Post Total Knee Replacement Research Articles

Tele-rehabilitation versus Face To Face Rehabilitation after Knee Joint Replacement

Background: Joint substitution of lower limbs like hip and knee replacements are viewed as a high volume surgery with great achievement rates and physical restoration assumes a significant role in recovery of these patients. However, access to recovery and follow up is restricted. Post joint substitution patients living in remote territories and those with the danger of joint dislocation find difficulty to recovery benefits once they are released from emergency clinic. Access issues produce extra burden. The purpose of current study was to evaluate whether telerehabilitation performed from a health center to patient’s place after discharge from hospital among knee replacement was practically effective as alternative treatment. Methods: A quasi-experimental study was conducted on 50 post total knee replacement patients for a period of 6 months at Ghurki hospital. Patients were divided into two groups. Group A received telerehabilitation. Group B received face to face rehabilitation for 2 months. Ranges, muscle strength and functional status were measured through goniometer, manual muscle testing and timed get up and go test. Assessment was done using Fischer exact test at baseline, after 2 weeks and followed up after 2 months. Results: p-value for knee flexion came out to be 0.03 where as for quadriceps it was 0.02 after 2 weeks, which was found to be statistically significant. After 2 months, p-value for knee flexion was 0.016 and 0.000 for functional status. Conclusion: Use of telerehabilitation is found to be equally effective as compared to face to face rehabilitation among knee replacement patients.

Short-Form New Knee Society Score: What Is Its Responsiveness and Convergent Validity with Other Scores?

The short-form version of New Knee Society Score (SF-NKSS) was designed with a purpose to reduce respondent burden. Literature review revealed only one report by Scuderi et al on responsiveness of derived SF-NKSS, but it was evaluated in two separate patient cohorts pre- and postsurgery. Our study had evaluated responsiveness and convergent validity of derived SF-NKSS in a single, large patient cohort followed longitudinally from preoperative status to over 1 year. Our database of 148 knee arthroplasty patients operated by the same surgeon, whose NKSS, Western Ontario and McMaster Universities Arthritis Index (WOMAC), and 12-item Short-Form Survey (SF-12) scores were prospectively collected preoperatively and postoperatively at 3 and 12 months for a study published earlier, was analyzed for derived SF-NKSS. Responsiveness was evaluated by determining the effect size, standardized response mean (SRM), and ceiling and floor effects. For convergent validity, Pearson's correlation coefficient was used. SF-NKSS was found to be most responsive with the largest effect size and SRM at 3 months (3.02 and 2.50, respectively) and at 12 months (3.58 and 2.92, respectively) with no ceiling or floor effect. SF-NKSS was followed in responsiveness by original NKSS, WOMAC, and SF-12 in a descending order. Convergent validity showed a strong correlation (r = 0.8-1.0; p < 0.001) of SF-NKSS with NKSS and a moderate to strong correlation (r = 0.5-0.6; p < 0.001) with WOMAC and SF-12. We concluded that SF-NKSS is a reliable, highly responsive tool for post-total knee replacement evaluation. It also has the ability to register improvement in the patient's recovery, which can continue even after 1 year. We found that the SF-NKSS can be used interchangeably with the original NKSS.

Improvement of Physical Performance and Quality of Life After Rehabilitation Program for Total Knee Replacement in Geriatric Patient

Introduction: Early medical rehabilitation after Total Knee Replacement (TKR) was necessary to optimize healing process and reduce pain postoperative that can restrain patients’ activity.Case Presentation: A 66-years-old women had right TKR due to osteoarthritis genu dextra with chronic pain. Patient has muscle weakness on affected leg, and still not able to walk. Medical Rehabilitation(MR) program started one day after surgery for 4 weeks. After 4 weeks of MR program, patient had mild pain, and can walk for 100 m. Pain intensity by visual analogue scale (VAS) reduced from 7/10 to2/10, knee flexion increased from 70° to120°, right quadriceps muscle strength increased from 4 to 5 by manual muscle test (MMT), time to do physical performance by time up and go (TUG) was reduced from15 to 12.8 sc, activity daily living (ADL) by Barthel Index sco re increased from 4 to 8.Conclusion: Four weeks Rehabilitation Medicine program in geriatric patient with post Right TKR for 4 weeks, effective to improved muscle strength, balance, and ADL.Keywords: Medical rehabilitation, total knee replacement, geriatric, physical performance, quality of life

Venous thromboembolism prevention protocol for adapting prophylaxis recommendations to the potential risk post total knee replacement: a randomized controlled trial.

