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Publication date: 1.03.2021
DOI: 10.51871/2588-0500_2021_05_01_5

UDC 615.825.6

PHYSICAL REHABILITATION OF PATIENTS AFTER
 THE JOINT ENDOPROSTHESIS REPLACEMENT USING ACTIVE MECHANOTHERAPY

O.V. Shakirova, T.V. Stebliy, S.A. Popik, N.V. Kozyavina, A.P. Palchenko

FSAEI of HE “Far Eastern Federal University”, Vladivostok,  Russia

 

Key words: mechanotherapy, joint endoprosthesis replacement, physical rehabilitation

Annotation. One of the most developing areas of modern methods of prevention and rehabilitation is the use of mechanotherapy apparatus systems, the design of which is based on biomechanical laws of joint movement. The aim of the study was the experimental substantiation of the use of active mechanotherapy in the nearest postoperative period in patients after the hip joint endoprosthesis replacement. In all patients, the amplitude of movements in the joint increased, the number of patients with severe and moderate limp almost halved. At the same time, the positive dynamics in the experimental group, which used not only passive but also active mechanotherapy in the nearest postoperative period, was more pronounced, therefore, the process of recovery after the joint endoprosthesis replacement, took less time.

 

Introduction. According to the data given by the World Health Organization, currently more than 1,5 million surgeries of the hip joint endoprosthesis replacement are performed in the world every year [4]. The mechanotherapy that is needed for the recovery of painless movements in adjacent joints, acceleration of reparation processes and achievement of positive functional result supports to the recovery of the supporting dynamic function of patients after the hip joint endoprosthesis replacement [2, 6, 10, 12, 14]. Support with technical bioengineering measures of rehabilitation is a part of the implementation of a set of measures aimed for the improvement of life quality of disabled people. One of the most developing areas of modern methods of prevention and rehabilitation is the use of mechanotherapy apparatus system, the design of which is based on biomechanical laws of joint movement [7, 11]. The aim of the study was the experimental substantiation of the use of active mechanotherapy in the nearest postoperative period in patients after the hip joint endoprosthesis replacement.

Methods and organization. The study was conducted on the base of the Center of Recovery Medicine and Rehabilitation in the Medical Center of the Far Eastern Federal University. 22 patients in the nearest postoperative period (5-7 days) after the hip joint endoprosthesis replacement, aged 44-62 years, who were divided into the experimental (EG) and control (CG) groups, 11 people each, were examined. In order to conduct recovery therapy for EG patients, apart from therapeutic exercises and physiotherapeutic procedures, a set of using the Kinetec Spectra training devices of passive mechanotherapy and the Thera-Vital training devices of active-passive mechanotherapy was developed. The CG patients were engaged in the traditional rehabilitation program, including therapeutic exercises combined with physiotherapeutic procedures and passive mechanotherapy. The duration of the rehabilitation course was 14 days. The effect of Kinetec Spectra DC is based on the Continuous Passive Motion (СРМ) – therapy of joints of lower extremities – the increase in mobility in the isolated joint by dosed tissue stretching in conditions of muscle relaxation. Kinetec Spectra allows to flex a hip joint passively in the range of 0° to 120° using different programs, speed and pauses. The duration of the standard procedure was 20 minutes. The active mechanotherapy using the
Thera-Vital mechanotherapeutic apparatus of active-passive effect was also aimed at the motion of a hip joint in the active flexion-extension function. Programs were presented in game format, which was an additional motivation for patients. During training, such parameters as the duration of training without pauses, activity, symmetry, distance and calorie expenditure were being controlled and processed. The 6-minute “Orthopedics” program based on the principle of minimal load and need to diagnose the patient’s response to active mechanotherapy was chosen for the 1st day. During the session, a percentage ratio of the activity in every extremity was presented on the screen. The patient assessed the activity in every leg and could correct it by raising the activity column. The 6-minute “Goalkeeper” program, which is a virtual game, was chosen for the 2nd day. The goalkeeper would move either to the top corner of the gate, if the patient spun the pedals faster, or down, if the patient slowed down. The activity in extremities was shown only after the end of the program. On the 3rd day of rehabilitation the same program was suggested with an addition of load (+1kg) and duration (+1 minute). Programs “Hedgehog” and “Automobile”, similar in principle of operation, in which the patient had to execute active circular movements with both extremities, were prepared for the 4th and the 5th day of the study. The remaining period of rehabilitation included the interchange of programs with gradual addition of load and duration. The treadmill therapy with the weight unloading to 35,0-50,0%  in order to recover the walking function and form the correct motor stereotype was used actively in both groups.

Results and discussion. The evaluation of quality of therapy undoubtedly depends not only on the physical but also on the mental state of a person, who counts on an improvement of their health after any given surgery [3, 13]. During the preparatory questionnaire, it was found that 13,6% of patients assessed their state as “bad”, 86,3% of patients informed a decrease in motor activity, 36,0% of patients noted a sleep deprivation, 27,0% of patients reported the need in physical assistance. Thus, the life quality of patients shortly after the surgery of the hip joint endoprosthesis replacement was worse in comparison with their normal way of living [1, 8, 9, 15]. The test based on the Lequesne scale allowed evaluating the degree of intensity of disability when arriving to the rehabilitation center (Table 1). In the average, the total index of disability was 12,5, which corresponded to a profound degree of disability on the Lequesne scale.

