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Medicina (Kaunas, Lithuania) May 2022: The aim of this systematic review was to determine whether prehabilitation before total hip arthroplasty, in the form of exercise therapy, education alone, or both... (Review)
Review
: The aim of this systematic review was to determine whether prehabilitation before total hip arthroplasty, in the form of exercise therapy, education alone, or both together, improves postoperative outcomes, such as physical functioning, compared with no intervention. : A systematic literature search was performed in the online databases PubMed, PEDro and Cochrane Library using the following search keywords: "prehabilitation", "preoperative care", and "total hip replacement". : A total of 400 potentially relevant studies were identified. After title, abstract and full-text screening, 14 studies fulfilled all inclusion criteria and were included in this systematic review. Patients who completed exercise-based prehabilitation before their operation showed significant postoperative improvements compared with no intervention in the following tests: six-minute walk test, Timed Up and Go test, chair-rise test, and stair climbing. For various other assessments, such as the widely used Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Hip disability and Osteoarthritis Outcome Score (HOOS), 36-item Short Form Survey (SF-36) and Barthel Index, no significant differences in outcomes regarding exercise therapy were reported in the included studies. Education alone had no effect on postoperative outcomes. : Prehabilitation in the form of a prehabilitation exercise therapy is an effective prehabilitation measure with regard to postoperative physical functioning, while prehabilitation in the form of education has no significant effects. No negative effects of prehabilitation on the outcomes examined were reported.
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Humans; Osteoarthritis; Postural Balance; Preoperative Care; Preoperative Exercise; Time and Motion Studies
PubMed: 35744005
DOI: 10.3390/medicina58060742 -
Knee Surgery, Sports Traumatology,... Aug 2022The use of virtual reality (VR) based rehabilitation has increased substantially within orthopedic surgery, particularly in the field of total knee arthroplasty (TKA).... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The use of virtual reality (VR) based rehabilitation has increased substantially within orthopedic surgery, particularly in the field of total knee arthroplasty (TKA). The objective of this systematic review and meta-analysis was to compare patient-reported outcomes and cost analyses from randomized controlled trials (RCT) utilizing VR-based rehabilitation in patients following TKA.
METHODS
MEDLINE, EMBASE, and Cochrane databases were searched for RCTs involving VR-based rehabilitation following TKA. Quantitative synthesis was conducted for pain scores and functional outcomes. Narrative outcomes were reported for results not amenable to quantitative synthesis.
RESULTS
A total of 9 RCTs with 835 patients were included with follow-up ranging from 10 days to 6 months postoperatively. No differences in pain scores were demonstrated between VR-based and traditional rehabilitation at 2 weeks and 3 months postoperatively. VR-based rehabilitation demonstrated improved functional outcomes at 12 weeks (n = 353) postoperatively [mean difference (MD) - 3.32, 95% confidence interval (CI) - 5.20 to - 1.45, moderate certainty evidence] and 6 months (n = 66) postoperatively [MD - 4.75, 95% CI - 6.69 to - 2.81, low certainty evidence], compared to traditional rehabilitation. One trial demonstrated significant cost savings with the use of VR-based rehabilitation.
CONCLUSIONS
VR-based rehabilitation for patients undergoing TKA represents an evolving field that may have advantages over traditional therapy for some patients. The current review is limited by the low quality of evidence in the literature. This is a rapidly evolving field with more trials needed to determine the impact of VR-based rehabilitation on patients undergoing TKA.
LEVEL OF EVIDENCE
Level I; meta-analysis of randomized controlled trials.
Topics: Arthroplasty, Replacement, Knee; Humans; Orthopedics; Pain; Randomized Controlled Trials as Topic; Virtual Reality
PubMed: 35182172
DOI: 10.1007/s00167-022-06910-x -
British Journal of Anaesthesia Apr 2015Several studies have identified clinical, psychosocial, patient characteristic, and perioperative variables that are associated with persistent postsurgical pain;... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Several studies have identified clinical, psychosocial, patient characteristic, and perioperative variables that are associated with persistent postsurgical pain; however, the relative effect of these variables has yet to be quantified. The aim of the study was to provide a systematic review and meta-analysis of predictor variables associated with persistent pain after total knee arthroplasty (TKA).
