McGrath Mike S, Mont Michael A, Siddiqui Junaed A, Baker Erin, Bhave Anil
Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA.
Clin Orthop Relat Res. 2009 Jun;467(6):1485-92. doi: 10.1007/s11999-009-0804-z. Epub 2009 Mar 31.
Knee flexion contractures can severely impair function after total knee arthroplasties. We evaluated the use of a custom-molded knee device to treat 47 patients who had knee flexion contractures (mean, 22 degrees; range, 10 degrees-40 degrees) after primary or revision total knee arthroplasties and who had failed conventional therapeutic methods. The device was used for 30 to 45 minutes per session two to three times per day in conjunction with standard physical therapy modalities two to three times per week. Twenty-seven of 29 patients who underwent primary total knee arthroplasty and 13 of 18 patients who underwent revisions achieved full extension after a mean treatment time of 9 weeks (range, 6-16 weeks). Full knee extension was maintained at a minimum followup of 18 months (mean, 24 months; range, 18-36 months). The mean Knee Society knee and functional scores improved from 50 points and 34 points to 91 points and 89 points, respectively. This protocol had comparable rates of improvement in knee extension with less treatment time when compared with other nonoperative treatments reported in the literature. The custom knee device may be a useful adjunct to a physical therapy regimen for knee flexion contractures after total knee arthroplasty.
Level IV, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
膝关节屈曲挛缩会严重损害全膝关节置换术后的功能。我们评估了一种定制的膝关节装置用于治疗47例在初次或翻修全膝关节置换术后出现膝关节屈曲挛缩（平均22度；范围10度至40度）且传统治疗方法无效的患者。该装置每天使用两到三次，每次30至45分钟，并结合标准物理治疗方式，每周进行两到三次。29例接受初次全膝关节置换术的患者中有27例，18例接受翻修手术的患者中有13例，在平均治疗9周（范围6至16周）后实现了完全伸直。在至少18个月的随访（平均24个月；范围18至36个月）中，膝关节保持完全伸直。膝关节协会膝关节和功能评分平均分别从50分和34分提高到91分和89分。与文献中报道的其他非手术治疗相比，该方案在膝关节伸直改善率相当的情况下治疗时间更短。定制膝关节装置可能是全膝关节置换术后膝关节屈曲挛缩物理治疗方案的有用辅助手段。
IV级，预后研究。有关证据水平的完整描述，请参阅作者指南。