Background:Total knee replacement (TKR) is a major orthopedic surgery that is considered high risk for the development of venous thromboembolism (VTE).Objective:The aim of this study is to evaluate the clinical outcomes that resulted from the use of a new proposed VTE risk stratification protocol for selecting a suitable extended VTE prophylaxis for post TKR surgery patients administered in conjunction with patient education programs.Method:A randomized controlled trial was conducted in two medical centers in Saudi Arabia. A total of 242 patients were enrolled in the study, 121 patients in each group. The experimental group (A) was assessed by using the proposed VTE risk stratification protocol and also took part in patient education programs about TKR and its complications. The control group (B) was assessed by using the 2005 Caprini risk assessment tool and no education programs were given to this group. Both groups were followed for 35 days post operation.Results:The mean age of the participants was 65.86 (SD 8.67) and the majority of them were female 137 (56.6%). The mean body mass index of the study sample was 32.46 (SD 5.51). There were no significant differences between the two groups except for surgery type; the proportion of bilateral TKR in group A was higher than in group B (69/121 (28.5%) vs. 40/121(16.5%), p<0.05). There were no confirmed pulmonary embolism cases in the study sample and diagnosis of deep-vein thrombosis was confirmed in 12/242 (5.0%) of patients: 1/121 (0.8%) in group A and 11/121 (9.1%) in group B (p<0.05). The readmission rate for all patients was 2.5% (6/242), all of whom were in group B (p<0.05).Conclusion:The proposed VTE risk stratification protocol that was applied in conjunction with patient education programs reduced VTE complications and readmission events, post TKR surgery. Trial Registration: ClinicalTrials.gov: Identifier: NCT04031859.

Younger age is associated with increased odds of manipulation under anesthesia for joint stiffness after total knee arthroplasty

IntroductionLimited range of motion (ROM) after total knee replacement (TKR) is associated with low function and might require manipulation under anaesthesia (MUA). In order to identify factors associated with a limited ROM we investigated predictors for MUA. We hypothesized that older age was associated with higher MUA due to limited ROM post TKR. MethodsIn a case control study we investigated all patients undergoing primary TKR at a University Hospital in Sweden between 2007–2012. We registered background factors and compared those between the group who underwent MUA and those who did not. Odds ratios (OR) were calculated in a univariate analysis and an adjusted regression analysis. ResultsOf the total of 669 TKRs performed, 31 patients who had undergone MUA were identified. The prevalence of MUA was 4.6%. The mean increase in ROM after MUA was 27 degrees at final minimum one-year follow-up. After controlling for confounders, patients with good health and young age had increased OR for MUA. OR decreased 0.93 (CI 0.93–0.97) per increased age year in the multiple regression analysis. Diabetes mellitus, BMI and sex did not have a significant effect on the odds ratio for MUA. DiscussionYoung patients undergoing TKR has earlier been identified as a group with a higher grade of dissatisfaction and complications. We found an association between young age and MUA after TKR indicating an additional, rather unknown complication for this group of patients. The background and reasons for this has to be further investigated. Level of evidenceII, cohort study/case control study (case control is level III).

