Manual lenfatik drenajın total diz artroplastisini takip eden toparlanma süreci üzerindeki etkisi

Giriş: Diz ekleminin günlük yaşam aktivitelerinde büyük önemi vardır, bu nedenle gonartroz hastaların yaşam kalitesini çok dramatik bir şekilde etkiler. Total diz artroplastisi (TDA), özellikle terminal dönemdeki gonartrozlu hastalarda ağrı, deformite ve instabilite ile baş edebilmek için altın standart olarak kabul edilmektedir. Fizik tedavi ve rehabilitasyon programlarının bu cerrahi işlemin başarısını arttırdığı bilinmektedir. Diz eklemi çevresindeki ödem, iyileşme sürecini uzatan majör postoperatif komplikasyonlardan biri olduğundan, bu soruna karşı tedavi yöntemlerinin kullanılması önemlidir. Amaç: Bu çalışmada TDA sonrası manuel lenfatik drenajın (MLD) ödem, hareket açıklığı, ağrı, günlük yaşam aktivitelerinin bağımsızlığı, yürüme mesafesi ve diz fonksiyonelliği üzerine etkinliğinin değerlendirilmesi amaçlandı. Gereç ve Yöntem: Total diz artroplastisi geçiren 16 hasta iki gruba ayrılarak bunlardan birine standart postoperatif rehabilitasyon prosedürü (egzersiz terapisi, cryoterapi ve pozisyonlama) uygulanırken diğer gruba standart protokole ek olarak, postoperatif sürecin 2. ve 4. günlerde günde bir kez 30 dakikalık MLD terapisi uygulandı. Ameliyat sonrası 2., 4. ve 6. günlerde hacimsel değişiklikler alt ekstremitenin her bir 4 cm’lik segmenti için Sitzia ve ark.’nın formülüne dayanarak hesaplandı; aktif EHA ve istirahatte diz postürü universal gonyometre ile ölçüldü; ağrı görsel analog skala (GAS) ile; yürüme mesafesi, bir gün içindeki toplam yürüme mesafesi hesaplanarak; günlük yaşam aktivitelerindeki bağımsızlık seviyesi Fonksiyonel bağımsızlık ölçeği ile değerlendirildi. Ayrıca diz ekleminin işlevselliğini değerlendirmek için postoperatif 15. günde Lysholm diz skoru hesaplandı. Bulgular: Postoperatif 2. gün, 4. gün ve 6. gün FİM ortalaması (sırasıyla p=0.972, p=0.575, p=0.398), aktif EHA (sırasıyla p=0.288, p=0.522, p=0.622), diz postürü (sırasıyla p=0.870, p=0.521, p=0.445), yürüme mesafesi (sırasıyla p=1.000, p=0.258, p=0.113), ameliyat edilen alt ekstremite hacmi (sırasıyla p=0.451, p= 0.384, p=0.268), gün içindeki ağrıya yönelik GAS (sırasıyla p=0.192, p=0.488, p=0.506) ve gece ağrısına yönelik GAS (sırasıyla p=0.137, p=0.562, p=0.748) manuel lenfatik drenaj yapılan ve yapılmayan gruplarda benzerdi Lysholm skorunun ortalaması manuel lenfatik drenaj grubunda 46.25±24.50 ve manual lenfatik drenaj yapılmayan grupta 61.12±17.70 idi (p=0.186). Sonuç: Gruplar arasında anlamlı bir fark olmamasına rağmen MLD’nin etkinliği daha büyük örneklemle yapılacak çalışmalarda gösterilebilir.

Anahtar Kelimeler:

Manuel lenfatik drenaj, total diz artroplastisi, fizik Tedavi

The effect of manual lymphatic drainage on postoperative recovery process following total knee arthroplasty

Background: Knee joint has great importance on daily living activities thus gonarthrosis does affect quality of life of patients very dramatically. Total knee arthroplasty (TKA) is accepted as gold standard in order to cope with pain, deformity and instability especially in patients with gonarthrosis who are in terminal stage. Physical therapy and rehabilitation programs are known to increase the success of this surgical procedure. As edema around knee joint is one of the major postoperative complications, which prolong recovery process, it is important to use therapeutic modalities against this problem. Objective: In this study it was aimed to evaluate the effectiveness of manual lymphatic drainage (MLD) following TKA on edema, range of motion, pain, independence of daily living activities, gait distance and knee functionality. Material and Method: 16 patients with TKA were divided into two groups while one of them is applied standard postoperative rehabilitation procedure (exercise therapy, cryotherapy and positioning) and the other group had MLD therapy on the second and fourth days of the postoperative process for thirty minutes and in one session during the day in addition to standard protocol. On post-op 2nd, 4th, and 6th days, the volumetric changes were calculated based on a formula of Sitzia et al. for each 4 cm segment of the lower extremity, active ROM and knee posture at rest were measured by a universal goniometer, pain by using visual analog scale (VAS), walking distance by calculating total walking distance in a day, independence level in daily living activities by using Functional independence measurement (FIM) scale. In addition, Lysholm knee score was calculated on postoperative 15th day in order to evaluate functionality of knee joint. Results: At postoperative 2nd day, 4th day and 6th day, the mean of FIM (p=0.972, p=0.575, p=0.398, respectively), active ROM (p=0.288, p=0.522, p=0.622, respectively), knee posture (p=0.870, p=0.521, p=0.445, respectively), gait distance (p=1.000, p=0.258, p=0.113, respectively), volume of the operated lower extremity (p=0.451, p=0.384, p=0.268, respectively), VAS for pain daytime (p=0.192, p=0.488, p=0.506, respectively) and night (p=0.137, p=0.562, p=0.748, respectively) were similar in both MLD and non-MLD groups. The mean of Lysholm score was 46.25±24.50 in MLD group and 61.12±17.70 in non-MLD group (p=0.186). Conclusion: Although there is no significant difference between groups, the effectiveness of MLD can be showed in studies which will be performed with a larger sample size.

Keywords:

Manual lymphatic drainage, total knee arthroplasty, physical therapy,

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