMI, and pain on the first, third, and 15th days following surgery. All patients were tested for physiotherapy on the second, third, and fourth postop days. After surgery, walking was tested on the third, fourth, and fifth days. Significant differences in postoperative pain relief and physiotherapy initiation times were observed. There are notable associations between treatment groups and recovery metrics, such as pain levels and mobility on various days' post-surgery. Significant demographic influences (age, gender, BMI) on recovery outcomes are observed, particularly in walking and pain at day 15 post-operation. lidocaine and methylprednisolone improve postoperative pain relief and functional recovery in knee arthroscopy patients, with most experiencing reduced pain early post-surgery (early physiotherapy) and an expedited return to walking (decreased morbidity). Patients taking just methylprednisolone recovered slower. Age, gender, and BMI affected pain and walking abilities post-operation but not physiotherapy time, underscoring the personalised approach needed in postoperative treatment.

Surgical Treatment of Temporomandibular Joint Ankylosis: our experience with 36 cases.

To evaluate and compare outcomes of patients with temporomandibular joint ankylosis (TMJA) treated by gap arthroplasty, costochondral graft, and total alloplastic joint reconstruction. A retrospective cohort study reviewed and analyzed data from patients with TMJA from January 1, 2009 to December 31, 2019, at the Maxillofacial and Oral Surgery Department, University of the Witwatersrand. Patients with TMJA were treated either with gap arthroplasty, costochondral graft, or total alloplastic joint reconstruction. Data collected included age, sex, etiology of ankylosis, sides involved, preoperation and postoperation mouth opening (MO), treatment type, complications, and revision surgery. Patients were followed up for at least 18 months after the surgical procedure. Comparison of means across the treatment groups was analyzed using paired t tests or analysis of variance test. A P value of less than 0.05 was considered statistically significant. The study sample comprised of 36 patients [bilateral, n=22; unilateral, n=14 (21 male, 15 female)]. Trauma was the most common etiology (n=27, 75%), followed by chronic infections (n=4, 11.11%) and juvenile arthritis (n=3, 8.3%). A paired t test revealed no statistical significance between treatment modality and postoperative MO and complications over 18 months (P=0.5316 and P=0.426, respectively). The mean MO increased from 4 to 28mm. Reankylosis was the most common complication (n=5). All 3 treatment options yield acceptable outcomes in patients with TMJA. Irrespective of surgical technique, early postoperative exercises, active physiotherapy, and follow-up are imperative for successful rehabilitation and prevention of reankylosis.

Post-Operative Analgesia and Enhanced Recovery after Pecs 1 and Pecs 2 Blocks in Patients Undergoing Modified Radical Mastectomy/Breast-Conserving Surgery with Axillary Lymph Nodal Clearance

Background Patients undergoing modified radical mastectomy (MRM)/breast-conserving surgery (BCS) with axillary nodal clearance experience significant post-operative pain, resulting in immobilization and increased usage of analgesics. These factors in turn result in delayed discharge. The pecs 1 and pecs 2 blocks have proven to be of significant benefit in relieving post-operative pain in such patients. Objectives A case series was performed at our institute to note the effects of pecs 1 and pecs 2 blocks on post-operative opioid use, early mobilization of the upper limbs, decreased incidence of early post-operative limb swelling and enhanced recovery after surgery. Material and Methods We included six patients who underwent BCS with axillary lymph node dissection/MRM wherein intraoperative pecs 1 and pecs 2 blocks were used. Patients were given pecs 1 and 2 blocks with 10+20 mL 0.25% injection of bupivacaine under ultrasound guidance after induction. Results In our study, opioids were completely avoided and it was seen that post-operative pain was adequately controlled with single doses of non-steroidal anti-inflammatory drugs if patients received intra-operative pecs 1 and 2 blocks. The pain control was rather sustained and adequate for the institution of early post-operative physiotherapy and thus early discharge and enhancing recovery after surgery. Conclusion Post-operative analgesia provided by pecs 1 and 2 blocks resulted in adequate and sustained pain control for early institution of upper limb physiotherapy and mobilization of patients after MRM/BCS with axillary lymph node dissection, which subsequently results in decreased incidence of early post-operative oedema of limb on operated side and early recovery after surgery.