術後 1 年を経過した人工膝関節全置換術症例の満足度に影響する身体活動量と膝関節伸展筋力との関係

術後 1 年を経過した人工膝関節全置換術症例の満足度に影響する身体活動量と膝関節伸展筋力との関係

Comparing cost and effectiveness of IVPCA morphine with perioperative multimodal analgesia of oral etoricoxib and oxycontin: A retrospective study

IntroductionGood pain control modality for post total knee replacement promotes patient's comfort and facilitates functional recovery, which may prevent post-operative complications; and shorten hospital stay. Therefore, manage pain efficiently and effectively have financial implications to the hospital. This retrospective study analyzed the clinical outcomes and costs of the intravenous (IV) patient-controlled analgesia (PCA) with a new perioperative multimodal analgesia (PMA) of using etoricoxib and oxycontin. MethodsThis retrospective study analyzed a total of 102 inpatients, 53 received both IVPCA and regular oral analgesics from September 2016 to February 2017, while 49 received preemptive oral etoricoxib before surgery and duly together with oxycontin and paracetamol after surgery from September 2017 to February 2018. Pain scores as the primary outcome were measured by Numeric Rating Scale (0–10) at rest (NRS-R) and on movement (NRS-M). They were analyzed by one-way analysis of covariance (ANCOVA). Other outcomes included side effects from analgesics, range of motion (ROMo), patient satisfaction, length of hospital stay and costs of medications. ResultsPatients in PMA group achieved better outcomes than PCA group. NRS-M of PMA group shown lower mean pain score and (standard error) than PCA group (2.96 [0.31] vs 4.26 [0.29]; p = 0.003), side effects from analgesics (18% vs 45%), ROM≥ 90° (55.1% vs 30.2%), patient satisfaction (8.97 vs 7.5 out of 10; p = 0.005), and length of hospital stay (6 days vs 8 days; p < 0.001). Moreover, the medication cost of PMA was 59.9% lower than PCA regimen. ConclusionsThis PMA approach achieved better outcomes and saved hospital costs.

Stiffness post-total knee replacement: A proof of principle study investigating the effect of gene expression analysis of markers of fibrosis

BackgroundTo establish proof of principle of a link between phenotypic expression and stiffness after TKR. MethodsFrom 100 patients, genetic expression of markers of fibrosis was performed for 15 synovial samples from patients categorised as ‘best post-operative range of movement (ROM)’ and 15 samples from patients with ‘worst ROM’. These markers included Matrix Metalloproteinases (MMPs), A Disintegrin and Metalloproteinases with Thrombospondin (ADAMTS) and Tissue Inhibitors of Matrix Metalloproteinases (TIMPs). Genetic marker data were compared to Oxford Knee Scores (OKS) and Pain Catastrophizing Scores (PCS). ResultsQuantitative markers for gene expression demonstrated more outliers in stiff compared to non-stiff knees, suggesting a greater imbalance in pro- and anti-fibrotic markers in stiff knees. Whilst there was a significant difference in the range of post-operative knee flexion (p = 0.001) and extension (p = 0.001), there was no statistically significant difference between stiff and non-stiff knees in pre-operative or post-operative OKS (p ≥ 0.06). There was no difference in the individual components of the individual PCS score items nor the PCS total scores when stiff and non-stiff knees were compared (p > 0.05). ConclusionBiological factors, namely gene expression of MMPs, TIMPs and ADAMTS, may contribute towards post-TKR stiffness. This now warrants further investigation to better understand this relationship based on larger, multi-centre, cohorts. Level of evidenceLevel 3.

The impact of pre-operative telephone support and education on symptoms of anxiety, depression, pain and quality of life post total knee replacement: An exploratory case study

The impact of pre-operative telephone support and education on symptoms of anxiety, depression, pain and quality of life post total knee replacement: An exploratory case study

Correlation between the Laboratory Test Results and Knee Functional Improvement of Pre- and Post-Total Knee Replacement Operation

