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physioscience 2007; 3(1): 9-15
DOI: 10.1055/s-2007-962871
Originalarbeit

© Georg Thieme Verlag KG Stuttgart · New York

Wie standardisiert sind Nachbehandlungsschemata für Knieendoprothesen in der Schweiz?

Following Total Knee Arthroplasty How Standardised Are Treatment Schemes In Switzerland?J.-A Overberg1 , P. Oesch2 , G. Perrot3
  • 1Merian Iselin Spital, Basel
  • 2Rehabilitationszentrum Valens
  • 3Kurzentrum Rheinfelden
Further Information

Publication History

eingereicht: 16.10.2006

angenommen: 13.12.2006

Publication Date:
23 February 2007 (online)

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Zusammenfassung

Hintergrund: In der Diskussion unter Physiotherapeuten zeigen sich große Unterschiede in der postoperativen Nachbehandlung von Patienten mit Knietotalprothese.

Ziel: Welche Verordnungen zur postoperativen Physiotherapie von Knieendoprothesen werden gemacht und sind diese Evidenz-basiert.

Methode: Auswertung von aktuellen physiotherapeutischen Nachbehandlungsschemata von Knieendoprothesen in Schweizer Kliniken und Literatursuche zur Evidenz dieser Schemata.

Ergebnisse: 30 Nachbehandlungsschemata aus 28 Kliniken konnten analysiert werden. Die 5 häufigsten Verordnungen bezogen sich auf die Verwendung von Bewegungsschienen (93 %), gefolgt von Bettmobilisation (87 %), Beinbelastung und passiver Gelenksmobilisation (83 %) sowie Quadrizepstraining (73 %). Ein standardisiertes Vorgehen war nicht zu erkennen. Angaben zur sozialen und beruflichen Reintegration fehlten weitgehend. Teilweise fehlte die wissenschaftliche Evidenz für diese Maßnahmen.

Schlussfolgerungen: Die unterschiedlichen Nachbehandlungsschemata zur physiotherapeutischen Behandlung nach Knieendoprothesen erschweren die postoperative Behandlung. Ein einheitliches Vorgehen ist dringend nötig.

Abstract

Background: Physiotherapists report that there are large differences in the post surgical treatment of patients with total knee arthroplasty.

Objective: Which treatment prescriptions are made and are these evidence based.

Method: An evaluation of the current physiotherapy prescriptions after total knee arthroplasty in Swiss clinics and a literature search for the evidence of these prescriptions was made.

Results: 30 post surgical treatment procedures from 28 clinics were analysed. The five most frequently prescribed treatments were continuous passive motion (93 %), followed by bed mobilisation (87 %), weight bearing and passive joint mobilisation (83 %) and quadriceps strengthening (73 %). A standardised procedure could not be identified. Indications aiming for a social and occupational reintegration were almost completely lacking. Scientific evidence for some measures was missing.

Conclusions: The variable prescriptions for post surgical physiotherapy after total knee arthroplasty complicate the treatment. Standardised treatment guidelines are urgently required.