Chronic Unreduced Anterior Shoulder Dislocation Managed by Latarjet Procedure: A Prospective Study.

The shoulder joint is the most common joint to undergo dislocation, with the anterior subtype being the most common. The most accepted definition of chronic dislocation is a shoulder joint that has remained dislocated for a minimum of three weeks. Due to rare presentation, there is a lack of consensus among surgeons regarding the optimal management option of chronic shoulder dislocation. The goal of this prospective study was to assess the efficacy of open reduction with Latarjet procedure in the management of chronic unreduced shoulder dislocation. A total of seven patients were included in this study. Five patients were males and two were females. The study was conducted in a single tertiary care centre between July 2015 and May 2018. All patients were managed by open reduction with the Latarjet procedure. The capsulolabral structures were repaired in all the cases. The post-operative functional outcome was assessed by shoulder range, Rowe score, and the University of California, Los Angeles (UCLA) score at regular intervals for a period of one year. There was a significant improvement in terms of pain relief and functional status of the patients. The patients were satisfied as they could do their daily routine activities without pain at a one-year follow-up. Early post-operative rehabilitation and physiotherapy are key to improving the functional range.

Prospective study of Intertrochanteric femur fractures managed with proximal femoral nailing

Background: Elderly patients with a minor fall can sustain a fracture in this area because of debilitated bone due to osteoporosis or pathological fracture and this account for 90%. Benefits of intramedullary devices like PFN include preserved blood supply to the bone fragments, less operative blood loss and less disruption of the environment. The study was conducted to determine the union rate, functional outcome and the complication in intertrochanteric fractures treated by PFN. Materials and Methods: A prospective observational study on 30 patients with intertrochanteric fractures were done at a tertiary care centre between April 2018 to March 2019. All patients were managed by proximal femoral nail. The patients were evaluated radiologically and functionally. The radiographic evaluation was done for a minimum of three cortices union on anteroposterior and lateral views. The functional evaluation was done on the basis of Harris Hip Score (HHS).Results: The results of the treatment of stable intertrochanteric fractures using Proximal Femoral Nail were assessed by Harris Hip Score system. Most of the patients were having fair to excellent outcome.Conclusion: we consider that the PFN is a highly accepted minimally invasive implant for unstable proximal femoral fractures but future modification of the implant to avoid Z-effect phenomenon, careful surgical technique and selection of the patients should further reduce its complication rate. Early post-operative ambulation and physiotherapy improves the results of PFN.

Postoperative rehabilitation after total knee joint replacement

Objective:The pilot study objective was to evaluate the effect of comprehensive post-operative physiotherapeutic treatment on the selected physiotherapeutic parameters as well as patients’ quality of life after a total knee joint replacement surgery.
 Results:Thirty patients after total knee joint arthroplasty were enrolled into the pilot study. After completing the physiotherapeutic processes, we have observed among the patients who underwent a total knee replacement surgery, a significant increase in muscle strength as with the flexors as well as the extensors (p = 0.001), improvement in their range of motion in knee joint flexion, in comparison to its range before treatment (p = 0.001), knee pain reduction (p = 0.001) and post-operative swelling (p <0.001), respectively. After undergoing the physiotherapeutic procedures, we recorded a statistically significant improvement in the monitored physical components: dressing (p = 0.008) and toilet use (p = 0.001), transfer from bed to chair (p = 0.008), walking on flat surface (p = 0.001), climbing stairs (p = 0.001). Passing the physiotherapy significantly reduced the degree of dependence of operated patients (p = 0.001).
 Conclusion:Early post-operative physiotherapy treatment positively affects patients’ general condition. In addition, it improves muscle strength, range of motion of the operated joint, eliminates postoperative pain and reduces swelling that improves patients’ self-sufficiency. Standard physiotherapy nowadays and in the next few years will take a unique place in patients’ management after total knee joint replacement.
 Contact:PhDr. Mgr. Michal Vavro, PhD.Vysoká škola zdravotníctva a sociálnej práce sv. Alžbety, n.o. Bratislava; FZaSP sv. Ladislava, ul. Slovenská 11, 940 34 Nové Zámky, Slovenská republika+421 918531658michalkotkd@gmail.com