Objective: This study aimed to identify correlations of laboratory test results and knee joint function between pre- and post-operation of knee joint replacement surgery. Methods: The study covered 60 - 75 aged 50 patients who had operated with knee replacement surgery. 25 patients were male and another 25 patients were female. We compared laboratory test results of pre- and 3rd, 7th and 14th day of post-operation. Moreover, pre-operation knee joint function was compared with 3rd, 7th, 14th and 30th day of post-operation. Furthermore, we investigated the relationship among WBC, hemoglobin and function tests. Pre- and post-operative knee joint function tests were conducted by WOMAC (The Western On-tario and McMaster Universities Osteoarthritis), VAS (Visual Analogue Scale), TUG (Time up and Go) score, and MMT (Muscle Manual Test). Results: In pre-operation, patients’ average WBC was 6.447 ± 2.115 cells/μL, monocyte was 6.554 ± 3.101 cells/μL, lymphocyte was 31.177 ± 9.512 cells/μL and C-reactive protein was 0.6205 ± 0.922 mg/dL. In 3rd day of post-operation, WBC was 8.901 ± 2.869 cells/μL, monocyte was 4.881 ± 2.332 cells/μL, lymphocyte was 17.048 ± 9.702 cells/μL and C-reactive protein was 4.2762 ± 2.293 mg/dL. There was a statistically significant difference reported on pre- and post-operation pain, stiffness and daily activity (P < 0.001). On the other hand, patients’ post-operative TUG score was significantly higher than pre-operative TUG scores (P < 0.0001). Furthermore, hemoglobin, red blood cell and TUG score of the 3rd day of post-operation were raised up and they were statistically significant (P < 0.036). In addition, WBC of pre-operation and 3rd, 7th, 14th day of TUG score was significantly correlated (P < 0.04). Conclusion: Results of WBC, hemoglobin, hematocrit, total protein, total bilirubin, and creatinine had increased in 3rd and 7th day of post-operation and had stabilized from 14th day of post-operation. Stiffness and TUG performance were controversially correlated in 3rd, 7th, 14th, 30th day of post-operation. However, in 7th and 14th of post-operation, patients’ muscle strength and knee joint amplitude had become stabilized and improved from 30th day of post-operation. Moreover, after the operation, the number of WBC controversially affected patients’ mobility. In addition, we found that as hemoglobin and red blood cells increased, walking ability improved as well.

The Effect of Drain vs. no Drain on Straight Leg raising in post Total Knee Replacement Patients

OBJECTIVE: To compare the use of drains vs. no drains in post TKR patients on the basis of mean days to achieve first straight leg raise.METHODOLOGY: This Cohort Observational Study was carried out at section of Orthopaedic, Dept of Surgery, Aga Khan University Karachi. A total of 94 patients meeting the selection criteria and giving informed consent were included in the study. Inclusion criteria: Patient having bilateral knee joint osteoarthritis grade 4. Exclusion criteria: Septic knee, any infection elsewhere in the body, patients undergoing total knee replacement due to any other cause like rheumatoid arthritis , post traumatic arthritis etc , apart from osteoarthritis. Consecutive series was used and were operated by a single orthopedic surgeon with >5 years of experience. In the first 47 patients suction drain was used while in the next 47 no drain was used. The assessment of straight leg raising (SLR) was performed by a senior physiotherapist with experience of >3 years in orthopedics physiotherapy, twice a day postoperatively, until the patient performed unassisted straight leg rise. The researcher recorded all the demographic and other relevant variables along with the outcome in the Proforma.RESULTS: The results showed significant difference in SLR, but no difference in knee society score between drain group versus no drain group.CONCLUSION: We found advantage of using drain in patients with knee replacement surgeries in terms of rehabilitation that is straight leg raising. Based on the study results and discussion of findings with previous literature, it is recommended that multicenter studies with large sample sizes, measuring multiple outcomes should be conducted in future to reach a firm conclusion regarding use of drain or not in post TKR patients.

Achieving important improvement in womac pain and function by three months post-surgery influences satisfaction 1 year following total knee replacement