METHODS
Included studies were required to measure predictor variables prior to or at the time of surgery, include a pain outcome measure at least 3 months post-TKA, and include a statistical analysis of the effect of the predictor variable(s) on the outcome measure. Counts were undertaken of the number of times each predictor was analysed and the number of times it was found to have a significant relationship with persistent pain. Separate meta-analyses were performed to determine the effect size of each predictor on persistent pain. Outcomes from studies implementing uni- and multivariable statistical models were analysed separately.
RESULTS
Thirty-two studies involving almost 30 000 patients were included in the review. Preoperative pain was the predictor that most commonly demonstrated a significant relationship with persistent pain across uni- and multivariable analyses. In the meta-analyses of data from univariate models, the largest effect sizes were found for: other pain sites, catastrophizing, and depression. For data from multivariate models, significant effects were evident for: catastrophizing, preoperative pain, mental health, and comorbidities.
CONCLUSIONS
Catastrophizing, mental health, preoperative knee pain, and pain at other sites are the strongest independent predictors of persistent pain after TKA.
Topics: Arthroplasty, Replacement, Knee; Bias; Female; Humans; Male; Pain, Postoperative
PubMed: 25542191
DOI: 10.1093/bja/aeu441 -
Nursing Open Sep 2023This study aims to investigate the effect and methods of cryotherapy in reducing swelling after total knee arthroplasty. (Review)
Review
AIM
This study aims to investigate the effect and methods of cryotherapy in reducing swelling after total knee arthroplasty.
DESIGN
Systematic review.
METHODS
We searched PubMed, Embase, CINAHL, Cochrane Library, KoreaMed, KERIS and National Science Digital Library for randomized controlled trials on 19 August 2021. This systematic review was conducted according to the PRISMA 2009 checklist.
RESULTS
A total of eight randomized controlled trials were systematically reviewed to determine the effect and methods of cryotherapy on reducing postoperative swelling. The effects were not significantly different in six studies. Application time per cryotherapy session was 10-20 min when using an ice pack and up to 48 h when using an automated device. The duration ranged from 2 days to 1 week or until discharge, and the frequency varied from 2 to 72 times per day.
Topics: Humans; Arthroplasty, Replacement, Knee; Pain, Postoperative; Randomized Controlled Trials as Topic; Cryotherapy; Edema
PubMed: 37334865
DOI: 10.1002/nop2.1906 -
Chinese Journal of Traumatology =... Jun 2018Posttraumatic arthritis (PTA) may develop years after acetabular fracture, hindering joint function and causing significant chronic musculoskeletal pain. Given the... (Review)
Review
PURPOSE
Posttraumatic arthritis (PTA) may develop years after acetabular fracture, hindering joint function and causing significant chronic musculoskeletal pain. Given the delayed onset of PTA, few studies have assessed outcomes of delayed total hip arthroplasty (THA) in acetabular fracture patients. This study systematically reviewed the literature for outcomes of THA in patients with PTA and prior acetabular fracture.
METHODS
Pubmed, EMBASE, SCOPUS, and Cochrane library were searched for articles containing the keywords "acetabular", "fracture", "arthroplasty", and "post traumatic arthritis" published between 1995 and August 2017. Studies with less than 10 patients, less than 2 years of follow-up, conference abstracts, and non-English language articles were excluded. Data on patient demographics, surgical characteristics, and outcomes of delayed THA, including implant survival, complications, need for revision, and functional scores, was collected from eligible studies.