Clinical study of temporomandibular joint ankylosis & its management

Introduction: TMJ ankylosis is one of the problem at OGH and a challenge both to the Anesthesiologist and the surgeon. Aim: To study the etiology, occurrence in relation to age, sex, side and severity & choice of management of Temporomandibular joint Ankylosis and their outcome. Methodology: This is a study of the cases, which numbered about 15 cases, has been operated in the Department of Plastic Surgery at Osmania General Hospital between 2011 to 2015 and 2017 to 2018 in association with department of Radiology and department of Oral Medicine . The Epidemiology, Causes and Management of Temporomandibular Joint Ankylosis and Outcome are studied in all patients. All these patients had clinical and radiological evidence of bony ankylosis with minimal inter incisor distance pre-operatively. Results: In the present study, the age of presentation in this study was between 10 and 35 years with commonest age being second decade. In this study TMJ Ankylosis was common in females. (female: male=2:1). Childhood trauma was the major cause. Unilateral involvement was more common (5:1) and frequently on left side. Most of the patients presented to the hospital when the mouth opening dropped below 0.5 cm. All the patients were intubated successfully with awake blind nasal intubation. All the patients were routinely extubated when patient was stable. In this study Acrylic ball interpositional arthroplasty in adults was the procedure of choice with no major complications. Average mouth opening achieved in this study was 36mm. Early postoperative physiotherapy with molar bite blocks & active chewing exercises and follow-up is mandatory to prevent recurrence. No recurrence was noticed in this study group. Conclusion: The primary objective of adequate mouth opening which is long lasting is achieved in this series.

Physiotherapy for Simple Mastectomy Following Phyllodes Tumor

Phyllodes tumors are relatively rare breast tumors. Management of these tumors with surgical resection may cause postoperative complications. The purpose of this case study was to define the role of early postoperative physiotherapy in a patient with phyllodes tumor of the breast following simple mastectomy. A 50-year-old woman was brought to the outpatient department following a 1-year history of the lump in the right breast, worsening gradually in the preceding 2 months, and subsequently diagnosed to be a phyllodes tumor. She was treated with simple mastectomy followed by a drain insertion. Postoperatively, she presented with reduced chest expansion and functional mobility and postural impairments. Treatment protocol was set and follow-up was made on the 8th postoperative day. We conclude that early physiotherapy intervention can help in improving the functional mobility and preventing further postoperative complications.

No rest for elderly femur fracture patients: early surgery and early ambulation decrease mortality

BackgroundLiterature has shown a significant correlation between early treatment and mortality in femur fractures, but the influence of time to ambulation on mortality has not been studied. The purpose of the present study is to evaluate whether time to ambulation is correlated to femur fracture mortality independently from time to surgery.Patients and methodsAll patients older than 65 years admitted at a level I trauma center with proximal femoral fracture during a 1-year period were included. The following data were collected: age, gender, date and time of admission to emergency department, height, weight, body mass index, type and side of fracture, ASA score, date and time of surgery, surgical time, time to ambulation, length of hospitalization, death during hospitalization, and mortality at 6 and 12 months.ResultsThe study sample comprises 516 patients. The mean age was 83.6 years; ASA score was 3–5 in 53% of patients; 42.7% presented with medial fracture; mean time between admission and surgery was 48.4 h; 22.7% of patients were not able to walk during the first 10 days after fracture; mean duration of hospitalization was 13 days; and mortality was 17% at 6 months and 25% at 1 year. Early surgery and walking ability at 10 days after trauma were independently and significantly associated with mortality at 6 months (p = 0.014 and 0.002, respectively) and at 1 year (0.027 and 0.009, respectively).ConclusionsEarly surgery in femur fracture became a priority in health systems, but early postoperative physiotherapy also plays a major role in prevention of mortality: independently from surgical timing, patients who did not walk again within 10 days from surgery showed mortality rates higher than those of patients who did.Level of evidenceIV.