Purpose: Our prior work showed that achieving important improvement (II) in function by one year post total knee replacement (TKR) was directly associated with satisfaction with outcome. However, understanding the impact of the time of achievement of II has the potential to further our understanding of outcomes and inform care pathways. The objective of this work was to determine if the timing to achieve II in WOMAC pain and function and higher demand function as measured by the Late Life Disability (LLDI) was associated with satisfaction. Methods: We followed 354 patients from pre- to 1-year post-TKR. Pre-surgery, participants completed demographic and health questionnaires, the WOMAC pain and function and LLDI limitation subscales and identified outcome expectations for pain, other symptoms, mobility/activities of daily living (ADL), and participation in social roles/instrumental activities of daily living (IADL). The WOMAC and LLDI questionnaires also were completed at 3, 6, and 12 months post surgery. Satisfaction was completed at 12 months. All were scored 0-100 with higher scores indicating better outcome. Using II values for WOMAC pain, function and high demand activities generated from a separate cohort, we derived an ordinal variable of achieved II by 3, 6 or 12 months post-surgery or not achieved for each outcome. Based on sensitivity analysis, we categorized those who had baseline scores precluding achievement of II who reached the measure ceiling as achieving the II. We used a Bayesian path model with non-informative priors to evaluate if time to II achievement was associated with outcome satisfaction, adjusting for age, sex, education, obesity, depression (Hospital Anxiety and Depression Scale), comorbidity count and self-rated health. Expectations were modeled as individual predictors. As the Bayesian model (model 1) provided only a single estimator for our ordinal II variables, we also fit a generalized linear model to understand which time(s) of II achievement was associated with satisfaction (model 2). Results: Sample mean age was 65 years; 65% were female; and, 66% had >high school education. The mean comorbidity count was 1.6 (sd = 1.3) and depression was 5.3 (sd = 3.5). 40% rated their overall health as very good/excellent. The mean pre-surgery pain, function and high demand activities scores were 47.8 (sd = 17.8), 50.3 (sd = 18.5) and 59.2 (sd = 11.0) respectively. Mean satisfaction was 80.7 (sd = 21.9). Those who achieved II in pain, function and high demand activities by 3 months had satisfaction scores 87.8−89.3 compared to lower scores for all others; range 64.7−69.8 for those who did not achieve II. Fifty-seven, 47, 57 and 15% expected improvement in pain, other symptoms, mobility/ADL and social roles/IADL respectively. In model 1 (Fig. 1), earlier II achievement in pain (estimate −0.191) and function (estimate −0.389) was directly associated with higher satisfaction and higher expectation for mobility/ADL improvements (−0.106) was directly associated with lower satisfaction. Earlier achievement of II in function was associated with higher demand II achievement (0.628) but II in higher demand activities was not associated with satisfaction. All other significant effects were indirect. Model 2 showed that achievement of II in each of pain, function and high demand activities by 3 months was significantly associated with higher satisfaction as compared to achievement by 6 or 12 months (2–5 fold impact) or not achieving II (12–17 fold impact). Conclusions: People who achieve important improvement in pain, and function by 3 months post TKR are more satisfied with their outcome. Efforts to minimize recovery time should be tested to determine if more people recover more quickly and are satisfied with their outcomes.

The outcome of secondary resurfacing of the patella following total knee arthroplasty: Results from the Trent and Wales Arthroplasty Register

BackgroundWe sought to determine whether patients undergoing secondary patella resurfacing (SPR) benefited from the procedure by assessing postoperative satisfaction via a postal questionnaire. MethodsAll such patients included in the Trent and Wales Arthroplasty Register were invited to participate using patient-reported outcome measures (PROMs). We identified 223 patients who had undergone SPR over a 20-year period. Forty-two had died according to death register checks. Eighty-eight of 181 (48.6%) questionnaires were completed. The mean age at resurfacing was 67 (min. 42, max. 81); 52% were female. The median time to follow-up was 55months (interquartile range (IQR) 41–111). Median time to SPR was 28months (IQR 20–42). ResultsThirty-nine patients (44%) felt that SPR resolved the problem of pain in the front of their knee. All PROMs were significantly better for those who felt that the resurfacing had worked (Oxford Knee Score 29 vs. 16, P<0.05, modified Kujala 51 vs. 32, P<0.05, EQ5D-3L 0.616 vs. 0.384, P<0.05). Based on PROMs, SPR produces a satisfactory outcome in two of every five patients. ConclusionsSurgeons must be clear on the cause of anterior knee pain post-total knee replacement, and patients must be made aware of what outcomes can be reasonably expected from this procedure.

