SERKAN BAKIRHAN, BAYRAM ÜNVER, Vasfi KARATOSUN

Tek taraflı ve iki taraflı total diz artroplastili hastaların ameliyat sonrası erken dönem fonksiyonel hareketlerinin karşılaştırılması

Amaç: Tek taraﬂı ve iki taraﬂı total diz artroplastisi (TDA) uygulanan hastaların ameliyat sonrası erken dönemdeki fonksiyonel hareketleri karşılaştırıldı. Çalışma planı: Çalışmaya, gonartroz nedeniyle primer TDA uygulanan 241 hasta alındı. Bu hastaların 130’una iki taraflı (12 erkek, 118 kadın; ort. yaş 67.5±7.6), 111’ine tek taraﬂı (7 erkek, 104 kadın; ort. yaş 66.3±9.0) TDA uygulandı. Tüm hastalarda iki taraﬂı TDA endikasyonu vardı. Hastalara aynı rehabilitasyon programı uygulandı. Hastaların ameliyat öncesi ve sonrası 2. ve 6. günlerdeki ve taburcu edilirken Iowa Yardım Düzeyi Skalası ile fonksiyonel hareketleri, Iowa Yürüme Hızı Skalası ile yürüme hızları değerlendirildi. Ayrıca, diz hareket açıklıkları ölçüldü ve diz fonksiyonları HSS (Hospital for Special Surgery) diz skoru ile değerlendirildi. Sonuçlar: İki grubun ameliyat öncesi tüm verileri benzer bulundu (p>0.05). Ameliyat öncesine göre, taburculuk sırasındaki fonksiyonel hareket düzeyleri iki grupta da anlamlı düzelme gösterdi (p

Anahtar Kelimeler:

Fonksiyon iyileşmesi, Günlük yaşam etkinlikleri, Ameliyat sonrası dönem, Hareket açıklığı, eklem, Artroplasti, replasman, diz

Comparison of early postoperative functional activity levels of patients undergoing unilateral and bilateral total knee arthroplasty

Objectives: We compared early postoperative functional activities of patients undergoing unilateral and bilateral total knee arthroplasty (TKA). Methods: A total of 241 patients underwent bilateral (n=130; 12 men, 118 women; mean age 67.5±7.6 years) or unilateral (n=111; 7 men, 104 women; mean age 66.3±9.0 years) primary TKA for gonarthrosis. All the patients had indications for bilateral TKA and received the same rehabilitation program postoperatively. Functional activities and walking speed of the patients were assessed with the Iowa Level of Assistance Scale and Ambulation Velocity Scale, respectively, before surgery and on the second and sixth postoperative days and during discharge. In addition, knee range of motion and HSS (Hospital for Special Surgery) knee scores were measured. Results: There were no signiﬁcant differences between the two groups preoperatively (p>0.05). Compared to baseline, functional activity levels during discharge showed signiﬁcant improvement in both groups (p<0.05), whereas improvement in walking speed was signiﬁcant only in the unilateral TKA group (p<0.05). Comparison of postoperative functional activity levels favored unilateral over bilateral TKA in all instances (p<0.05). The two groups did not differ signiﬁcantly with respect to postoperative walking speed, HSS knee scores, range of motion of the knee, and mean hospital stay (p>0.05). Complications included knee hematoma (n=2) and deep vein thrombosis (n=1) in the unilateral TKA group, and knee hematoma (n=1) in the bilateral TKA group. Conclusion: Postoperative physiotherapy programs should consider decreases in functional activities of patients undergoing bilateral TKA.

Keywords:

Recovery of Function, Activities of Daily Living, Postoperative Period, Range of Motion, Articular, Arthroplasty, Replacement, Knee,

