全膝关节置换术后关节纤维化的多模式保守治疗与麻醉下手法治疗的比较：一项回顾性队列比较的可行性研究

Multimodal conservative management of arthrofibrosis after total knee arthroplasty compared to manipulation under anesthesia: a feasibility study with retrospective cohort comparison.

作者信息

Rauzi Michelle R, Foran Jared R H, Bade Michael J

机构信息

Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, 13121 E 17th Ave, Aurora, CO, 80045, USA.

Panorama Orthopedics & Spine Center, 660 Golden Ridge Rd. #250, Golden, CO, 80401, USA.

出版信息

Pilot Feasibility Stud. 2022 Mar 25;8(1):71. doi: 10.1186/s40814-022-01026-y.

DOI:10.1186/s40814-022-01026-y

PMID:35337388

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8953056/

Abstract

BACKGROUND

The ideal treatment of early-stage arthrofibrosis after total knee arthroplasty is unclear. The purpose of this study was to determine the treatment effect, including variability, and feasibility of a multimodal physical therapy program as compared to manipulation under anesthesia.

METHODS

This was a prospective feasibility study with a retrospective cohort comparison. Ten consecutive patients (aged 64 ± 9 years, 7 females) with early-stage arthrofibrosis were enrolled 6 weeks after primary total knee arthroplasty and participated in the multimodal physical therapy program. The multimodal physical therapy program consisted of manual therapy, therapeutic exercise, and static progressive splinting delivered over 4 weeks. The outcomes included knee range of motion (ROM), adherence, patient satisfaction, and safety. Data were compared to a retrospective cohort of 31 patients with arthrofibrosis (aged 65 ± 9 years, 20 females) who underwent manipulation under anesthesia followed by physical therapy.

RESULTS

Overall, knee ROM outcomes were similar between multimodal physical therapy (110° ± 14) and manipulation under anesthesia (109° ± 11). Seven out of ten patients achieved functional ROM (≥ 110°) and avoided manipulation under anesthesia with the multimodal physical therapy program. Three out of 10 multimodal physical therapy patients required manipulation under anesthesia secondary to failure to demonstrate progress within 4 weeks of the multimodal physical therapy program. Adherence to the multimodal physical therapy program was 87 ± 9%. The median patient satisfaction with the multimodal physical therapy program was "very satisfied." Safety concerns were minimal.

CONCLUSION

The use of the multimodal physical therapy program is feasible for treating early-stage arthrofibrosis after total knee arthroplasty, with 70% of patients avoiding manipulation under anesthesia. Randomized controlled trials are needed to determine the efficacy of the multimodal physical therapy program and to determine the optimal patient selection for the multimodal physical therapy program versus manipulation under anesthesia.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT04837872 .

摘要

背景

全膝关节置换术后早期关节纤维化的理想治疗方法尚不清楚。本研究的目的是确定多模式物理治疗方案与麻醉下手法治疗相比的治疗效果（包括变异性）和可行性。

方法

这是一项前瞻性可行性研究，并进行回顾性队列比较。连续10例初次全膝关节置换术后6周出现早期关节纤维化的患者（年龄64±9岁，7例女性）入组并参与多模式物理治疗方案。多模式物理治疗方案包括手法治疗、治疗性锻炼和静态渐进性夹板固定，为期4周。结果包括膝关节活动范围（ROM）、依从性、患者满意度和安全性。数据与31例接受麻醉下手法治疗后再进行物理治疗的关节纤维化患者（年龄65±9岁，20例女性）的回顾性队列进行比较。

结果

总体而言，多模式物理治疗组（110°±14）和麻醉下手法治疗组（109°±11）的膝关节ROM结果相似。10例患者中有7例通过多模式物理治疗方案实现了功能性ROM（≥110°），并避免了麻醉下手法治疗。10例接受多模式物理治疗的患者中有3例因在多模式物理治疗方案4周内未显示进展而需要麻醉下手法治疗。多模式物理治疗方案的依从性为87±9%。患者对多模式物理治疗方案的满意度中位数为“非常满意”。安全问题极少。