Thomas P1, Reddy KJ2, Deekshith SRk2, Saladi BSs2, Venkata Ramanaih M3, Rajanikanth D3, Deepak KS3
1Apollo Health City, Hyderabad, India, 2Apollo Health City, Orthopaedics, Hyderabad, India, 3Apollo Health City, Physiotherapy, Hyderabad, India
Background: Total knee replacements are among the most commonly performed surgeries.It is performed on patients whose knee joints have been damaged by progressive arthritis,trauma or other destructive diseases of the joint. post operative pain management plays a key role in attaining good functional outcome and early mobilization in TKA patients.different PCA techniques are used for managing post operative pain after TKA .Early and aggressive physiotherapy is found to be equally important in pain management and achieving good functional outcome after TKA.
Purpose: The objective of this study is to evaluate the effects of early and aggressive physiotherapy with and without PCA on functional outcome of post TKA patients
Methods: This is a randomized controlled study performed on 150 patients who underwent unilateral TKA at our hospital during January 2017 and January 2018.All surgeries were performed by single surgeon and anesthetist team.patients were divided into 3 groups as following.1 GROUP A -patients who were given epidural PCA 2. GROUP B-patients who were given femoral PCA 3.GROUP C- patients who were given therapeutic ultrasound and cryotherapy without PCA .Early rehabilitation and physiotherapy were started within 6 hours after surgery.All the 3 groups were followed by same exercise regime ,patients in GROUP C received additional therapeutic ultrasound and cryotherapy without any PCA. Either PCA or therapeutic ultrasound and cryotherapy were given to patients for 2 days,outcome was measured based on following parameters 1.Ambulating distance-6 minute walk test 2.Post operative pain -VAS scale 3.Average in- hospital stay 3.quadriceps muscle strength-MMT 4.Range of motion at knee-Goniometer 5.Functional out come of patient-WOMAC score
Results: Of the total 150 patients 53 patients were in GROUP A - received epidural PCA ,51 patients were in GROUP B-received femoral PCA,and remaining 46 were in GROUP C who did not receive any PCA but only therapeutic ultrasound and cryotherapy .Out of 53 patients in GROUP A 51 achieved greater ambulating distance,lesser post operative pain,average in-hospital stay was less than 72 hours,quadriceps muscle strength was 4 and active knee ROM was 90 degrees knee flexion,in GROUP B out of 51 patients 48 achieved greater ambulating distance,lesser post operative pain,average in- hospital stay was less than 72 hours,quadriceps muscle strength was 4 and active knee ROM was 90 degrees knee flexion and in GROUP C out of 46 patients 42 achieved greater ambulating distance,lesser post operative pain,average in- hospital stay was less than 72 hours,quadriceps muscle strength was 4 and active knee ROM was 90 degrees knee flexion at the time of discharge
Conclusion(s): Early rehabilitation and physiotherapy using therapeutic ultrasound and cryotherapy is equally effective as in different PCA techniques in post operative pain management in different TKA patients.In our study therapeutic ultrasound and cryotherapy achieved good functional outcomes in post operative patients on par with different PCA techniques.
Implications: Early rehabilitation and physiotherapy along with therapeutic ultrasound and cryotherapy if started within 6 hours after surgery is equally effective in pain management and achieving good surgical outcomes in TKA patients.
Keywords: therapeutic ultrasound, TKA, therapeutic ultrasound, PCA, cryotherapy
Funding acknowledgements: funded by apollo health city
Purpose: The objective of this study is to evaluate the effects of early and aggressive physiotherapy with and without PCA on functional outcome of post TKA patients
Methods: This is a randomized controlled study performed on 150 patients who underwent unilateral TKA at our hospital during January 2017 and January 2018.All surgeries were performed by single surgeon and anesthetist team.patients were divided into 3 groups as following.1 GROUP A -patients who were given epidural PCA 2. GROUP B-patients who were given femoral PCA 3.GROUP C- patients who were given therapeutic ultrasound and cryotherapy without PCA .Early rehabilitation and physiotherapy were started within 6 hours after surgery.All the 3 groups were followed by same exercise regime ,patients in GROUP C received additional therapeutic ultrasound and cryotherapy without any PCA. Either PCA or therapeutic ultrasound and cryotherapy were given to patients for 2 days,outcome was measured based on following parameters 1.Ambulating distance-6 minute walk test 2.Post operative pain -VAS scale 3.Average in- hospital stay 3.quadriceps muscle strength-MMT 4.Range of motion at knee-Goniometer 5.Functional out come of patient-WOMAC score
Results: Of the total 150 patients 53 patients were in GROUP A - received epidural PCA ,51 patients were in GROUP B-received femoral PCA,and remaining 46 were in GROUP C who did not receive any PCA but only therapeutic ultrasound and cryotherapy .Out of 53 patients in GROUP A 51 achieved greater ambulating distance,lesser post operative pain,average in-hospital stay was less than 72 hours,quadriceps muscle strength was 4 and active knee ROM was 90 degrees knee flexion,in GROUP B out of 51 patients 48 achieved greater ambulating distance,lesser post operative pain,average in- hospital stay was less than 72 hours,quadriceps muscle strength was 4 and active knee ROM was 90 degrees knee flexion and in GROUP C out of 46 patients 42 achieved greater ambulating distance,lesser post operative pain,average in- hospital stay was less than 72 hours,quadriceps muscle strength was 4 and active knee ROM was 90 degrees knee flexion at the time of discharge
Conclusion(s): Early rehabilitation and physiotherapy using therapeutic ultrasound and cryotherapy is equally effective as in different PCA techniques in post operative pain management in different TKA patients.In our study therapeutic ultrasound and cryotherapy achieved good functional outcomes in post operative patients on par with different PCA techniques.
Implications: Early rehabilitation and physiotherapy along with therapeutic ultrasound and cryotherapy if started within 6 hours after surgery is equally effective in pain management and achieving good surgical outcomes in TKA patients.
Keywords: therapeutic ultrasound, TKA, therapeutic ultrasound, PCA, cryotherapy
Funding acknowledgements: funded by apollo health city
Topic: Orthopaedics; Critical care; Neurology
Ethics approval required: Yes
Institution: apollo health city
Ethics committee: institutional ethics committee
Ethics number: AP2786
All authors, affiliations and abstracts have been published as submitted.
