Georgetown University School of Medicine, Washington, DC.
Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
J Bone Joint Surg Am. 2021 Mar 3;103(5):446-455. doi: 10.2106/JBJS.20.00983.
»: A formal unsupervised activity program should be recommended to all patients recovering from total knee arthroplasty (TKA) and total hip arthroplasty (THA).
»: In a subset of all patients undergoing TKA or THA, studies have found that an unsupervised activity program may be as efficacious as supervised physical therapy (PT) after surgery. Certain patients with inadequate independent function may continue to benefit from supervised PT.
»: For TKA, supervised telerehabilitation has also been proven to be an effective modality, with studies suggesting equivalent efficacy compared with supervised in-person PT.
»: Following TKA, there is no benefit to the use of continuous passive motion or cryotherapy devices, but there are promising benefits from the use of pedaling exercises, weight training, and balance and/or sensorimotor training as adjuncts to a multidisciplinary program after TKA.
»: No standardized postoperative limitations exist following TKA, and the return to preoperative activities should be dictated by an individual's competency and should consist of methods to minimize high impact stress on the joint.
»: Despite traditional postoperative protocols recommending range-of-motion restrictions after THA, it is reasonable to recommend that hip precautions may not be needed routinely following elective primary THA.
»: 建议所有接受全膝关节置换术(TKA)和全髋关节置换术(THA)的患者都参加正式的非监督活动计划。
»: 在接受 TKA 或 THA 的所有患者中,有研究发现,非监督活动计划在手术后可能与监督物理治疗(PT)同样有效。某些独立功能不足的患者可能会继续从监督 PT 中受益。
»: 对于 TKA,远程监督康复治疗也已被证明是一种有效的治疗方式,研究表明与监督面对面 PT 具有等效疗效。
»: TKA 后,连续被动运动或冷冻疗法设备没有益处,但使用踩踏运动、举重以及平衡和/或感觉运动训练作为 TKA 后多学科方案的辅助手段具有很大的益处。
»: TKA 后不存在标准化的术后限制,应根据个人的能力来决定恢复术前活动的时间,并且应包括减少对关节高冲击压力的方法。
»: 尽管传统的术后方案建议在 THA 后限制活动范围,但在择期进行原发性 THA 后,常规不需要髋关节预防措施是合理的。