Salim ERSÖZLÜ, ORÇUN ŞAHİN, A. Fevzi ÖZGÜR, İ. Cengiz TUNCAY

İki farklı sürekli pasif hareket protokolünün total diz protezi sonrası diz hareket açıklığına etkileri: İleriye dönük bir çalışma

Amaç: İleriye dönük yürütülen bu çalışmada, total diz protezi (TDP) sonrasında iki farklı zamanda başlanan sürekli pasif hareketin (SPH), standart fizik tedaviyle karşılaştırmalı olarak, kısa ve uzun dönem sonuçlar üzerine etkisi araştırıldı. Çalışma planı: Primer osteoartrit tanısıyla TDP uygulanan 86 hasta cerrahi sonrasında rastgele seçimle üç gruba ayrıldı. Kontrol grubuna (n=28) sadece standart fizik tedavi protokolü uygulandı; 29’ar hastadan oluşan grup I ve grup II’de ise standart fizik tedavi protokolüne ek olarak, sırasıyla ameliyat sonrası birinci gün ve üçüncü günden başlanarak ve hasta taburcu edilene kadar, günde üç kez birer saat SPH uygulandı. Hastaların ameliyat öncesi ve ameliyat sonrası diz hareket açıklıkları ölçüldü. Hastalar Diz Derneği’nin (The Knee Society) klinik ve fonksiyonel skorlama sistemleri ile değerlendirildi. Tüm hastalar en az iki yıl (dağılım 26-52 ay) takip edildi. Sonuçlar: Grup I’de ortalama 22 saat, grup II’de 19 saat SPH uygulandı (p>0.05). Gruplar arasında, ameliyat sonrası 3. gün (p=0.01) ve taburcu olurken (p=0.004) ölçülen diz fleksiyonu değerleri anlamlı farklılık göstermesine rağmen, birinci ay ve sonraki ölçümlerde diz fleksiyonu değerleri üç grup arasında anlamlı farklılık göstermedi (p>0.05). Pasif diz fleksiyonunun 100 dereceye ulaşması için geçen süre ve hastanede kalış süresi SPH uygulanan iki grupta kontrol grubundan sırasıyla ortalama 3 gün ve 2 gün daha kısaydı (p=0.03 ve p=0.04). Üç grupta da hastaların ameliyat sonrası Diz Derneği klinik ve fonksiyonel skorları ameliyat öncesine göre belirgin derecede artmasına karşın (p0.05). Çıkarımlar: Total diz protezi sonrası uygulanan SPH protokolleri hastanede kalış süresini kısaltsa da, orta ve uzun dönemde diz fleksiyonu ile klinik ve fonksiyonel sonuçlar açısından standart fizik tedavi uygulamalarına kıyasla bir üstünlük sağlamamaktadır.

Anahtar Kelimeler:

Fizik tedavi yöntemleri, Hareket açıklığı, eklem, Diz eklemi, Yatış süresi, Motor aktivite, Osteoartrit, İleriye dönük çalışma, Hareket tedavisi, sürekli pasif, Artroplasti, replasman, diz

The effects of two different continuous passive motion protocols on knee range of motion after total knee arthroplasty: a prospective analysis

Objectives: We prospectively evaluated the effects of continuous passive motion (CPM) started after two different time intervals following total knee arthroplasty (TKA) on short- and longterm results, in comparison with standard physical therapy. Methods: Eighty-six patients were randomized to three groups following TKA for primary osteoarthritis. The control group (n=28) received only conventional physical therapy. Group I and II, each consisting of 29 patients, were treated with conventional physical therapy combined with CPM that was started on the first and third postoperative days, respectively, and continued until discharge with three one-hour sessions daily. Preoperative and postoperative measurements of the knee range of motion were recorded. Clinical and functional results were assessed using the Knee Society rating system. The patients were followed-up for at least two years (range 26 to 52 months). Results: The duration of CPM was 22 hours in group I, and 19 hours in group II (p>0.05). Knee flexion values measured in the CPM groups on day 3 and at discharge showed significant differences with those of the control group, but no significant differences were found between the groups after the first postoperative month in this respect (p>0.05). The mean duration to reach 100 degrees of passive knee flexion (p=0.03) and the mean length of hospital stay (p=0.04) in the CPM groups were shorter by three and two days compared to the control group, respectively. Clinical and functional knee scores showed significant improvements in all the groups postoperatively (p<0.001), but there were no significant differences between the groups with respect to pre-and postoperative knee scores (p>0.05). Conclusion: Even though CPM protocols applied following TKA may shorten the length of hospital stay, CPM applications do not offer additional short- and long-term benefits over standard physical therapy with respect to knee flexion and clinical and functional results.

Keywords:

Physical Therapy Modalities, Range of Motion, Articular, Knee Joint, Length of Stay, Motor Activity, Osteoarthritis, Prospective Studies, Motion Therapy, Continuous Passive, Arthroplasty, Replacement, Knee,

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