Table 1

The evaluation of disability after the hip joint endoprosthesis according to the Lequesne index before the beginning of the experiment (n=22)

Evaluation parameter

Evaluation

Number of patients, %

Pain or discomfort during nighttime

No

13,6

Only during movement or in certain position

63,6

Without movement

22,7

Pain during walking

No

4,5

Only after some time

68,1

“Starting” pain

27,4

The maximum moving distance

More than 1 km

13,6

1 km approximately (8-15 min)

22,7

500 to 900 m

45,4

300 to 500 m

18,1

Additional support measures

Two walking sticks or crutches

100

Can You go through a normal flight of stairs?

With small effort

18,1

With effort

31,8

With big effort

50,1

Can You get in and out of a car? 

With effort

36,3

With big effort

63,6

 

The result obtained during the evaluation of the functional state of a hip joint of patients based on the Harris hip scale was 52,7 points in average, which corresponded to the “unsatisfactory” mark. During testing based on the visual analogue scale (VAS), 14 people assessed their pain sensations as “moderate”, 5 people – as “mild” and 3 people – as “severe” and “very severe”. The visual analogue scale was a 10 cm long line drawn on a blank piece of paper, where 0 cm corresponds to the “no pain” mark, 10 cm – to the “worst pain possible” mark (Fig. 1). The patient must put a point in accordance with experienced pain sensations [5]. Therefore, when arriving to the rehabilitation center, patients had profound disability, experienced pain and discomfort and assessed their state as “unsatisfactory”. In order to evaluate the effectiveness of the suggested set of the use of mechanotherapeutic apparatus of active-passive effect, the functional state of the patients was
re-examined after the end of the rehabilitation course.

 

Fig. 1. Visual analogue scale of pain syndrome intensity

Conclusion. During the questionnaire, it was revealed that none of the patients, who went through the rehabilitation course, did not note the overall unwellness during the hospital discharge. In the EG, the motor activity was significantly increased and the quality of sleep was improved. None of the patients complained about severe pain sensations after the rehabilitation course. In addition, a number of patients with an absence of pain syndrome or their mild manifestation was more than a half (63,6%) in the EG, the number of such patients was lower in the CG – 45,4%. During re-evaluation of disability based on the Lequesne scale, the total index in the EG was 5,5±0,5, which corresponded to the moderate disability, in the CG it was 7,0±0,3, in some patients a pronounced disability was revealed. The pain syndrome intensity was significantly decreased in both groups. In the EG less patients noted the “starting” pain during walking, than patients of the CG; more than a half of those asked in the EG were not experiencing pain or discomfort during nighttime, in the CG there was only 27,0% of such patients. All patients noted an increase in the maximum moving distance, including moving on stairs. During the examination of discharged patients using the Harris hip scale, it was revealed that the average result in the EG was almost 5 points higher than in the CG, and it was 76,1±0,7, which corresponded to the “satisfactory” mark of the joint function. Moreover, a function of the joint endoprosthesis was assessed as “good” by some patients of the EG, but there were no good results in the CG. The amplitude of movement in a joint was increased in all patients, a number of patients with severe and moderate limp was almost halved. Specialists of the Center of Recovery Medicine and Rehabilitation noted that positive dynamics in the EG, which used not only passive, but also the active mechanotherapy in the nearest postoperative period, were more pronounced, therefore, the process of recovery after the joint endoprosthesis took less time.

Therefore, the use of active mechanotherapy measures in the nearest postoperative period after the hip joint endoprosthesis contributed to the increase in the amplitude of movement in a joint and the decrease of number of patients with severe and moderate limp.

 

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Information about the authors: Olga Viktorovna Shakirova – Associate Professor, Doctor of Medical Sciences, Director of the Department of Physical Culture and Sports of the FSAEI of HE “Far Eastern Federal University”, Vladivostok,  e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.; Tatyana Viktorovna Steblij – Candidate of Pedagogical Sciences, Associate Professor of the Department of Physical Culture and Sports of the FSAEI of HE “Far Eastern Federal University”, Vladivostok, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.; Sergej Alekseevich Popik – Candidate of Pedagogical Sciences, Associate Professor of the Department of Physical Culture and Sports of the FSAEI of HE “Far Eastern Federal University”, Vladivostok,  e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.; Nina Valentinovna Kozyavina – Candidate of Medical Sciences, Associate Professor of the Department of Physical Culture and Sports of the FSAEI of HE “Far Eastern Federal University”, Vladivostok, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.; Aleksandr Petrovich Pal’chenko – Associate Professor of the Department of Physical Culture and Sports of the FSAEI of HE “Far Eastern Federal University”, Vladivostok, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it..