Soma Yuichiro, Yoshioka Tomokazu, Kubota Shigeki, Sugaya Hisashi, Shimizu Yukiyo, Hada Yasushi, Yamazaki Masashi
Physical Medicine and Rehabilitation, Institute of Medicine, University of Tsukuba, Tsukuba, JPN.
Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, JPN.
Cureus. 2024 May 11;16(5):e60122. doi: 10.7759/cureus.60122. eCollection 2024 May.
BACKGROUND AND OBJECTIVE: Opening wedge high tibial osteotomy (OWHTO) influences the knee extensor mechanism, the range of passive motion of knee extension and persistent quadriceps, and anterior knee pain and weakness. Rehabilitation should focus on quadriceps strength and improving joint mobility. The single-joint hybrid assistive limb device (HAL-SJ) is a wearable exoskeleton cyborg. In this study, we investigated the feasibility and safety of HAL-SJ training after the early postoperative period following OWHTO and whether the use of this device can improve functional outcomes, including knee muscle extensor strength and knee extension range of motion without knee pain. METHODS: Patients who had been diagnosed with knee osteoarthritis and had undergone OWHTO were assessed for eligibility in this prospective trial conducted at our institution between June 2015 and November 2020. The participants were split into two groups, i.e., 10 patients in the hybrid assistive limb (HAL) group and eight patients in the control group. We initiated HAL-SJ therapy on postoperative day 8 and continued it until the patient's discharge. During the hospitalization period, patients engaged in HAL-SJ-assisted knee extension exercises. This exercise routine encompassed five sets, each comprising 10 repetitions, and was conducted twice a week. We conducted assessments aimed at detecting any potential adverse events that could be linked to HAL training. Assessment of the knee extension angle via the visual analog scale (VAS) and strength assessments using a hand-held dynamometer (HHD) were conducted. To compare clinical outcomes before and after OWHTO, knee extension angle, the VAS, HHD, Japanese Orthopaedics Association (JOA) score, and the Japanese Knee Osteoarthritis Measure (JKOM) were assessed at four distinct time points. RESULTS: No adverse events were observed during the study. The assessment of clinical outcomes before and after OWHTO demonstrated a gradual improvement in outcomes. CONCLUSION: The single-joint hybrid assistive limb device in patients who underwent OWHTO appears to be potentially safe. It contributed to enhanced muscle activity efficiency by reducing knee pain and improving knee extension angles in the early postoperative phase.
背景与目的：开放性楔形高位胫骨截骨术（OWHTO）会影响膝关节伸肌机制、膝关节被动伸展活动范围以及股四头肌持续状态，还有膝关节前部疼痛和无力。康复应着重于股四头肌力量和改善关节活动度。单关节混合辅助肢体装置（HAL-SJ）是一种可穿戴的外骨骼半机械人。在本研究中，我们调查了OWHTO术后早期进行HAL-SJ训练的可行性和安全性，以及使用该装置是否能改善功能结局，包括膝关节伸肌力量和膝关节伸展活动范围且无膝关节疼痛。 方法：在我们机构于2015年6月至2020年11月进行的这项前瞻性试验中，对被诊断为膝关节骨关节炎且接受了OWHTO的患者进行资格评估。参与者被分为两组，即混合辅助肢体（HAL）组10例患者和对照组8例患者。我们在术后第8天开始HAL-SJ治疗，并持续至患者出院。在住院期间，患者进行HAL-SJ辅助的膝关节伸展锻炼。该锻炼常规包括五组，每组10次重复，每周进行两次。我们进行了旨在检测任何可能与HAL训练相关的潜在不良事件的评估。通过视觉模拟量表（VAS）评估膝关节伸展角度，并使用手持测力计（HHD）进行力量评估。为了比较OWHTO前后的临床结局，在四个不同时间点评估膝关节伸展角度、VAS、HHD、日本骨科协会（JOA）评分和日本膝关节骨关节炎测量（JKOM）。 结果：研究期间未观察到不良事件。OWHTO前后的临床结局评估显示结局逐渐改善。 结论：接受OWHTO的患者使用单关节混合辅助肢体装置似乎具有潜在安全性。它通过减轻膝关节疼痛和改善术后早期膝关节伸展角度，有助于提高肌肉活动效率。
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