Schlüsselwörter

Nachbehandlung - Richtlinien - Knietotalprothese - Physiotherapie - Evidenz

Key words

post-surgical physiotherapy - guidelines - knee arthroplasty - evidence

Literatur

  • 1 Bellamy N, Buchanan W W. et al . Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee.  J Rheumatol. 1988;  15 1833-1840
    PubMedGoogle Scholar
  • 2 Berth A, Urbach D. et al . Improvement of voluntary quadriceps muscle activation after total knee arthroplasty.  Arch Phys Med Rehabil. 2002;  83 1432-1436
    CrossrefPubMedGoogle Scholar
  • 3 Binazzi R, Soudry M. et al . Knee arthroplasty rating.  J Arthroplasty. 1992;  7 145-148
    PubMedGoogle Scholar
  • 4 Bizzini M, Boldt J. et al . Rehabilitation guidelines after total knee arthroplasty.  Orthopäde. 2003;  32 527-534
    PubMedGoogle Scholar
  • 5 Brosseau L, Yonge K A. et al . Thermotherapy for treatment of osteoarthritis.  Cochrane Database Syst Rev. 2003;  4 CD004522
    PubMedGoogle Scholar
  • 6 Brosseau L, Milne S. et al . Efficacy of continuous passive motion following total knee arthroplasty: a metaanalysis.  J Rheumatol. 2004;  31 2251-2264
    PubMedGoogle Scholar
  • 7 BSA . Medizinische Statistik der Krankenhäuser, Hauptbehandlung (CHOP).  1998, 2000, 2003;  , http://www.bfs.admin.ch/content/bfs/portal/de/index/themen/gesundheit/gesundheitsversorgung/behandlungen/analysen__berichte/stand/01.html
    Google Scholar
  • 8 Chen B, Zimmerman J R. et al . Continuous passive motion after total knee arthroplasty: a prospective study.  Am J Phys Med Rehabil. 2000;  79 421-426
    CrossrefPubMedGoogle Scholar
  • 9 Chiarello C M, Gundersen L. et al . The effect of continuous passive motion duration and increment on range of motion in total knee arthroplasty patients.  J Orthop Sports Phys Ther. 1997;  25 119-127
    PubMedGoogle Scholar
  • 10 Colwell C W, Morris B A. The influence of continuous passive motion on the results of total knee arthroplasty.  Clin Orthop Relat Res. 1992;  276 225-228
    PubMedGoogle Scholar
  • 11 Creditor M C. Hazards of hospitalization of the elderly.  Ann Intern Med. 1993;  118 219-223
    CrossrefPubMedGoogle Scholar
  • 12 Fries J F, Spitz Jr P. et al . Measurement of patient outcome in arthritis.  Arthritis Rheum. 1980;  23 137-145
    CrossrefPubMedGoogle Scholar
  • 13 Frost H, Lamb S E. et al . A randomized controlled trial of exercise to improve mobility and function after elective knee arthroplasty. Feasibility, results and methodological difficulties.  Clin Rehabil. 2002;  16 200-209
    CrossrefPubMedGoogle Scholar
  • 14 Harms M, Engstrom B. Continuous passive motion as an adjunct to treatment in the physiotherapy management of the total knee arthroplasty patient.  Physiotherapy. 1991;  7 301-307
    PubMedGoogle Scholar
  • 15 Horton T, Jackson R. et al . Is routine splintage following primary total knee replacement necessary? A prospective randomised trial.  The Knee. 2002;  9 229-231
    CrossrefPubMedGoogle Scholar
  • 16 Jesudason C, Stiller K. Are bed exercises necessary following hip arthroplasty?.  Aust J Physiother. 2002;  48 73-81
    PubMedGoogle Scholar
  • 17 Johnson D P. The effect of continuous passive motion on wound-healing and joint mobility after knee arthroplasty.  J Bone Joint Surg Am. 1990;  72 421-426
    PubMedGoogle Scholar
  • 18 Kennedy D M, Stratford P W. et al . Assessing stability and change of four performance measures: a longitudinal study evaluating outcome following total hip and knee arthroplasty.  BMC Musculoskelet Disord. 2005;  6 3
    CrossrefPubMedGoogle Scholar
  • 19 Kumar P J, McPherson E J. et al . Rehabilitation after total knee arthroplasty: a comparison of 2 rehabilitation techniques.  Clin Orthop Relat Res. 1996;  331 93-101
    CrossrefPubMedGoogle Scholar
  • 20 Lingard E A, Sledge C B. et al . Patient expectations regarding total knee arthroplasty: differences among the United States, United Kingdom and Australia.  J Bone Joint Surg Am. 2006;  88 1201-1207
    PubMedGoogle Scholar
  • 21 MacDonald S J, Bourne R B. et al . Prospective randomized clinical trial of continuous passive motion after total knee arthroplasty.  Clin Orthop Relat Res. 2000;  380 30-35
    CrossrefPubMedGoogle Scholar
