Clin Orthop Surg.  2015 Jun;7(2):191-198. 10.4055/cios.2015.7.2.191.

A Novel Non-Invasive Adjuvant Biomechanical Treatment for Patients with Altered Rehabilitation after Total Knee Arthroplasty: Results of a Pilot Investigation

• Yaari L
• Kosashvili Y
• Segal G
• Shemesh S
• Velkes S
• Mor A
• Debi R
• Bernfeld B
• Elbaz A

• KMID: 2164544
• DOI: http://doi.org/10.4055/cios.2015.7.2.191

Abstract

BACKGROUND
Many factors contribute to suboptimal results after total knee arthroplasty (TKA) but little is known regarding the value of postsurgical rehabilitation after TKA. We examined the effects of an enhanced closed kinematic chain exercises program (AposTherapy) on gait patterns and clinical outcomes among patients with a lack of progress in their postsurgical rehabilitation.
METHODS
Twenty-two patients were prospectively followed during the study. Gait spatiotemporal parameters were measured at the initial evaluation, after 15 minutes of therapy, and after 3 months of therapy. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the short form (SF) 36 health survey were completed by patients before treatment and after 3 months of treatment.
RESULTS
The WOMAC and SF-36 scores improved significantly after 3 months of treatment. Gait velocity, single limb support, and step length of the operated leg improved significantly even after a single 15 minutes treatment. Normal gait velocity was observed in 36% of patients after 3 months of treatment.
CONCLUSIONS
A physiotherapy program that included enhanced closed kinematic chain biomechanical therapy was beneficial for patients who experienced a suboptimal rehabilitation course after TKA.

Keyword

Knee; Arthroplasty; Rehabilitation; Gait

MeSH Terms

Aged
Aged, 80 and over
Arthroplasty, Replacement, Knee/*rehabilitation
Biomechanical Phenomena
Female
Humans
Male
Middle Aged
Physical Therapy Modalities/*instrumentation
Pilot Projects
Postoperative Complications/*therapy
Prospective Studies
Shoes
Treatment Failure

Figure

• 

  Fig. 1 The unique biomechanical device was comprised of two individually calibrated biomechanical elements attached to a specially designed sole with two mounting rails and a positioning matrix to enable flexible positioning of each biomechanical element. One element is attached under the hindfoot and the second element is attached under the forefoot. The biomechanical elements are available in different degrees of convexity and resilience.

• 

  Fig. 2 Distribution (%) of gait velocity groups pretreatment, after a single treatment session, and after 3 months of treatment.

Reference

1. Konig A, Walther M, Kirschner S, Gohlke F. Balance sheets of knee and functional scores 5 years after total knee arthroplasty for osteoarthritis: a source for patient information. J Arthroplasty. 2000; 15(3):289–294.

2. Misra AN, Smith RB, Fiddian NJ. Five year results of selective patellar resurfacing in cruciate sparing total knee replacements. Knee. 2003; 10(2):199–203.

3. Heck DA, Robinson RL, Partridge CM, Lubitz RM, Freund DA. Patient outcomes after knee replacement. Clin Orthop Relat Res. 1998; (356):93–110.

4. Zeni JA Jr, Snyder-Mackler L. Early postoperative measures predict 1- and 2-year outcomes after unilateral total knee arthroplasty: importance of contralateral limb strength. Phys Ther. 2010; 90(1):43–54.

5. Moffet H, Collet JP, Shapiro SH, Paradis G, Marquis F, Roy L. Effectiveness of intensive rehabilitation on functional ability and quality of life after first total knee arthroplasty: a single-blind randomized controlled trial. Arch Phys Med Rehabil. 2004; 85(4):546–556.

6. Walsh M, Woodhouse LJ, Thomas SG, Finch E. Physical impairments and functional limitations: a comparison of individuals 1 year after total knee arthroplasty with control subjects. Phys Ther. 1998; 78(3):248–258.

7. Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res. 2010; 468(1):57–63.

8. Foran JR, Mont MA, Etienne G, Jones LC, Hungerford DS. The outcome of total knee arthroplasty in obese patients. J Bone Joint Surg Am. 2004; 86(8):1609–1615.

9. Liebs TR, Herzberg W, Roth-Kroeger AM, Ruther W, Hassenpflug J. Women recover faster than men after standard knee arthroplasty. Clin Orthop Relat Res. 2011; 469(10):2855–2865.

