Journal of Shandong University (Health Sciences) ›› 2024, Vol. 62 ›› Issue (10): 1-7.doi: 10.6040/j.issn.1671-7554.0.2024.1024

• Special Topic on Enhanced Recovery after Orthapaedic Surgery •    

Application and efficacy analysis of common rehabilitation devices used after knee replacement surgery

LIU Peilai*, LI Xuezhou*, LU Qunshan, SUN Houyi, YANG Jie, LI Zhe   

  1. Department of Orthopedic, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China
  • Published:2024-10-12

Abstract: This review systematically summarizes the common rehabilitation devices used in postoperative rehabilitation of knee replacement and their roles at different stages of recovery. Knee replacement is a primary treatment for knee osteoarthritis, and postoperative rehabilitation is crucial for functional recovery and improvement in patients quality of life. Based on the different stages of rehabilitation, the goals are categorized into pain relief and swelling reduction, restoration of joint mobility, strengthening of muscle power, and improvement of gait and balance. This paper provides a detailed overview of the commonly used medical devices at each stage, such as cold therapy devices, patient-controlled analgesia pumps, continuous passive motion machines, transcutaneous electrical nerve stimulation devices, neuromuscular electrical stimulation devices, and gait training equipment. Although the efficacy of some devices remains controversial, particularly in pain management and joint mobility restoration, they have demonstrated positive effects in accelerating postoperative recovery and enhancing patient satisfaction. With the promising prospects of virtual reality and robot-assisted rehabilitation devices, future personalized rehabilitation plans are expected to further optimize the recovery experience and outcomes for patients.

Key words: Knee replacement, Rehabilitation devices, Cold therapy, Continuous passive motion machine, Electrical stimulation devices, Gait analysis

CLC Number: 