A Clinical and Radiological Investigation of the Use of Dermal Fat Graft as an Interpositional Material in Temporomandibular Joint Ankylosis Surgery.

Management of temporomandibular joint (TMJ) ankylosis is mainly through surgical intervention. Interpositional materials are a necessity when it comes to prevention of TMJ re-ankylosis after arthroplasty. Early aggressive postoperative physiotherapy is essential for the prevention or treatment of TMJ hypomobility or ankyloses. Recently, it has been shown that abdominal dermis fat helps promote smooth, pain-free joint function and it is stable after interposition and less prone to fragmentation. The purpose of this study was to assess that whether dermal fat is a good choice of interpositional material when it comes to decreased pain perception during aggressive physiotherapy after release of ankyloses thus ensuring good compliance by the patient. We also assessed the fate of the graft material on computed tomography to evaluate any volume changes if occurred after interposition.

Study of patellar fractures treated with modified tension band technique

Introduction: Patella fractures are common and it constitutes about 1% of all skeletal injuries resulting from either direct or indirect trauma. The subcutaneous location of the patella makes it vulnerable to direct trauma as in dashboard injuries or a fall on the flexed knee, whereas violent contraction of the quadriceps results in indirect fractures of patella. These fractures are usually transverse and are associated with tears of medial or lateral retinacular expansions. In this study a series of 30 cases of fracture patella were studied after treating with Modified Tension Band Wiring technique.Methods: This prospective study was done in Department of Orthopaedics at Balaji Institute of surgery research and rehabilitation for the disabled (BIRRD) Hospital, Tirupati, Andhra Pradesh during the period from November 2013 to May 2015 over a period of one and half year. This study consists of 30 cases of fracture patella treated by modified tension band wiring. The cases were selected based on inclusion and exclusion criteria. Inclusion criteria 1.All closed and type I and type IIopen displaced transverse patellar fractures. 2.Transverse fracture with displacement of more than 2 to 3 mm and articular step of more than 2mm. 3.Comminuted fractures where reconstruction and fixation by modified tension band wiring is possible. Exclusion criteria 1.Type III compound fractures. 2.Grossly comminuted, vertical or marginal fractures. 3.Old fractures (more than 2-3 weeks). 4.Pathological fractures. Conclusion: Our study shows that modified tension band wiring is a definitive procedure in management of displaced transverse patellar fracture with least complications and also helps for early mobilization post-operatively. In our study we observed excellent result in 86.6% and good in about 10% and poor in 3.3% of cases. 4 Out of 30 cases had complications. Early post-operative Physiotherapy is a very essential tool of success in the management of these fractures, which helps in reducing complication like stiffness of knee and in providing good function. Long-term follow up is necessary to assess late complications like osteoarthritis and late functional outcome.

Enhancing early post-operative physiotherapy input to patients undergoing an oesophagectomy: A quality improvement project

Introduction Postoperative pulmonary complications are a serious morbidity following an oesophagectomy with rates as high as 45%. In 2017, a local physiotherapy review identified a high number of patients being diagnosed with significant complications such as post-operative pulmonary complications which increased length of stay, requirement for critical care admissions and need for respiratory physiotherapy. As a result, strategies to reduce PPC rates were proposed. This quality improvement project explored the impact of increasing physiotherapy input during the first three days post oesophagectomy on the incidence of PPCs. Methods A Plan-Do-Study-Act approach was adopted. Following the increase of physiotherapy input to twice daily during the first 3 post-operative days, data was collected over a 6-month period. This data was then compared to previously collected data pre-quality improvement intervention. The primary outcome was post-operative pulmonary complications occurrence, and secondary measures were mobility markers and hospital length of stay. Results Comparison of pre and during quality improvement data demonstrated that despite increased physiotherapy input there was no reduction on the incidence of post-operative pulmonary complications or secondary outcomes. Conclusion Enhancing physiotherapy input in the first 3 post-operative days had no effect on reducing the incidence of post-operative pulmonary complications. Similarly, there was no change in the achievement of mobility markers or hospital length of stay. Further research is now required to explore other interventions such as pre-habilitation, including inspiratory muscle training, and their impact on post-operative pulmonary complications occurrence.