RESULTS
With 1830 studies were screened and data from 10 studies with 448 patients were included in this review. The median patient age on date of THA was 51.5 years, ranging from 19 to 90 years. The median time from fracture to THA was 37 months, with a range of 27-74 months. Mean follow-up times ranged from 4 to 20 years. The mean Harris hip scores (HHS) improved from 41.5 pre-operatively, to 87.6 post-operatively. The most prevalent postoperative complications were heterotopic ossification (28%-63%), implant loosening (1%-24%), and infection (0%-16%). The minimum 5-year survival of implants ranged from 70% to 100%. Revision rates ranged from 2% to 32%.
CONCLUSION
Despite the difficulties associated with performing THA in patients with PTA from previous acetabular fracture (including soft tissue scarring, existing hardware, and acetabular bone loss) and the relatively high complication rates, THA in patients with PTA following prior acetabular fracture leads to significant improvement in pain and function at 10-year follow-up. Further high quality randomized controlled studies are needed to confirm the outcomes after delayed THA in these patients.
Topics: Acetabulum; Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip; Fractures, Bone; Humans; Middle Aged; Osteoarthritis; Postoperative Complications
PubMed: 29773451
DOI: 10.1016/j.cjtee.2018.02.004 -
PloS One 2017To investigate the role of early initiation of rehabilitation on length of stay (LOS) and cost following total hip arthroplasty, total knee arthroplasty, or... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To investigate the role of early initiation of rehabilitation on length of stay (LOS) and cost following total hip arthroplasty, total knee arthroplasty, or unicompartmental knee arthroplasty.
DATA SOURCES
Electronic databases PubMed, CINAHL, Pedro, Embase, AMED, and the Cochrane Library were searched in July 2016. Five additional trials were identified through reference list scanning.
STUDY SELECTION
Eligible studies were published in English language peer-reviewed journals; included participants that had undergone total hip arthroplasty, total knee arthroplasty, or unicompartmental knee arthroplasty reported clearly defined timing of rehabilitation onset for at least two groups; and reported at least one measure of LOS or cost. Inclusion criteria were applied by 2 independent authors, with disagreements being determined by a third author. Searching identified 1,029 potential articles, of which 17 studies with 26,614 participants met the inclusion criteria.
DATA EXTRACTION
Data was extracted independently by 2 authors, with disagreements being determined by a third author. Methodological quality of each study was evaluated independently by 2 authors using the Downs and Black checklist. Pooled analyses were analyzed using a random-effects model with inverse variance methods to calculate standardized mean differences (SMD) and 95% confidence intervals for LOS.
DATA SYNTHESIS
When compared with standard care, early initiation of physical therapy demonstrated a decrease in length of stay for the 4 randomized clinical trials (SMD = -1.90; 95% CI -2.76 to -1.05; I2 = 93%) and for the quasi-experimental and 5 prospective studies (SMD = -1.47; 95% CI -1.85 to -1.10; I2 = 88%).
CONCLUSION
Early initiation of rehabilitation following total hip arthroplasty, total knee arthroplasty, or unicompartmental knee arthroplasty is associated with a shorter LOS, a lower overall cost, with no evidence of an increased number of adverse reactions. Additional high quality studies with standardized methodology are needed to further examine the impact of early initiation of physical therapy among patients with joint replacement procedures.
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Humans; Length of Stay; Physical Therapy Modalities; Treatment Outcome
PubMed: 28575058
DOI: 10.1371/journal.pone.0178295 -
Osteoarthritis and Cartilage Jul 2019Falls are common after total hip arthroplasty (THA) and total knee arthroplasty (TKA). While previous studies have investigated various risk factors for falls in... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Falls are common after total hip arthroplasty (THA) and total knee arthroplasty (TKA). While previous studies have investigated various risk factors for falls in patients following THA and TKA, no systematic reviews have summarized these risk factors. Therefore, the current systematic review aimed to summarize evidence regarding risk factors for falls in patients after THA and/or TKA.
