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Mazzuchelli N, Agostini E, Beinat M, Lamprect G, Marzioti P, Possamai A, Pesavento V, Toffano M, Zadini A.
S.C. Medicina Riabilitativa Azienda Ospedaliero-Universitaria “Ospedali Riuniti” Trieste
S.C. Medicina Riabilitativa Azienda Ospedaliero-Universitaria “Ospedali Riuniti” Trieste
Joint recovery after knee replacement surgery: comparison between a passive motion device with a fixed rotation centre or a variable rotation centre
8th Mediterranean Congress ofPhysical and Rehabilitation Medicine – Limassol – Cyprus 29/9 – 2/10 - 2010
Foreword - In industrialized countries the increase of the average age and the high prevalence of osteoarthritis renders makes the use of knee surgery increasingly more and more frequent repeated. In the rehabilitation phase, devices for lower limb passive mobilization are employed in addition to treatment with dedicated therapists, from the first after-surgery day.
However, in our clinical practice we have observed that devices with a fixed rotation centre exert traction cause unnecessary stress/traction on the fascial and ligamentous structures of the operated knee, thus limiting its use over time and therefore slowing down the recovery of the joint range. Since January 2010, in our Rehabilitation Unit, we have started to use a passive motion device with a variable rotation centre that aims at respecting the knee flexion-extension physiology, thus respecting joint biomechanics.
Subjects and Methods - This trial tests began in March 2010. Subjects are represented by 10 patients (5 female and 5 male) who underwent surgery of knee arthroprosthesis.
Maximum age of subjects 84 years, minimum age of subjects 64 years, average age of subjects 73,14 years. The controls consist of patients who underwent the same kind of operation.
The first ones, in the rehabilitation phase, in addition to treatment with dedicated therapists, were treated with a variable rotation centre passive motion device KTJ. The controls were treated instead with a variable rotation centre passive motion device.
Patients were selected according to the type of prosthetic operation (total or unicompartmental), sex and age. The range of motion was evaluated and joint pain symptoms were assessed by VAS before and after treatment.
The lenght of individual rehabilitation sessions was also measured.
Results - Patients treated with a variable rotation centre passive motion device for the lower limb, showed an average recovery of ROM (Range Of Motion) for each rehabilitation session of 6.37 ° to 5.7 ° compared to patients treated with passive motion device with a fixed rotation centre ( Chart 1).
The recovery of the ROM (Range Of Motion) as reported in the full rehabilitation cycle defines rather a clear benefit for patients treated with a variable rotation centre passive motion device with a recovery of 32.7 ° to 20 ° compared to patients treated with a passive motion device with a fixed rotation centre (Chart 2 ). No benefits in neither groups were shown from the use of a passive motion device with a fixed rotation centre in the recovery of the extension joint. Treatment endurability is quite overlapping in both groups with a minimum benefit in patients treated with a variable rotation centre passive motion device in which the average duration of the treatment was found to be 45.1 minutes versus 44.28 minutes in patients treated with a passive motion device with a fixed rotation centre (Chart 3). In the end the pain symptom, recorded before and after treatment using the VAS scale, defined a reduction of its average value from 2.55 in the pre treatment to 2.35 in the post-treatment device in the group treated with a variable rotation centre passive motion device, while there were no changes of the pain symptom (pain symptom’s average value is 2.09 before and after treatment) in patients treated with a passive motion device with a fixed rotation centre (Chart 4).
However, in our clinical practice we have observed that devices with a fixed rotation centre exert traction cause unnecessary stress/traction on the fascial and ligamentous structures of the operated knee, thus limiting its use over time and therefore slowing down the recovery of the joint range. Since January 2010, in our Rehabilitation Unit, we have started to use a passive motion device with a variable rotation centre that aims at respecting the knee flexion-extension physiology, thus respecting joint biomechanics.
Subjects and Methods - This trial tests began in March 2010. Subjects are represented by 10 patients (5 female and 5 male) who underwent surgery of knee arthroprosthesis.
Maximum age of subjects 84 years, minimum age of subjects 64 years, average age of subjects 73,14 years. The controls consist of patients who underwent the same kind of operation.
The first ones, in the rehabilitation phase, in addition to treatment with dedicated therapists, were treated with a variable rotation centre passive motion device KTJ. The controls were treated instead with a variable rotation centre passive motion device.
Patients were selected according to the type of prosthetic operation (total or unicompartmental), sex and age. The range of motion was evaluated and joint pain symptoms were assessed by VAS before and after treatment.
The lenght of individual rehabilitation sessions was also measured.
Results - Patients treated with a variable rotation centre passive motion device for the lower limb, showed an average recovery of ROM (Range Of Motion) for each rehabilitation session of 6.37 ° to 5.7 ° compared to patients treated with passive motion device with a fixed rotation centre ( Chart 1).
The recovery of the ROM (Range Of Motion) as reported in the full rehabilitation cycle defines rather a clear benefit for patients treated with a variable rotation centre passive motion device with a recovery of 32.7 ° to 20 ° compared to patients treated with a passive motion device with a fixed rotation centre (Chart 2 ). No benefits in neither groups were shown from the use of a passive motion device with a fixed rotation centre in the recovery of the extension joint. Treatment endurability is quite overlapping in both groups with a minimum benefit in patients treated with a variable rotation centre passive motion device in which the average duration of the treatment was found to be 45.1 minutes versus 44.28 minutes in patients treated with a passive motion device with a fixed rotation centre (Chart 3). In the end the pain symptom, recorded before and after treatment using the VAS scale, defined a reduction of its average value from 2.55 in the pre treatment to 2.35 in the post-treatment device in the group treated with a variable rotation centre passive motion device, while there were no changes of the pain symptom (pain symptom’s average value is 2.09 before and after treatment) in patients treated with a passive motion device with a fixed rotation centre (Chart 4).
Conclusions - The employment of a variable rotation centre passive motion device during the rehabilitation phase after a surgery of knee arthroprosthesis, makes the recovery of the ROM (Range Of Motion) much faster and determines a prompt and immediate pain reduction in the treatment itself.
It also allows the implementation of longer duration rehabilitation cycles.
According to our experience and according to the results obtained, we may state that, during rehabilitation after knee arthroprosthesis surgery, the use of a KTJ variable rotation centre passive motion device should be strongly suggested and considered.
It also allows the implementation of longer duration rehabilitation cycles.
According to our experience and according to the results obtained, we may state that, during rehabilitation after knee arthroprosthesis surgery, the use of a KTJ variable rotation centre passive motion device should be strongly suggested and considered.