Temporary External Fixation Can Stabilize Hip Transposition Arthroplasty After Resection of Malignant Periacetabular Bone Tumors.

The choice of reconstructive procedure to restore limb function is challenging after internal hemipelvectomy. Hip transposition arthroplasty, also known as resection arthroplasty, removes a malignant or aggressive tumor of the pelvis and acetabulum after which the remaining femoral head is moved proximally to the lateral surface side of the sacrum or the underside of the resected ilium after internal hemipelvectomy. It may provide reasonable functional results and have some advantages such as lowering the risk of an infected implant compared with other reconstructions because no foreign implants are used. Hip transposition is generally managed with prolonged bed rest or immobilization postoperatively to stabilize the soft tissue surrounding the remaining femur. Because enabling patients to be mobile while the soft tissues heal might be advantageous, we reviewed our experience with an external fixation for this procedure. (1) Does temporary external fixation facilitate postoperative physiotherapy in patients who undergo hip transposition arthroplasty? (2) What functional Musculoskeletal Tumor Society (MSTS) scores were achieved at short term in a small series of patients treated with hip transposition and temporary external fixation? (3) What were the complications of using external fixation in a small series of patients who received it for malignant tumors? Between 2008 and 2012, we treated seven patients (three men and four women; median age, 37 years; age range, 18-53 years) with acetabular resection for malignant bone tumors; all were managed with a hip transposition, initially stabilized using external fixation. No other types of procedures were used for this indication in this period. Minimum followup in this retrospective study was 45 months, except for one patient who died at 18 months (range of followup duration, 18-90 months; median followup, 57 months), and no patients were lost to followup. The pins for external fixation were inserted into the affected side of the femur and the healthy contralateral ilium. External fixation was removed 6 weeks postoperatively and weightbearing was started at that time. Preoperative chemotherapy was administrated in four patients, but postoperative chemotherapy was delayed since it was given after external fixation removal in three patients. The postoperative rehabilitation course and functional results were assessed by chart review, functional results were determined using MSTS scores, tallied by physiotherapists who were not part of the surgical team, and complications were ascertained through chart review. Major complications were defined as complications that were treated with additional operations, such as deep infection, or ones that could cause severe postoperative dysfunction, such as nerve injury. With temporary external fixation, standing next to a bed was achieved in median 7 days (range, 6-9 days) postoperatively, transferring to a wheel chair in median 8 days (range, 6-28 days), and gait training using parallel bars in median 15 days (range, 7-48 days). At most recent followup, three patients could walk without a crutch or cane, three could walk with a cane, and one could walk with a crutch. The median MSTS score at most recent followup (median, 57 months) was 63%. Two patients had complications that resulted in reoperations; one had a wound dehiscence, and one had an abdominal herniation that gradually developed, and which was reconstructed using polypropylene mesh 2 years after pelvic resection. Two patients had nerve palsies that recovered by the end of the first year. All patients had pin tract infections that resolved with nonsurgical approaches. Hip transposition with temporary external fixation can stabilize the bone soft tissue after pelvic resection. Although we did not have a comparison group of patients, we believe that external fixation facilitates early postoperative physiotherapy and rehabilitation and provides good functional results without major surgical complications. Because it delays the resumption of chemotherapy, more patients with longer followup are needed to determine whether this will be associated with poorer oncologic results. Level IV, therapeutic study.