  • 22 Martin S D, Scott R D. et al . Current concepts of total knee arthroplasty.  J Orthop Sports Phys Ther. 1998;  28 252-261
    PubMedGoogle Scholar
  • 23 McDonald S, Hetrick S. et al . Pre-operative education for hip or knee replacement.  Cochrane Database Syst Rev. 2004;  1 CD003526
    PubMedGoogle Scholar
  • 24 McInnes J, Larson M G. et al . A controlled evaluation of continuous passive motion in patients undergoing total knee arthroplasty.  Jama. 1992;  268 1423-1428
    CrossrefPubMedGoogle Scholar
  • 25 Mizner R L, Petterson S C. et al . Early quadriceps strength loss after total knee arthroplasty. The contributions of muscle atrophy and failure of voluntary muscle activation.  J Bone Joint Surg Am. 2005;  87 1047-1053
    PubMedGoogle Scholar
  • 26 Mizner R L, Snyder-Mackler L. Altered loading during walking and sit-to-stand is affected by quadriceps weakness after total knee arthroplasty.  J Orthop Res. 2005;  23 1083-1090
    PubMedGoogle Scholar
  • 27 Moffet H, Collet J P. et al . Effectiveness of intensive rehabilitation on functional ability and quality of life after first total knee arthroplasty: A single-blind randomized controlled trial.  Arch Phys Med Rehabil. 2004;  85 546-556
    CrossrefPubMedGoogle Scholar
  • 28 Mont M A, Mathur S K. et al . Cementless total knee arthroplasty in obese patients. A comparison with a matched control group.  J Arthroplasty. 1996;  11 153-156
    PubMedGoogle Scholar
  • 29 Montgomery F, Eliasson M. Continuous passive motion compared to active physical therapy after knee arthroplasty: similar hospitalization times in a randomized study of 68 patients.  Acta Orthop Scand. 1996;  67 7-9
    PubMedGoogle Scholar
  • 30 Pap G, Machner A. et al . Functional changes in the quadriceps femoris muscle in patients with varus gonarthrosis.  Z Rheumatol. 2000;  59 380-387
    CrossrefPubMedGoogle Scholar
  • 31 Pope R, Corcoran S. et al . Continuous passive motion after primary total knee arthroplasty: Does it offer any benefits?.  The Journal of Bone and Joint Surgery. 1997;  79 914-917
    CrossrefPubMedGoogle Scholar
  • 32 Reitman R D, Emerson R H. et al . A multimodality regimen for deep venous thrombosis prophylaxis in total knee arthroplasty.  J Arthroplasty. 2003;  18 161-168
    PubMedGoogle Scholar
  • 33 Salmon P, Hall G M. et al . Recovery from hip and knee arthroplasty: Patients’ perspective on pain, function, quality of life, and well-being up to 6 months postoperatively.  Arch Phys Med Rehabil. 2001;  82 360-366
    CrossrefPubMedGoogle Scholar
  • 34 Shields R K, Enloe L J. et al . Reliability, validity, and responsiveness of functional tests in patients with total joint replacement.  Phys Ther. 1995;  75 169-176; discussion 176 - 179
    CrossrefPubMedGoogle Scholar
  • 35 Silva M, Shepherd E F. et al . Knee strength after total knee arthroplasty.  J Arthroplasty. 2003;  18 605-611
    PubMedGoogle Scholar
  • 36 Stevens J E, Mizner R L. et al . Quadriceps strength and volitional activation before and after total knee arthroplasty for osteoarthritis.  J Orthop Res. 2003;  21 775-779
    CrossrefPubMedGoogle Scholar
  • 37 Stevens J E, Mizner R L. et al . Neuromuscular electrical stimulation for quadriceps muscle strengthening after bilateral total knee arthroplasty: a case series.  J Orthop Sports Phys Ther. 2004;  34 21-29
    CrossrefPubMedGoogle Scholar
  • 38 Venkataramanan V, Gignac M A. et al . Expectations of recovery from revision knee replacement.  Arthritis Rheum. 2006;  55 314-321
    CrossrefPubMedGoogle Scholar
  • 39 Walker R H, Morris B A. et al . Postoperative use of continuous passive motion, transcutaneous electrical nerve stimulation, and continuous cooling pad following total knee arthroplasty.  J Arthroplasty. 1991;  6 151-156
    PubMedGoogle Scholar
  • 40 Ware J E, Sherbourne C D. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection.  Med Care. 1992;  30 473-483
    CrossrefPubMedGoogle Scholar
  • 41 Youm Jr T, Maurer S G. et al . Postoperative management after total hip and knee arthroplasty.  J Arthroplasty. 2005;  20 322-324
    PubMedGoogle Scholar

Dipl. PT Jan-Arie Overberg

Merian Iselin Spital

Föhrenstr. 2

CH-4009 Basel

Email: jan-arie.overberg@mis-bs.ch

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