Department of Physical Therapy, University of Delaware, Newark, DE, USA.
J Orthop Sports Phys Ther. 2012 Feb;42(2):135-44. doi: 10.2519/jospt.2012.3773. Epub 2012 Feb 1.
Case report.
Rehabilitation that includes progressive quadriceps strengthening after total knee arthroplasty (TKA) leads to superior outcomes. Though patients with TKA show marked functional improvement after outpatient physical therapy, they continue to adopt movement asymmetries characterized by reduced knee excursion on the operated limb and excessive loading on the contralateral limb. The purpose of this case report was to describe the functional and biomechanical improvements in a patient who, after TKA, participated in a novel physical therapy protocol that included retraining of symmetrical movement patterns.
A 57-year-old female with unilateral knee osteoarthritis was evaluated prior to TKA and at 3 and 10 weeks after surgery. Postoperative rehabilitation included progressive quadriceps strengthening and movement retraining that consisted of visual, verbal, and tactile feedback to promote symmetrical weight bearing during strengthening exercises and functional activities. Outcomes were compared to a historical cohort of patients with TKA.
Prior to TKA, the patient scored below average on all functional measures and walked with knee biomechanics that were abnormal and asymmetrical. After symmetry retraining, her knee motion and moments were restored to normal levels. The patient also walked with greater magnitude and more symmetrical knee excursion compared to a cohort of similar patients.
This case report describes the use of a novel rehabilitation protocol intended to improve walking biomechanics and functional outcomes after TKA. Restoration of symmetrical movement patterns could improve long-term outcomes of TKA. Further research is needed to evaluate the effectiveness and implementation of similar rehabilitation strategies in a wide range of patients after TKA.
Therapy, level 4.
病例报告。
全膝关节置换术（TKA）后进行渐进式股四头肌强化康复可带来更好的效果。尽管 TKA 患者在门诊物理治疗后表现出明显的功能改善，但他们仍继续采用运动不对称的方式，表现为手术侧膝关节活动度减小和对侧肢体过度负荷。本病例报告的目的是描述一位患者在接受 TKA 后，参加一种新的物理治疗方案，包括重新训练对称运动模式，其功能和生物力学的改善情况。
一位 57 岁女性，患有单侧膝骨关节炎，在 TKA 前、术后 3 周和 10 周进行了评估。术后康复包括渐进式股四头肌强化和运动再训练，包括视觉、言语和触觉反馈，以促进强化锻炼和功能活动期间的对称负重。结果与 TKA 的历史队列进行了比较。
在 TKA 之前，患者在所有功能测量中得分均低于平均水平，且膝关节生物力学异常且不对称。经过对称训练后，她的膝关节运动和力矩恢复到正常水平。与类似患者队列相比，患者行走时的膝关节运动幅度和对称性也更大。
本病例报告描述了一种新的康复方案的使用，旨在改善 TKA 后的步行生物力学和功能结果。恢复对称运动模式可能会改善 TKA 的长期结果。需要进一步研究来评估类似康复策略在广泛的 TKA 患者中的有效性和实施情况。
治疗，4 级。
