Department of Orthopaedic Surgery, University Hospital Ghent, Ghent, Belgium.
Department of Rehabilitation Sciences, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium.
Bone Joint J. 2024 Dec 1;106-B(12):1416-1425. doi: 10.1302/0301-620X.106B12.BJJ-2024-0553.R1.
Approximately 10% to 20% of knee arthroplasty patients are not satisfied with the result, while a clear indication for revision surgery might not be present. Therapeutic options for these patients, who often lack adequate quadriceps strength, are limited. Therefore, the primary aim of this study was to evaluate the clinical effect of a novel rehabilitation protocol that combines low-load resistance training (LL-RT) with blood flow restriction (BFR).
Between May 2022 and March 2024, we enrolled 45 dissatisfied knee arthroplasty patients who lacked any clear indication for revision to this prospective cohort study. All patients were at least six months post-surgery and had undergone conventional physiotherapy previously. The patients participated in a supervised LL-RT combined with BFR in 18 sessions. Primary assessments included the following patient-reported outcome measures (PROMs): Knee injury and Osteoarthritis Outcome Score (KOOS); Knee Society Score: satisfaction (KSSs); the EuroQol five-dimension five-level questionnaire (EQ-5D-5L); and the pain catastrophizing scale (PCS). Functionality was assessed using the six-minute walk Test (6MWT) and the 30-second chair stand test (30CST). Follow-up timepoints were at baseline, six weeks, three months, and six months after the start.
Six weeks of BFR with LL-RT improved all the PROMs except the sports subscale of the KOOS compared to baseline. Highest improvements after six weeks were found for quality of life (QoL) (mean 28.2 (SD 17.2) vs 19 (SD 14.7); p = 0.002), activities of daily living (mean 54.7 (SD 18.7) vs 42.9 (SD 17.3); p < 0.001), and KSSs (mean 17.1 (SD 8.8) vs 12.8 (SD 6.7); p < 0.001). PROMs improvements continued to be present at three-month and six-month follow-up compared to baseline. However, no significant differences were observed in the paired comparisons of the six-week, three-month, and six-month follow-up. The same trends are observed for the 6MWT and 30CST.
The reported regime demonstrates improved QoL and function of dissatisfied knee arthroplasty patients. In light of this, the pathway described may provide a valuable and safe treatment option for dissatisfied knee arthroplasty patients for whom therapeutic options are limited.
大约 10%至 20%的膝关节置换术患者对手术结果不满意，而明确的翻修手术指征可能并不存在。对于这些通常缺乏足够股四头肌力量的患者，治疗选择有限。因此，本研究的主要目的是评估一种新的康复方案的临床效果，该方案将低负荷阻力训练（LL-RT）与血流限制（BFR）相结合。
2022 年 5 月至 2024 年 3 月，我们招募了 45 名不满意膝关节置换术且无明确翻修指征的患者进行这项前瞻性队列研究。所有患者均在手术后至少 6 个月，且之前已接受过常规物理治疗。患者参加了 18 次监督下的 LL-RT 联合 BFR。主要评估指标包括以下患者报告的结果测量（PROMs）：膝关节损伤和骨关节炎结果评分（KOOS）；膝关节学会评分：满意度（KSSs）；欧洲五维健康量表 5 级问卷（EQ-5D-5L）；以及疼痛灾难化量表（PCS）。功能性通过 6 分钟步行测试（6MWT）和 30 秒椅子站立测试（30CST）进行评估。随访时间点为基线、6 周、3 个月和开始后 6 个月。
与基线相比，BFR 联合 LL-RT 治疗 6 周后，除 KOOS 的运动亚量表外，所有 PROMs 均得到改善。6 周后，生活质量（QoL）的改善最高（平均 28.2（SD 17.2）比 19（SD 14.7）；p = 0.002），日常生活活动（平均 54.7（SD 18.7）比 42.9（SD 17.3）；p < 0.001）和 KSSs（平均 17.1（SD 8.8）比 12.8（SD 6.7）；p < 0.001）。与基线相比，在 3 个月和 6 个月的随访中，PROMs 的改善仍持续存在。然而，在 6 周、3 个月和 6 个月的随访中，配对比较没有观察到显著差异。在 6MWT 和 30CST 中也观察到了相同的趋势。
报告的方案显示不满意膝关节置换术患者的 QoL 和功能得到改善。有鉴于此，对于治疗选择有限的不满意膝关节置换术患者，所描述的方法可能提供有价值且安全的治疗选择。