A prospective study of functional outcome in intra articular distal humerus fracture treated with dual plating

Background: In adults, distal humerus fractures are uncommon and intra-articular, oftenly involve both the medial and lateral columns. Open reduction and surgical fixation with plating gives good results. The aim of this study is to evaluate clinical outcome in intra articular distal humerus fractures treated with dual plating and evaluate the intermediate term results (minimum follow up of two years) of communited intra-articular distal humerus fractures treated with bicolumnar plating with or without olecranon osteotomy in elderly Indian population. Methods: This is a prospective type of study of 20 cases of supracondylar fracture humerus with inter condylar extension treated surgically with dual plating which were admitted to Jaya Aarogya Hospital & Trauma Center, Gwalior, Madhya Pradesh, between 2015 to 2016. All the patients of supra condylar fracture distal humerus with age between 18 to 60 years with medical fitness for surgery were included in the study. Results: The mean age of the patient was 40±2 years, 12(60%) cases were males, and 8(40%) cases were females. Right sided involvement was more frequent in the present study 13(65%) cases. 14(70%) cases sustained fracture due to road traffic accident, 06(30%) cases had a domestic fall. The average duration of surgery was 94±10 mins. The average duration of the radiological union was 14±06 weeks in 12(60%) cases, 15±04 weeks in 5 (25%) cases, 19±05 weeks in 3 (15%) cases. The outcome was calculated using the ASES and DASH scores. The American shoulder and elbow surgeons score showed excellent in 5 (25%) good in 11 (55%) fair in 4(20%) and no poor outcome. Conclusions: For good functional results, precise preoperative planning, adequate surgical approach, anatomical inter fragmentary stabilization, medial-post erolateral plating, and early post-operative physiotherapy help in restoring painless and functional elbow for distal humeral intra-articular fractures. This step-by-step approach results in satisfactory functional results.

PUREAIR protocol: randomized controlled trial of intensive pulmonary rehabilitation versus standard care in patients undergoing surgical resection for lung cancer

BackgroundNon-small cell lung cancer is the most common type of lung cancer. Surgery is proven to be the most effective treatment in early stages, despite its potential impact on quality of life. Pulmonary rehabilitation, either before or after surgery, is associated with reduced morbidity related symptoms and improved exercise capacity, lung function and quality of life.MethodsWe describe the study protocol for the open-label randomized controlled trial we are conducting on patients affected by primary lung cancer (stages I-II) eligible for surgical treatment. The control group receives standard care consisting in one educational session before surgery and early inpatient postoperative physiotherapy. The treatment group receives, in addition to standard care, intensive rehabilitation involving 14 preoperative sessions (6 outpatient and 8 home-based) and 39 postoperative sessions (15 outpatient and 24 home-based) with aerobic, resistance and respiratory training, as well as scar massage and group bodyweight exercise training.Assessments are performed at baseline, the day before surgery and one month and six months after surgery. The main outcome is the long-term exercise capacity measured with the Six-Minute Walk Test; short-term exercise capacity, lung function, postoperative morbidity, length of hospital stay, quality of life (Short Form 12), mood disturbances (Hospital Anxiety and Depression Scale) and pain (Numeric Rating Scale) are also recorded and analysed. Patient compliance and treatment-related side effects are also collected. Statistical analyses will be performed according to the intention-to-treat approach. T-test for independent samples will be used for continuous variables after assessment of normality of distribution. Chi-square test will be used for categorical variables. Expecting a 10% dropout rate, assuming α of 5% and power of 80%, we planned to enrol 140 patients to demonstrate a statistically significant difference of 25 m at Six-Minute Walk Test.DiscussionPulmonary Resection and Intensive Rehabilitation study (PuReAIR) will contribute significantly in investigating the effects of perioperative rehabilitation on exercise capacity, symptoms, lung function and long-term outcomes in surgically treated lung cancer patients. This study protocol will facilitate interpretation of future results and wide application of evidence-based practice.Trial registrationClinicalTrials.gov Registry n. NCT02405273 [31.03.2015].

Strength and mobilization training within the first week following total hip arthroplasty

