Harikesavan Karvannan, Chakravarty R D, Maiya Arun G
Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Bangalore, India.
Orthopaedic Joint Replacement Surgeon, Manipal Hospital, Bangalore, India.
J Clin Orthop Trauma. 2019 Mar-Apr;10(2):340-344. doi: 10.1016/j.jcot.2018.04.017. Epub 2018 Apr 30.
Total knee replacement (TKR) is an optimal treatment for persons with severe knee joint pain and disability, who were unsuccessful with conservative management. Early mobilization can be defined as moving out of bed and/or walking quickly after the surgery for reducing the risks allied with bed rest. There is a paucity of studies on effects of early mobilization on a performance-based measure of timed up and go test (TUG), six-minute walk test (SMWT) and a self-reported disease-specific measure of a knee injury and Osteoarthritis outcome score (KOOS) following TKR.
A prospective pre-post-trial was conducted at Manipal Hospital, Bangalore, India. Participants underwent early (POD '0') mobilization on the same postoperative day within 7 h post-TKR surgery. Outcome measures were recorded by an independent blinded observer. The statistical significance level was set at 'p' value < 0.05. The difference between pre-operative and post-operative outcome measure at 1 month and 3 months post-intervention were analyzed using repeated measures of ANOVA.
The study included a total of 78 participants (59 Females; 19 Males) and the mean age of the included participants was 64.1 ± 7 years. Amongst, 78 participants, 53 underwent unilateral TKR, 25 underwent bilateral TKR. There were three dropouts in the study due to post-operative complications. Significant improvements from pre-operative to one month were observed following POD '0' mobilization on NPRS (7.35 ± 1.2 to 4.3 ± 1.7), SMWT (169 ± 70 to 236.7 ± 80.7). KOOS subscales of pain, symptom, and quality of life showed significant changes at one month and 3 months. TUG, Knee strength, Knee ROM and KOOS ADL subscale shown improvements only at 3 months post-intervention.
Our study findings suggest that POD '0' (early) mobilization can result in reduced pain and an increase in walking speed at 1 month. Significant changes were observed in pain, Knee strength, Knee ROM, TUG, SMWT and KOOS subscales at 3 months following total knee replacement.
全膝关节置换术（TKR）是治疗膝关节严重疼痛和残疾且保守治疗无效患者的最佳方法。早期活动可定义为术后尽快下床和/或行走，以降低与卧床休息相关的风险。关于全膝关节置换术后早期活动对基于表现的计时起立行走测试（TUG）、六分钟步行测试（SMWT）以及自我报告的特定疾病膝关节损伤和骨关节炎疗效评分（KOOS）的影响，相关研究较少。
在印度班加罗尔的马尼帕尔医院进行了一项前瞻性前后对照试验。参与者在全膝关节置换术后7小时内的同一天（术后第0天）进行早期活动。结果指标由独立的盲法观察者记录。统计学显著性水平设定为“p”值<0.05。使用重复测量方差分析干预后1个月和3个月时术前和术后结果指标之间的差异。
该研究共纳入78名参与者（59名女性；19名男性），纳入参与者的平均年龄为64.1±7岁。其中，78名参与者中，53例行单侧全膝关节置换术，25例行双侧全膝关节置换术。该研究中有3名参与者因术后并发症退出。术后第0天活动后，从术前到1个月，数字疼痛评分量表（NPRS）（7.35±1.2至4.3±1.7）、六分钟步行测试（SMWT）（169±70至236.7±80.7）有显著改善。KOOS的疼痛、症状和生活质量子量表在1个月和3个月时显示出显著变化。计时起立行走测试（TUG）、膝关节力量、膝关节活动度（ROM）和KOOS日常生活活动（ADL）子量表仅在干预后3个月有所改善。
我们的研究结果表明，术后第0天（早期）活动可在1个月时减轻疼痛并提高步行速度。全膝关节置换术后3个月时，疼痛、膝关节力量、膝关节活动度、计时起立行走测试（TUG）、六分钟步行测试（SMWT）和KOOS子量表有显著变化。