"Fear of the Known and Unknown": Factors Affecting Participation Following Knee Replacement Among Persons With Participation Restriction.

Evidence suggests that more than 30% of patients post-total knee replacement (TKR) are living with participation restrictions, yet little is known about their perceptions of and factors contributing to these restrictions. The purpose of this study was to identify emergent or recurring themes behind participation restrictions after TKR. Nineteen participants between 50 and 85 years old reporting participation restrictions 1 to 5 years post-TKR completed semistructured qualitative interviews about their participation experience after TKR. Participants provided background information in written questionnaires. Data collected from in-person interviews were analyzed qualitatively using a grounded theory approach. Participants discussed 3 major themes with regard to participation post-TKR: (1) limiting activities requiring long-distance walking due to continued knee impairments, (2) avoiding activities with negative or unknown outcome expectancies, and (3) using problem solving to identify strategies to participate in important activities. An unknown or negative outcome expectancy, particularly with regard to activities requiring long-distance walking, may lead to participation restrictions in some patients post-TKR. As participants reported using self-efficacy and coping strategies to improve participation, further physical rehabilitation or interdisciplinary rehabilitation incorporating the identified strategies may be effective with some patients post-TKR.

Developing a class format to improve the management of total knee replacement (TKR) patients in an out-patient physiotherapy setting

Purpose: Historically patients at North Manchester General Hospital received traditional 1:1 Physiotherapy treatments post TKR. Literature suggests a class environment can be more cost effective and yield improved results. Therefore a TKR class was set up in 2015. This poster highlights the findings from the first year demonstrating clinical outcomes, patient satisfaction and cost-effectiveness.

First degree burns after 1-year of post total knee replacement: Case report

Introduction: There are reported thermal injuries after prolonged use of laptops in the literature. Now for the first time, we report on a case, in which thermal injuries secondary to laptop over the scar of total knee arthroplasty. We report a case of a 69-year-old lady with a background history of left total knee replacement, who sustained a first degree thermal burn over the scar and lateral aspect of the thigh of the replaced knee after prolonged use of her laptop. To date this is the only case where a laptop burn happened to a patient after having total knee replacement. Conclusion: This case report highlights the management of such cases and can be used to educate other arthroplasty surgeons how to emphasise to patients about this possible risk associated with prolonged use of laptops in their consultation and consent.&#x0D; Keywords: First degree burns, laptop, total knee replacement.

A comparison of the proprioception of osteoarthritic knees and post total knee arthroplasty

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Proprioception of the knee joint is an important factor for establishing balance, and smooth walking. The effect of arthroplasty on proprioception can be a determinant of post-operative function and subjective feeling of the arthroplasty. We wished to check the status of osteoarthritic knees and how their proprioceptive function is, in comparison to knees post total knee replacement.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; We compared 80 unilateral knee replacement patients with their osteoarthritic counterpart in the opposite knee. There was 50% Cruciate Retaining (n =40), Posterior Stabilized 50% (n =40). We assessed the proprioception using threshold to detection of passive motion and conscious awareness of passive joint position.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 73.8% (n =59) of patients experienced a better joint position sense, 21% (n =17) had decreased joint position sense and 5% (n =4) had the same, when compared to the contralateral osteoarthritic knee. The mean of threshold to detection of passive motion was 2.16+0.68 for the replaced knees versus 2.72±0.61 for the contralateral osteoarthritic knee.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The proprioception of the knees that were replaced with arthroplasties had a better proprioceptive function then the osteoarthritic knees. This further solidifies the reasons to replace the dysfunctional osteoarthritic knee. &lt;/p&gt;

The mid term functional outcomes of NexGen legacy posterior stabilized flex fixed bearing total knee replacement in primary osteoarthritis