  • R608
[1] Li D, Li S, Chen Q, et al. The prevalence of symptomatic knee osteoarthritis in relation to age, sex, area, region, and body mass index in China: a systematic review and Meta-analysis[J]. Front Med(Lausanne), 2020, 16(7): 304.
[2] Canovas F, Dagneaux L. Quality of life after total knee arthroplasty[J]. Orthop Traumatol Surg Res, 2018,104(1S): S41-S46.
[3] Dunbar MJ, Richardson G, Robertsson O. I cant get no satisfaction after my total knee replacement: rhymes and reasons[J]. Bone Joint J, 2013, 95-B(11 Suppl a): 148-152.
[4] Mistry JB, Elmallah RD, Bhave A, et al. Rehabilitative guidelines after total knee arthroplasty: a review[J]. J Knee Surg, 2016, 29(3): 201-217.
[5] Yang X, Li GH, Wang HJ, et al. Continuous passive motion after total knee arthroplasty: a systematic review and meta-analysis of associated effects on clinical outcomes[J]. Arch Phys Med Rehabil, 2019, 100(9): 1763-1778.
[6] Aggarwal A, Adie S, Harris IA, et al. Cryotherapy following total knee replacement[J]. Cochrane Database Syst Rev, 2023, 9(9): CD007911.
[7] Yue C, Zhang X, Zhu Y, et al. Systematic review of three electrical stimulation techniques for rehabilitation after total knee arthroplasty[J]. J Arthroplasty, 2018, 33(7): 2330-2337.
[8] Fukui J, Matsui Y, Mizuno T, et al. Comparison of gait analysis before and after unilateral total knee arthroplasty for knee osteoarthritis[J]. J Orthop Surg Res, 2024,19(1): 506.
[9] Schaubel HJ. The local use of ice after orthopedic procedures[J]. Am J Surg, 1946, 72(5): 711-714.
[10] Lee JM, Warren MP, Mason SM. Effects of ice on nerve conduction velocity[J]. Physiotherapy, 1978, 64(1): 2-6.
[11] 刘玉, 张楠心, 戴丽群, 等. 全膝关节置换后冷疗有效性的Meta分析[J]. 中国组织工程研究, 2020, 24(9): 1443-1448.
[12] Wyatt PB, Nelson CT, Cyrus JW, et al. The role of cryotherapy after total knee arthroplasty: a systematic review[J]. J Arthroplasty, 2023, 38(5): 950-956.
[13] Dundon JM, Rymer MC, Johnson RM. Total patellar skin loss from cryotherapy after total knee arthroplasty[J]. J Arthroplasty, 2013, 28(2): 375-377.
[14] Li JW, Ma YS, Xiao LK. Postoperative pain management in total knee arthroplasty[J]. Orthop Surg, 2019, 11(5): 755-761.
[15] Walder B, Schafer M, Henzi I, et al. Efficacy and safety of patient-controlled opioid analgesia for acute postoperative pain. a quantitative systematic review[J]. Acta Anaesthesiol Scand, 2001, 45(7): 795-804.
[16] Motamed C. Clinical update on patient-controlled analgesia for acute postoperative pain[J]. Pharmacy(Basel), 2022, 10(1): 22.
[17] Franzoni S, Rossi S, Cassinadri A, et al. Perioperative pain management in total knee arthroplasty: a narrative review of current multimodal analgesia protocols[J]. 2023, 13(6): 3798.
[18] Zhu Y, Feng Y, Peng L. Effect of transcutaneous electrical nerve stimulation for pain control after total knee arthroplasty: a systematic review and meta-analysis[J]. J Rehabil Med, 2017, 49(9): 700-704.
[19] 李凯明, 李玲慧, 梁龙, 等. 经皮电刺激改善全膝关节置换术后疼痛与功能的系统评价与Meta分析[J]. 海南医学院学报, 2019, 25(24): 1872-1877.
[20] Vance CGT, Dailey DL, Chimenti RL, et al. Using TENS for pain control: update on the state of the evidence[J]. Medicina(Kaunas), 2022, 58(10): 1332.
[21] Li J, Song Y. Transcutaneous electrical nerve stimulation for postoperative pain control after total knee arthroplasty: a meta-analysis of randomized controlled trials[J]. Medicine(Baltimore), 2017, 96(37): e8036.
[22] 司建洛, 杨木强, 司马靓杰, 等. 经皮电刺激耳神门穴对全膝关节置换后镇痛效果的影响[J]. 中国组织工程研究. 2017, 21(27): 4294-4299.
[23] Jauregui JJ, Cherian JJ, Gwam CU, et al. A meta-analysis of transcutaneous electrical nerve stimulation for chronic low back pain[J]. Surg Technol Int, 2016, 28: 296-302.
[24] Salter RB, Simmonds DF, Malcolm BW, et al. The biological effect of continuous passive motion on the healing of full-thickness defects in articular cartilage. An experimental investigation in the rabbit[J]. J Bone Joint Surg Am, 1980, 62(8): 1232-1251.
[25] Harvey LA, Brosseau L, Herbert RD. Continuous passive motion following total knee arthroplasty in people with arthritis[J]. Cochrane Database Syst Rev, 2014, 2014(2): Cd004260.
[26] Liao CD, Huang YC, Lin LF, et al. Continuous passive motion and its effects on knee flexion after total knee arthroplasty in patients with knee osteoarthritis[J]. Knee Surg Sports Traumatol Arthrosc, 2016, 24(8): 2578-2586.
[27] Gil-González S, Barja-Rodríguez RA, López-Pujol A, et al. Continuous passive motion not affect the knee motion and the surgical wound aspect after total knee arthroplasty[J]. J Orthop Surg Res, 2022, 17(1): 25.
[28] Jia ZF, Zhang Y, Zhang WP, et al. Efficacy and safety of continuous passive motion and physical therapy in recovery from knee arthroplasty: a systematic review and meta-analysis[J]. J Orthop Surg Res, 2024, 19(1): 68.
[29] Denis M, Moffet H, Caron F, et al. Effectiveness of continuous passive motion and conventional physical therapy after total knee arthroplasty: a randomized clinical trial[J]. Physical Therapy, 2006, 86(2): 174-185.
[30] Wirries N, Ezechieli M, Stimpel K, et al. Impact of continuous passive motion on rehabilitation following total knee arthroplasty[J]. Physiother Res Int, 2020, 25(4): e1869.
[31] Monaghan B, Caulfield B, OMathúna DP. Surface neuromuscular electrical stimulation for quadriceps strengthening pre and post total knee replacement[J]. Cochrane Database Syst Rev, 2010, 2010(1): Cd007177.
[32] Stevens-Lapsley JE, Balter JE, Wolfe P, et al. Early neuromuscular electrical stimulation to improve quadriceps muscle strength after total knee arthroplasty: a randomized controlled trial[J]. Phys Ther, 2012, 92(2): 210-226.