METHODS
MEDLINE, EMBASE, CINAHL, SPORTDiscus, and Physiotherapy Evidence Database (from inception to June 30, 2018) were searched. The methodological quality and quality of evidence of the included studies were assessed by two independent reviewers. Relevant data regarding participants' characteristics, study design, follow-up time points, and identified risk factors were extracted. Meta-analyses and narrative syntheses were performed.
RESULTS
Twelve studies with a total of 1,292,689 participants were included. Twenty-nine identified risk factors for post-THA/TKA falls were classified into either inpatient or post-discharge risk factors. Key risk factors for both post-THA and/or post-TKA inpatient falls that showed moderate level of evidence included: postoperative complications or comorbidities and revision THA/TKA. Likewise, risk factors for post-discharge falls after THA and/or TKA that demonstrated moderate level of evidence included: medications, psychiatric diseases, living alone, prior history of TKA, falls history and female gender. The quality of the included studies varied and sample sizes were not justified.
CONCLUSIONS
This review summarized both non-modifiable and modifiable risk factors for post-THA/TKA falls. Our findings highlight the importance of developing strategies to lower the falls risk among patients following THA/TKA.
Topics: Accidental Falls; Age Factors; Aged; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Female; Humans; Male; Middle Aged; Osteoarthritis, Hip; Osteoarthritis, Knee; Prevalence; Prognosis; Risk Assessment; Severity of Illness Index; Sex Factors
PubMed: 31028883
DOI: 10.1016/j.joca.2019.04.006 -
Brazilian Journal of Physical Therapy 2021In the early stages of total knee arthroplasty (TKA) rehabilitation, in which physical function in general can be affected, motor imagery (MI) might play a relevant role. (Meta-Analysis)
Meta-Analysis Review
Effects of motor imagery on strength, range of motion, physical function, and pain intensity in patients with total knee arthroplasty: A systematic review and meta-analysis.
BACKGROUND
In the early stages of total knee arthroplasty (TKA) rehabilitation, in which physical function in general can be affected, motor imagery (MI) might play a relevant role.
OBJECTIVE
To assess the impact of MI on strength, active range of motion (ROM), pain intensity, and physical function in patients with TKA.
METHODS
We conducted a systematic review and meta-analysis of randomised controlled trials. Pooled effects were calculated as standardised mean differences (SMDs) and 95% confidence intervals (CIs) for the relevant outcomes using random effects model. The certainty of evidence was assessed with GRADE approach.
RESULTS
This review included 7 articles. The addition of MI to standard therapy, based on low quality of evidence, showed a moderate increase in quadriceps strength (4 studies; SMD: 0.88; 95% CI: 0.42, 1.34) and a small reduction in pain intensity (SMD: 0.63; 95% CI: 0.08, 1.19). It is unclear whether MI can provide beneficial effects for active ROM and function.
CONCLUSIONS
There is low to very low-quality evidence that adding an MI intervention to standard rehabilitation for patients with TKA may improve quadriceps strength and pain intensity, but the effects of MI on ROM and physical function is unclear.
Topics: Arthroplasty, Replacement, Knee; Humans; Pain Measurement; Quadriceps Muscle; Range of Motion, Articular
PubMed: 34872869
DOI: 10.1016/j.bjpt.2021.11.001 -
Annals of Palliative Medicine Oct 2021A number of researches indicated preoperative functional exercise may improve the rehabilitation progress. This study aimed to investigate the effect of preoperative... (Meta-Analysis)
Meta-Analysis
BACKGROUND
A number of researches indicated preoperative functional exercise may improve the rehabilitation progress. This study aimed to investigate the effect of preoperative exercise intervention on rehabilitation before total knee arthroplasty (TKA) by literature retrieval and meta-analysis.