10. Lopez-Olivo MA, Landon GC, Siff SJ, et al. Psychosocial determinants of outcomes in knee replacement. Ann Rheum Dis. 2011; 70(10):1775–1781.

11. Scuderi GR. The stiff total knee arthroplasty: causality and solution. J Arthroplasty. 2005; 20:4 Suppl 2. 23–26.

12. Figgie HE 3rd, Goldberg VM, Heiple KG, Moller HS 3rd, Gordon NH. The influence of tibial-patellofemoral location on function of the knee in patients with the posterior stabilized condylar knee prosthesis. J Bone Joint Surg Am. 1986; 68(7):1035–1040.

13. Furia JP, Pellegrini VD Jr. Heterotopic ossification following primary total knee arthroplasty. J Arthroplasty. 1995; 10(4):413–419.

14. Ghani H, Maffulli N, Khanduja V. Management of stiffness following total knee arthroplasty: a systematic review. Knee. 2012; 19(6):751–759.

15. Elbaz A, Mor A, Segal G, et al. APOS therapy improves clinical measurements and gait in patients with knee osteoarthritis. Clin Biomech (Bristol, Avon). 2010; 25(9):920–925.

16. Haim A, Rozen N, Dekel S, Halperin N, Wolf A. Control of knee coronal plane moment via modulation of center of pressure: a prospective gait analysis study. J Biomech. 2008; 41(14):3010–3016.

17. Haim A, Rozen N, Wolf A. The influence of sagittal center of pressure offset on gait kinematics and kinetics. J Biomech. 2010; 43(5):969–977.

18. Haim A, Wolf A, Rubin G, Genis Y, Khoury M, Rozen N. Effect of center of pressure modulation on knee adduction moment in medial compartment knee osteoarthritis. J Orthop Res. 2011; 29(11):1668–1674.

19. Solomonow-Avnon D, Wolf A, Herman A, Rozen N, Haim A. Reduction of frontal-plane hip joint reaction force via medio-lateral foot center of pressure manipulation: a pilot study. J Orthop Res. 2015; 33(2):261–269.

20. Debbi EM, Wolf A, Haim A. Detecting and quantifying global instability during a dynamic task using kinetic and kinematic gait parameters. J Biomech. 2012; 45(8):1366–1371.

21. Khoury M, Wolf A, Debbi EM, Herman A, Haim A. Foot center of pressure trajectory alteration by biomechanical manipulation of shoe design. Foot Ankle Int. 2013; 34(4):593–598.

22. Bar-Ziv Y, Beer Y, Ran Y, Benedict S, Halperin N. A treatment applying a biomechanical device to the feet of patients with knee osteoarthritis results in reduced pain and improved function: a prospective controlled study. BMC Musculoskelet Disord. 2010; 11:179.

23. Haim A, Rubin G, Rozen N, Goryachev Y, Wolf A. Reduction in knee adduction moment via non-invasive biomechanical training: a longitudinal gait analysis study. J Biomech. 2012; 45(1):41–45.

24. Bade MJ, Stevens-Lapsley JE. Early high-intensity rehabilitation following total knee arthroplasty improves outcomes. J Orthop Sports Phys Ther. 2011; 41(12):932–941.

25. Pham T, Van Der Heijde D, Lassere M, et al. Outcome variables for osteoarthritis clinical trials: the OMERACT-OARSI set of responder criteria. J Rheumatol. 2003; 30(7):1648–1654.

26. Lin CW, March L, Crosbie J, et al. Maximum recovery after knee replacement: the MARKER study rationale and protocol. BMC Musculoskelet Disord. 2009; 10:69.

27. Minns Lowe CJ, Barker KL, Dewey M, Sackley CM. Effectiveness of physiotherapy exercise after knee arthroplasty for osteoarthritis: systematic review and meta-analysis of randomised controlled trials. BMJ. 2007; 335(7624):812.

28. Fitzgerald GK, Childs JD, Ridge TM, Irrgang JJ. Agility and perturbation training for a physically active individual with knee osteoarthritis. Phys Ther. 2002; 82(4):372–382.

29. Risberg MA, Holm I. The long-term effect of 2 postoperative rehabilitation programs after anterior cruciate ligament reconstruction: a randomized controlled clinical trial with 2 years of follow-up. Am J Sports Med. 2009; 37(10):1958–1966.

30. Bar-Ziv Y, Debbi EM, Ran Y, Benedict S, Halperin N, Beer Y. Long-term effects of AposTherapy in patients with osteoarthritis of the knee: a two-year followup. Arthritis. 2013; 2013:689236.