[33] Klika AK, Yakubek G, Piuzzi N, et al. Neuromuscular electrical stimulation use after total knee arthroplasty improves early return to function: a randomized trial[J]. J Knee Surg, 2022, 35(1): 104-111.
[34] Labanca L, Bonsanto F, Raffa D, et al. Does adding neuromuscular electrical stimulation to rehabilitation following total knee arthroplasty lead to a better quadriceps muscle strength recovery? a systematic review[J]. Int J Rehabil Res, 2022, 45(2): 118-125.
[35] Monsegue AP, Emans P, van Loon LJC, et al. Resistance exercise training to improve post-operative rehabilitation in knee arthroplasty patients: a narrative review[J]. Eur J Sport Sci, 2024, 24(7): 938-949.
[36] Valtonen A, Pöyhönen T, Sipilä S, et al. Effects of aquatic resistance training on mobility limitation and lower-limb impairments after knee replacement[J]. Arch Phys Med Rehabil, 2010, 91(6): 833-839.
[37] Valtonen A, Pöyhönen T, Sipilä S, et al. Maintenance of aquatic training-induced benefits on mobility and lower-extremity muscles among persons with unilateral knee replacement[J]. Arch Phys Med Rehabil, 2011, 92(12): 1944-1950.
[38] Lee CH, Kim IH. Aquatic exercise and land exercise treatments after total knee replacement arthroplasty in elderly women: a comparative study[J]. Medicina(Kaunas), 2021, 57(6): 589.
[39] Giaquinto S, Ciotola E, Dall’Armi V, et al. Hydrotherapy after total knee arthroplasty. a follow-up study[J]. Arch Gerontol Geriatr, 2010, 51(1): 59-63.
[40] Kim S, Hsu FC, Groban L, et al. A pilot study of aquatic prehabilitation in adults with knee osteoarthritis undergoing total knee arthroplasty - short term outcome[J]. BMC Musculoskelet Disord, 2021, 22(1): 388.
[41] Elbaz A, Mor A, Segal G, et al. Novel classification of knee osteoarthritis severity based on spatiotemporal gait analysis[J]. Osteoarthritis Cartilage, 2014, 22(3): 457-463.
[42] Knowlton CB, Lundberg HJ, Wimmer MA, et al. Can a gait-dependent model predict wear on retrieved total knee arthroplasty components?[J]. Bone Joint J, 2020, 102-b(6_Supple_A): 129-137.
[43] Yeung S, Kim HK, Carleton A, et al. Integrating wearables and modelling for monitoring rehabilitation following total knee joint replacement[J]. Comput Methods Programs Biomed, 2022, 225: 107063. doi:10.1016/j.cmpb.2022.107063.
[44] 赵伟, 苏鹏, 张力, 等. 三维步态分析在髋膝关节置换术中的应用[J]. 中国矫形外科杂志, 2022, 30(20): 1863-1867.
[45] Rühling M, Kirschbaum SM, Perka C, et al. Increased ankle pain after total knee arthroplasty is associated with a preoperative lateralized gait and talar tilt, but not with ankle laxity or the range of motion of the subtalar joint[J]. Bone Joint J, 2023, 105-b(11): 1159-1167.
[46] Pua YH, Liang Z, Ong PH, et al. Associations of knee extensor strength and standing balance with physical function in knee osteoarthritis[J]. Arthritis Care Res(Hoboken), 2011, 63(12): 1706-1714.
[47] Domínguez-Navarro F, Silvestre-Muñoz A, Igual-Camacho C, et al. A randomized controlled trial assessing the effects of preoperative strengthening plus balance training on balance and functional outcome up to 1 year following total knee replacement[J]. Knee Surg Sports Traumatol Arthrosc, 2021, 29(3): 838-848.
[48] Yau WP. Corr insights®: No benefit to sensor-guided balancing compared with freehand balancing in TKA: a randomized controlled trial[J]. Clin Orthop Relat Res, 2022, 480(8): 1545-1546.
[49] Gazendam A, Zhu M, Chang Y, et al. Virtual reality rehabilitation following total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials[J]. Knee Surg Sports Traumatol Arthrosc, 2022, 30(8): 2548-2555.
[50] 高海香, 王蕾, 陈萍, 等. 虚拟现实技术对全膝关节置换术后患者康复锻炼镇痛与康复效果的影响[J]. 中华疼痛学杂志. 2023, 19(5): 764-769.
[51] Gür O, Ba?瘙塂ar S. The effect of virtual reality on pain, kinesiophobia and function in total knee arthroplasty patients: a randomized controlled trial[J]. Knee, 2023, 45: 187-197. doi:10.1016/j.knee.2023.09.012.
[52] Pournajaf S, Goffredo M, Pellicciari L, et al. Effect of balance training using virtual reality-based serious games in individuals with total knee replacement: a randomized controlled trial[J]. Ann Phys Rehabil Med, 2022, 65(6): 101609.
[53] Koo KI, Hwang CH. Five-day rehabilitation of patients undergoing total knee arthroplasty using an end-effector gait robot as a neuromodulation blending tool for deafferentation, weight offloading and stereotyped movement: Interim analysis[J]. PLoS One, 2020, 15(12): e0241117.
[54] Yoshikawa K, Mutsuzaki H, Sano A, et al. Training with hybrid assistive limb for walking function after total knee arthroplasty[J]. J Orthop Surg Res, 2018, 13(1): 163.
[55] Kotani N, Morishita T, Saita K, et al. Feasibility of supplemental robot-assisted knee flexion exercise following total knee arthroplasty[J]. J Back Musculoskelet Rehabil, 2020, 33(3): 413-421.
[56] Wu K, Pan HH, Lin CH. Robotic exoskeletons and total knee arthroplasty: the future of knee rehabilitation and replacement-a meta-analysis[J]. Medicine(Baltimore), 2024, 103(17): e37876.
[1] YUE Yi, ZHANG Qing. Hospitalization expenses and influencing factors for medical insurance patients undergoing knee replacement in a grade-A tertiary hospital in Shandong Province [J]. Journal of Shandong University (Health Sciences), 2024, 62(3): 92-99.
[2] WU Hao1, FENG Rong-jie1, GUAN Shi-bing1, XU Qing-jia1, ZHANG li-shan1, LI Shu-yuan1, GONG Wei-ming2, JIA Tang-hong2 . Functional assessment of the foot with toe amputation by gait analysis [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2011, 49(4): 154-157.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!