Bakirhan Serkan, Unver Bayram, Karatosun Vasfi
School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey.
Acta Orthop Traumatol Turc. 2009;43(6):478-83. doi: 10.3944/AOTT.2009.478.
We compared early postoperative functional activities of patients undergoing unilateral and bilateral total knee arthroplasty (TKA).
A total of 241 patients underwent bilateral (n=130; 12 men, 118 women; mean age 67.5+/-7.6 years) or unilateral (n=111; 7 men, 104 women; mean age 66.3+/-9.0 years) primary TKA for gonarthrosis. All the patients had indications for bilateral TKA and received the same rehabilitation program postoperatively. Functional activities and walking speed of the patients were assessed with the Iowa Level of Assistance Scale and Ambulation Velocity Scale, respectively, before surgery and on the second and sixth postoperative days and during discharge. In addition, knee range of motion and HSS (Hospital for Special Surgery) knee scores were measured.
There were no significant differences between the two groups preoperatively (p>0.05). Compared to baseline, functional activity levels during discharge showed significant improvement in both groups (p<0.05), whereas improvement in walking speed was significant only in the unilateral TKA group (p<0.05). Comparison of postoperative functional activity levels favored unilateral over bilateral TKA in all instances (p<0.05). The two groups did not differ significantly with respect to postoperative walking speed, HSS knee scores, range of motion of the knee, and mean hospital stay (p>0.05). Complications included knee hematoma (n=2) and deep vein thrombosis (n=1) in the unilateral TKA group, and knee hematoma (n=1) in the bilateral TKA group.
Postoperative physiotherapy programs should consider decreases in functional activities of patients undergoing bilateral TKA.
我们比较了单侧和双侧全膝关节置换术（TKA）患者术后早期的功能活动情况。
共有241例患者接受了双侧（n = 130；男性12例，女性118例；平均年龄67.5±7.6岁）或单侧（n = 111；男性7例，女性104例；平均年龄66.3±9.0岁）原发性膝关节骨关节炎的TKA手术。所有患者均有双侧TKA的指征，并在术后接受相同的康复计划。分别在手术前、术后第二天和第六天以及出院时，使用爱荷华州协助量表和步行速度量表评估患者的功能活动和步行速度。此外，还测量了膝关节活动范围和HSS（特种外科医院）膝关节评分。
两组术前无显著差异（p>0.05）。与基线相比，两组出院时的功能活动水平均有显著改善（p<0.05），而步行速度仅在单侧TKA组有显著改善（p<0.05）。在所有情况下，术后功能活动水平的比较显示单侧TKA优于双侧TKA（p<0.05）。两组在术后步行速度、HSS膝关节评分、膝关节活动范围和平均住院时间方面无显著差异（p>0.05）。并发症包括单侧TKA组的膝关节血肿（n = 2）和深静脉血栓形成（n = 1），以及双侧TKA组的膝关节血肿（n = 1）。
术后物理治疗方案应考虑双侧TKA患者功能活动的下降情况。