Introduction: To evaluate the midterm functional outcomes of patients who had undergone total knee replacement (TKR) using posterior stabilized (PS) fixed bearing system from January 2005 until April 2006 for primary osteoarthritis of the knees. Methods: A retrospective study was done on forty-six patients, 87% female (n= 40) and 13% male (n=6), aged 54 to 81 years old (mean 69 ± 5.69) who had undergone primary TKR using the NexGen LPS-Flex Zimmer Warsaw. The patients were followed up for at least five years. A medial parapatellar approach and cemented posterior stabilized fixed bearing TKR system were used performed by one of two arthroplasty surgeons. All patients followed the same rehabilitation protocol post-operatively. Assessments were done using Oxford-12 knee scoring questionnaire to evaluate knee function and SF-36 to assess quality of life outcomes. Results: Oxford knee score revealed patients had lower (better) than average scores in terms of function (score 14.35 ± 4.21 out of 35) and pain (score 9.28 ± 3.01 out of 25). Analysis on the quality of life outcome score with SF-36 revealed a higher (better) score for mental component summary (MCS) relative to physical component summary (PCS). Patients had the highest score for role emotional (RE), followed by mental health (MH), and social functioning (SF). Conclusions: The NexGen LPS-Flex TKR produced a good functional outcome with minimal pain in the operated knee with better mental compared to physical health of patients in the midterm period post-total knee replacement.

A study investigating short- and medium-term effects on function, bone mineral density and lean tissue mass post-total knee replacement in a Caucasian female post-menopausal population: implications for hip fracture risk.

Significant increased hip fracture incidence has been reported in the year following total knee replacement. This study demonstrates that bone and muscle loss is a post-surgical consequence of total knee replacement, alongside poor outcomes in function and activity potentially contributing to reduced quality of life and increased hip fracture risk. A significant increase in hip fracture incidence in the year following total knee replacement (TKR) surgery has been reported. This study investigated function and activity following TKR and the effects of limited mobility on bone and muscle loss and their potential contribution to hip fracture risk. Changes in dual-energy X-ray absorptiometry (DXA) (GE Lunar Prodigy, Bedford MA), bone mineral density (BMD) at the neck of femur (NOF), total hip region (TH) and lumbar spine were measured alongside leg lean tissue mass (LLTM) in post-menopausal Caucasian females following TKR (N = 19) compared to controls (N = 43). Lumbar spine trabecular bone scores (TBSs) were calculated. Ipsilateral/contralateral weight bearing, lower limb function, 3-day pedometer readings, pain levels and falls were also recorded. Measurements were obtained at pre-surgery baseline and at 6weeks, 6months and 12months post-surgery. No statistically significant differences were demonstrated between groups at baseline bilaterally in LLTM or BMD at the NOF and TH. Losses in ipsilateral NOF and TH BMD and contralateral LLTM were significantly higher in the TKR group at 6months. Impairment in function and weight bearing persisted in the TKR group 12months post-operatively alongside deficits in bilateral muscle mass and ipsilateral NOF and TH BMD. Falls incidence was not significantly higher in the TKR group. Bone loss at the hip with associated muscle loss is a consequence of TKR that, in addition to poor patient outcomes in function and activity, potentially contributes to increased hip fracture risk in the year following surgery.

Hip Abductor Strengthening Exercises Following Total Knee Replacement- A Need or Luxury

Total knee replacement (TKR) is a well renowned surgical procedure for those presenting with intractable joint pain and impaired physical function following end stage knee osteoarthritis (OA). It is well established that any exercise performed and supervised will improve pain and physical function in people with knee OA. Proximal muscle contribution especially the hip abductors are important in providing frontal plane stability, the stabilization of trunk and hip during walking, maintaining the femoropelvic alignment, femoral head stability and transferring the forces from the lower limbs to the pelvis and considered as important for enhanced functional performance. Recent studies have proven that proximal muscle weakness especially hip abductors play a vital role in knee joint function and a significant reduction in hip abductor strength observed in knee OA. Hip abductor strengthening exercises given post TKR could possibly enhance physical function and pain, might share a contribution similar to quadriceps strength in improving functional performance. Hip abductor strengthening exercises could be a key component in rehabilitation following TKR for enhanced physical function. This review attempts to report the evidence supporting the involvement of the hip abductor strength and its influence on pain and physical functional in post total knee replacement.