Omari Adam, Ingelsrud Lina Holm, Bandholm Thomas Quaade, Lentz Susanne Irene, Troelsen Anders, Gromov Kirill
University of Copenhagen, Faculty of Health and Medical Sciences, Blegdamsvej 3B, 2200, Copenhagen N, Denmark.
Department of Orthopedic Surgery, Copenhagen University Hvidovre Hospital, Kettegård Alle 30, 2650, Hvidovre, Copenhagen, Denmark.
J Exp Orthop. 2021 Jun 9;8(1):38. doi: 10.1186/s40634-021-00354-x.
The optimal rehabilitation strategy after a unicompartmental knee arthroplasty (UKA) is unclear. This study aims to compare the effect of transitioning from a supervised to a self-management rehabilitation regime by pilot study of patient outcomes subsequent to UKA surgery.
Fifty consecutive patients scheduled to undergo unilateral UKA surgery at our institution between 22 February 2016 and 18of January 2017 were prospectively identified via local medical database and included. Performed UKAs were grouped into two cohorts, Supervised Cohort and Self-management Cohort, temporally separated by introduction of new rehabilitation. Self-management Cohort(n = 25) received an extensive inpatient rehabilitation regime along with outpatient referral to rehabilitation center. The Self-management Cohort(n = 25) were only instructed in use of crutches and free ambulation at own accord. Follow-up (F/U) was 1 year from receiving UKA. A range of outcomes were recorded, and between-cohort differences compared: knee joint range of motion, pain and functional limitations, length of stay (LOS), readmission rate, pain during activity and rest, and knee circumference.
Complete data was obtained for n = 45 patients. The mean between-cohort difference in ROM (range of motion) from preoperatively to discharge was 15.4 degrees (CI:5.2,25.8, p = 0.004), favoring the supervised regime, with no difference detected in any outcome at 3- or 12 months F/U. Median LOS was 1 day in both cohorts.
Transition to a simple rehabilitation regime following UKA surgery was associated with decreased ROM at discharge, which was not present at 3-month F/U. We found no other between-cohort differences for any other outcomes at 3- and 12-month F/U including functional limitations, although the study was likely underpowered for these outcomes. We encourage large-scale replication of these findings using randomized designs.
Therapeutic level II.
单髁膝关节置换术（UKA）后的最佳康复策略尚不清楚。本研究旨在通过对UKA手术后患者预后的初步研究，比较从监督康复模式转变为自我管理康复模式的效果。
通过本地医疗数据库前瞻性识别并纳入了2016年2月22日至2017年1月18日期间在本机构计划接受单侧UKA手术的50例连续患者。所实施的UKA手术被分为两个队列，即监督队列和自我管理队列，通过引入新的康复模式在时间上分开。自我管理队列（n = 25）接受了广泛的住院康复方案以及门诊转介至康复中心。自我管理队列（n = 25）仅被指导自行使用拐杖和自由行走。随访（F/U）从接受UKA手术开始为期1年。记录了一系列预后指标，并比较了队列间差异：膝关节活动范围、疼痛和功能受限情况、住院时间（LOS）、再入院率、活动和休息时的疼痛以及膝关节周长。
获得了n = 45例患者的完整数据。从术前到出院，队列间ROM（活动范围）的平均差异为15.4度（CI：5.2,25.8，p = 0.004），有利于监督模式，在3个月或12个月随访时，在任何预后指标中均未检测到差异。两个队列的中位LOS均为1天。
UKA手术后转变为简单的康复模式与出院时ROM降低有关，而在3个月随访时不存在这种情况。在3个月和12个月随访时，我们未发现其他队列间在任何其他预后指标上的差异，包括功能受限情况，尽管该研究对于这些预后指标可能效力不足。我们鼓励使用随机设计对这些发现进行大规模重复研究。
治疗性II级。