METHODS
Embase, Cochrane library, PubMed, Ovid, and ClinicalTrials.gov were selected as the search database platforms. All published English articles related to preoperative exercise of TKA from January 2000 to January 2021 were searched with the following keyword strategy: ("preoperative functional exercise" or "prehabilitation exercise") AND ("TKA" or "total knee arthroplasty"). After literature screened according to the inclusion and exclusion criteria, the risk of bias and quality of the included articles were evaluated. RevMan 5.3.5 software was used for analysis to obtain the forest plot and funnel plot.
RESULTS
A total of 911 articles were preliminarily searched in this study, and 12 were finally included for the quantitative analysis, comprising 889 patients; the result showed after intervention, the experimental group patients had wider ROM flexion than the control group patients [mean difference (MD) =4.28; 95% CI: 2.28 to 6.28; Z=4.19; P<0.0001]; the experimental group patients were with higher quadriceps strength value than the control group (MD =1.86, 95% CI: 0.58-3.15; Z=2.84, P=0.005); the WOMAC score (The Western Ontario and McMaster Universities Osteoarthritis Index), were higher for the experimental group patients (MD =-10.59; 95% CI: -11.88 to -9.29; Z=16.03; P<0.00001); and the standing and walking test index are higher (MD =-1.29, 95% CI: -1.90 to -0.67; Z=4.08; P<0.001); the quality of life score were higher too for the experimental group patients (MD =1.66; 95% CI: 1.13-2.20; Z=6.08; P<0.00001).
DISCUSSION
Preoperative exercise intervention before TKA can improve knee flexion and flexibility, reduce inflammatory pain and stiffness, improve muscle strength, improve joint function, and thus improve the quality of life of patients.
Topics: Arthroplasty, Replacement, Knee; Humans; Osteoarthritis, Knee; Preoperative Exercise; Quality of Life; Range of Motion, Articular
PubMed: 34763461
DOI: 10.21037/apm-21-2670 -
The Bone & Joint Journal Jun 2017The most effective surgical approach for total hip arthroplasty (THA) remains controversial. The direct anterior approach may be associated with a reduced risk of... (Review)
Review
AIMS
The most effective surgical approach for total hip arthroplasty (THA) remains controversial. The direct anterior approach may be associated with a reduced risk of dislocation, faster recovery, reduced pain and fewer surgical complications. This systematic review aims to evaluate the current evidence for the use of this approach in THA.
MATERIALS AND METHODS
Following the Cochrane collaboration, an extensive literature search of PubMed, Medline, Embase and OvidSP was conducted. Randomised controlled trials, comparative studies, and cohort studies were included. Outcomes included the length of the incision, blood loss, operating time, length of stay, complications, and gait analysis.
RESULTS
A total of 42 studies met the inclusion criteria. Most were of medium to low quality. There was no difference between the direct anterior, anterolateral or posterior approaches with regards to length of stay and gait analysis. Papers comparing the length of the incision found similar lengths compared with the lateral approach, and conflicting results when comparing the direct anterior and posterior approaches. Most studies found the mean operating time to be significantly longer when the direct anterior approach was used, with a steep learning curve reported by many. Many authors used validated scores including the Harris hip score, and the Western Ontario and McMaster Universities Arthritis Index. These mean scores were better following the use of the direct anterior approach for the first six weeks post-operatively. Subsequently there was no difference between these scores and those for the posterior approach.
CONCLUSION
There is little evidence for improved kinematics or better long-term outcomes following the use of the direct anterior approach for THA. There is a steep learning curve with similar rates of complications, length of stay and outcomes. Well-designed, multi-centre, prospective randomised controlled trials are required to provide evidence as to whether the direct anterior approach is better than the lateral or posterior approaches when undertaking THA. Cite this article: 2017;99-B:732-40.
Topics: Arthroplasty, Replacement, Hip; Bias; Blood Loss, Surgical; Evidence-Based Medicine; Gait; Humans; Length of Stay; Operative Time; Recovery of Function
PubMed: 28566391
DOI: 10.1302/0301-620X.99B6.38053