Keating Christopher, Muth Stephanie, Hui Cameron, Hoglund Lisa T
Physical Therapy Thomas Jefferson University.
Physical Therapy Christiana Care Health System.
Int J Sports Phys Ther. 2024 Sep 1;19(9):1138-1150. doi: 10.26603/001c.122488. eCollection 2024.
Knee osteoarthritis (OA) is a common condition that limits function and reduces quality of life. Total knee arthroplasty (TKA) is a surgical procedure that replaces the joint surfaces to address anatomical changes due to knee OA. While TKA improves symptoms and function, postoperative impairments are common, including reduced quadriceps strength. Blood flow restriction (BFR) may be a viable option for patients following TKA, as it can improve strength with a minimal amount of joint loading compared to traditional strength training. The purpose of this case report is to describe the impact of BFR use in an individual after TKA, employing pain measurements, quantitative sensory testing, patient-reported outcome measures, physical performance tests, and muscle strength and power testing to explore potential treatment effects and identify potential predictors of response for future studies.
A 49-year-old former female triathlete with a history of knee injury and arthroscopic surgery underwent a right TKA and sought physical therapy (PT) due to pain, limited range of motion (ROM), and knee instability during weight bearing activity. PT interventions included manual therapy, gait training, and a home program. Despite participating in supervised PT, she had persistent pain, ROM deficits, and muscle weakness 16 weeks following TKA. BFR was incorporated into her home program, 16-weeks postoperatively. The Short Form McGill Pain Questionnaire-2 (SF-MPQ-2) and Numeric Pain Rating Scale (NPRS) were used to measure pain. Quantitative sensory testing included pressure pain threshold (PPT) and two-point discrimination (TPD) to measure change in sensory perception. Patient-reported outcome measures to assess perceived physical function were the Knee injury and Osteoarthritis Outcome Score (KOOS) and the KOOS- Joint Replacement (KOOS-JR). Physical performance was measured through the 30-second fast walk test (30SFW), timed stair climb test (SCT), 30-second chair standing test (CST), and the timed up and go (TUG). Knee ROM was assessed through standard goniometry. Knee extensor and flexor muscle strength and power were measured with an instrumented dynamometer for isokinetic and isometric testing, generating a limb symmetry index (LSI).
Pain and quantitative sensory testing achieved clinically meaningful improvement suggesting reduced sensitivity during and after BFR utilization. Perceived physical function and symptoms significantly improved, particularly in sports and recreation activities, and were best captured in the KOOS, not the KOOS-JR. Physical performance reached clinically meaningful improvement in walking speed, chair stand repetitions, and timed stair climb tests after BFR. Isokinetic and isometric strength and power in knee extensors and flexors increased significantly after BFR compared to the uninvolved leg as determined by LSI.
In this case, BFR appeared to be a safe and well-tolerated intervention. The results suggest potential benefits in terms of increased function, strength, power, and reduced pain in this specific person after TKA. Comprehensive pain and sensory assessments alongside clinical measures may help identify suitable patients for BFR after TKA. The KOOS-Sport & Recreation subscale may be more responsive to monitor functional recovery compared to the KOOS-JR, possibly due to the subject's athletic background.
膝关节骨关节炎（OA）是一种常见病症，会限制功能并降低生活质量。全膝关节置换术（TKA）是一种外科手术，通过置换关节表面来应对膝关节OA引起的解剖学变化。虽然TKA可改善症状和功能，但术后功能障碍很常见，包括股四头肌力量减弱。血流限制（BFR）对于TKA术后患者可能是一种可行的选择，因为与传统力量训练相比，它可以在最小的关节负荷下增强力量。本病例报告的目的是描述BFR在一名TKA术后患者中的应用效果，采用疼痛测量、定量感觉测试、患者报告结局测量、身体性能测试以及肌肉力量和功率测试，以探索潜在的治疗效果并确定未来研究中反应的潜在预测因素。
一名49岁的前女子铁人三项运动员，有膝关节损伤和关节镜手术史，接受了右侧TKA手术，因疼痛、活动范围（ROM）受限以及负重活动时膝关节不稳定而寻求物理治疗（PT）。PT干预包括手法治疗、步态训练和家庭训练计划。尽管参加了监督下的PT治疗，但TKA术后16周她仍持续存在疼痛、ROM缺陷和肌肉无力。术后16周，BFR被纳入她的家庭训练计划。采用简短麦吉尔疼痛问卷 - 2（SF - MPQ - 2）和数字疼痛评分量表（NPRS）来测量疼痛。定量感觉测试包括压力疼痛阈值（PPT）和两点辨别（TPD），以测量感觉知觉的变化。用于评估感知身体功能的患者报告结局测量指标是膝关节损伤和骨关节炎结局评分（KOOS）以及KOOS - 关节置换（KOOS - JR）。通过30秒快速步行测试（30SFW）、定时楼梯攀爬测试（SCT）、30秒椅子站立测试（CST）以及定时起立行走测试（TUG）来测量身体性能。通过标准量角器评估膝关节ROM。使用仪器化测力计进行等速和等长测试，测量膝关节伸肌和屈肌的力量和功率，生成肢体对称指数（LSI）。
疼痛和定量感觉测试取得了具有临床意义的改善，表明在使用BFR期间及之后敏感性降低。感知身体功能和症状显著改善，特别是在运动和娱乐活动方面，并且在KOOS中体现得最好，而非KOOS - JR。BFR后，身体性能在步行速度、椅子站立重复次数和定时楼梯攀爬测试中达到了具有临床意义的改善。与未受影响的腿相比，通过LSI确定，BFR后膝关节伸肌和屈肌的等速和等长力量及功率显著增加。
在本病例中，BFR似乎是一种安全且耐受性良好的干预措施。结果表明，对于该特定TKA术后患者，在功能、力量、功率增加以及疼痛减轻方面可能具有潜在益处。综合疼痛和感觉评估以及临床测量可能有助于识别TKA术后适合BFR的患者。与KOOS - JR相比，KOOS - 运动与娱乐子量表可能对监测功能恢复更敏感，这可能归因于该受试者的运动背景。
4级。