Study designRandomized controlled trial. ObjectivesTo improve hip function by an additional targeted mobilization and strength training of the hip muscles within the first postoperative week following a total hip arthroplasty (THA) in contrast to standard physiotherapy. BackgroundThe aim of early postoperative physiotherapy is to improve the functioning of the artificial hip joint as well as the restoration of mobility and independence of the patient. Minimally invasive surgical techniques allow early mobilization with immediate full weight-bearing. Methods39 patients were divided into an intervention (IG) and control group (CG). After implantation of THA the CG completed standard physiotherapy, while the IG had an intensified active treatment with additional mobilization and strength training. Passive range of motion (flexion, extension, abduction), thigh circumference, holding force of the gluteal muscles, one-leg stance, covered distance walked in 6-min and subjective parameters were tested one day before and six days after surgery. ResultsImprovements in IG compared to CG were recorded in range of motion (flexion p < 0.01, extension p < 0.001, abduction p < 0.01) and gait performance (p < 0.001). No differences between groups were detected as regard thigh circumference, holding force of the gluteal muscles, one-leg stance and subjective parameters. Deterioration in IG compared to CG did not occur. ConclusionAn additional, targeted mobilization and strength training of the hip muscles with full weight-bearing, which begins at the 3rd day after implantation of a THA is tolerated well and improves within one week hip range of motion and gait performance compared to standard physiotherapy.

Does standard post-operative rehabilitation have its place after total knee replacement?

The pilot study objective was to evaluate the effect of comprehensive post-operative physiotherapeutic treatment on the selected physiotherapeutic parameters as well as patients' quality of life after a total knee joint replacement surgery. Thirty patients after total knee joint arthroplasty were enrolled into the pilot study. After completing the physiotherapeutic processes, we have observed among the patients who underwent a total knee replacement surgery, a significant increase in muscle strength as with the flexors as well as the extensors (p = 0.001), improvement in their range of motion in knee joint flexion, in comparison to its range before treatment (p = 0.001), knee pain reduction (p = 0.001) and post-operative swelling (p <0.001), respectively. After undergoing the physiotherapeutic procedures, we recorded a statistically significant improvement in the monitored physical components: dressing (p = 0.008) and toilet use (p = 0.001), transfer from bed to chair (p = 0.008), walking on flat surface (p = 0.001), climbing stairs (p = 0.001). Passing the physiotherapy significantly reduced the degree of dependence of operated patients (p = 0.001). Early post-operative physiotherapy treatment positively affects patients' general condition. In addition, it improves muscle strength, range of motion of the operated joint, eliminates post-operative pain and reduces swelling that improves patients' self-sufficiency. Standard physiotherapy nowadays and in the next few years will take a unique place in patients' management after total knee joint replacement (Tab. 5, Ref. 26).

Efficacy of hydrotherapy versus land exercises for post-operative lumbar spine

Background: Significant pathology in low back pain patients warrants surgical intervention such as discectomy and minimal invasive spine surgery that includes transforaminal lumbar interbody fusion, anterior lumbar interbody fusion and posterior lumbar interbody fusion. Effective early post-operative physiotherapy management enables better functional outcomes and early return to work but this is often limited by patient's tolerance to axial loading. Therapeutic exercises in water reduce the axial spinal load facilitating early mobilisation especially in post-operative spinal care compared to land based exercises. Studies have shown positive effects of hydrotherapy in reducing pain, improving function, increasing muscle strength and early return to work in chronic low back pain patients. However, no such study has investigated the effects of hydrotherapy in postoperative spinal patients.

Surgical Management of Tempromandibular Joint Ankylosis: An analysis of 20 cases

Introduction: Ankylosis is a Greek term meaning “stiff joint”. The fusion of the articular surfaces of head of condyle with the glenoid fossa leads to TMJ ankylosis. The subarticular layer is composed of a rich vascular network that penetrates the cortical layer. Haemarthrosis of this highly osteogenic layer due to trauma commonly leads to the organization of fibroosseous mass and bony ankylosis can ensue. Method: This clinical study included 22 patients from 2008-2013. Out of these 20 patients underwent surgery. There were 17 patients below 14 years of age and five patients above 14 years. Etiopathogenesis was traumatic in 19 cases, septic in 2 cases and autoimmune in one case. Result: The patients were followed up for one to six years. All patients under treatment showed a distinctive improvement both in articular functionality and symptoms. In two patients recurrence was noticed and they were taken for secondary surgery. The functional results of using temporalis fascia as an interpositional material were satisfactory. Discussion: We conclude that early postoperative physiotherapy and strict follow-up play an important role in preventing postoperative adhesions