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1. Mangaleshkar SR, Prasad PS, Chugh S, Thomas AP. Staged bilateral total knee replacement-a safer approach in older patients. Knee 2001;8:207-11.
2. Bullock DP, Sporer SM, Shirreffs TG Jr. Comparison of simultaneous bilateral with unilateral total knee arthroplasty in terms of perioperative complications. J Bone Joint Surg [Am] 2003;85:1981-6.
3. Leitch KK, Dalgorf D, Borkhoff CM, Kreder HJ. Bilateral total knee arthroplasty-staged or simultaneous? Ontario’s orthopedic surgeons reply. Can J Surg 2005;48:273-6.
4. Jones CA, Voaklander DC, Suarez-Alma ME. Determinants of function after total knee arthroplasty. Phys Ther 2003;83: 696-706.
5. Shields RK, Leo KC, Miller B, Dostal WF, Barr R. An acute care physical therapy clinical practice database for outcomes research. Phys Ther 1994;74:463-70.
6. Levine HB, Zuckerman JD. Joint replacement in the geriatric orthopaedic patient. Oper Tech Orthop 2002;12:92-102.
7. Clark CR. Cost containment: total joint implants. J Bone Joint Surg [Am] 1994;76:799-800.
8. Ünver B, Karatosun V, Bakırhan S. Total diz artroplastili geriatrik hastaların ameliyat sonrası erken dönem fonksiyonel düzeylerinin incelenmesi. Türk Geriatri Dergisi 2006; 9:19-24.
9. Ünver B, Dönmez B, Karatosun V. Primer total kalça protezi uygulamalarında protez tipinin hastane içi fonksiyonel düzey ve hastanede kalış süresi üzerine etkileri. Eklem Hastalıkları ve Cerrahisi 2006;17:123-7.
10. McLaughlin TP, Fisher RL. Bilateral total knee arthroplasties. Comparison of simultaneous (two-team), sequential, and staged knee replacements. Clin Orthop Relat Res 1985;(199):220-5.
11. Fick D, Crane T, Shakespeare D. A comparison of bilateral vs. unilateral total knee arthroplasty mobilised using a flexion regime. Knee 2002;9:285-9.
12. Hewitt B, Shakespeare D. Flexion vs. extension: a comparison of post-operative total knee arthroplasty mobilisation regimes. Knee 2001;8:305-9.
13. Ünver B, Karatosun V, Bakırhan S. Effects of obesity on inpatient rehabilitation outcomes following total knee arthroplasty. Physiotherapy 2008;94:198-203.
14. Ünver B, Karatosun V, Bakırhan S. Ability to rise independently from a chair during 6-month follow-up after unilateral and bilateral total knee replacement. J Rehabil Med 2005;37:385-7.
15. Ries MD, Philbin EF, Groff GD, Sheesley KA, Richman JA, Lynch F Jr. Improvement in cardiovascular fitness after total knee arthroplasty. J Bone Joint Surg [Am] 1996;78:1696-701.
16. Mahoney OM, McClung CD, dela Rosa MA, Schmalzried TP. The effect of total knee arthroplasty design on extensor mechanism function. J Arthroplasty 2002;17:416-21.
17. Memtsoudis SG, González Della Valle A, Besculides MC, Gaber L, Sculco TP. In-hospital complications and mortality of unilateral, bilateral, and revision TKA: based on an estimate of 4,159,661 discharges. Clin Orthop Relat Res 2008; 466:2617-27.
18. Restrepo C, Parvizi J, Dietrich T, Einhorn TA. Safety of simultaneous bilateral total knee arthroplasty. A metaanalysis. J Bone Joint Surg [Am] 2007;89:1220-6.
19. Ottenbacher KJ, Smith PM, Illig SB, Linn RT, Ostir GV, Granger CV. Trends in length of stay, living setting, functional outcome, and mortality following medical rehabilitation. JAMA 2004;292:1687-95.
20. Forrest G, Fuchs M, Gutierrez A, Girardy J. Factors affecting length of stay and need for rehabilitation after hip and knee arthroplasty. J Arthroplasty 1998;13:186-90.
21. Lin JJ, Kaplan RJ. Multivariate analysis of the factors affecting duration of acute inpatient rehabilitation after hip and knee arthroplasty. Am J Phys Med Rehabil 2004;83:344-52.
22. Denis M, Moffet H, Caron F, Ouellet D, Paquet J, Nolet L. Effectiveness of continuous passive motion and conventional physical therapy after total knee arthroplasty: a randomized clinical trial. Phys Ther 2006;86:174-85.
23. Lenssen AF, Crijns YH, Waltjé EM, van Steyn MJ, Geesink RJ, van den Brandt PA, et al. Efficiency of immediate postoperative inpatient physical therapy following total knee arthroplasty: an RCT. BMC Musculoskelet Disord 2006;7:71.
24. Vincent KR, Vincent HK, Lee LW, Alfano AP. Outcomes in total knee arthroplasty patients after inpatient rehabilitation: influence of age and gender. Am J Phys Med Rehabil 2006;85:482-9.
25. Powell RS, Pulido P, Tuason MS, Colwell CW Jr, Ezzet KA. Bilateral vs unilateral total knee arthroplasty: a pa- tient-based comparison of pain levels and recovery of am- bulatory skills. J Arthroplasty 2006;21:642-9.