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AB1124 The Importance of the Early Rehabilitation after Total Knee Replacement in Osteoarthritis and Rheumatoid Arthritis Patients
  1. M. Spalevic,
  2. L. Dimitrijevic,
  3. M. Kocic,
  4. I. Stankovic,
  5. V. Zivkovic
  1. Clinic of Physical and Rehabilitation Medicine, Clinical Center Nis, Serbia, Nis, Serbia

Abstract

Background Total knee replacement (TKR) revolutionized management of patients with advanced knee osteoarthritis and rheumatoid arthritis, in order to help them overcome pain and functional limitation, with very good long-term results.

Objectives Our aim was to estimate efficiency of the comprehensive early rehabilitation and physical therapy program following TKR, and to compare results between two categories of patients (OA and RA) related to pain, functional state and overall quality of life.

Methods Prospective clinical study included 60 female patients 45-77 years old (33 with advanced knee OA and 27 with RA) assigned for TKR. All patients received cemented knee endoprostheses and were involved afterwards in 3 weeks rehabilitation program at The Rehabilitation Clinic, Nis, which included kinesy and occupational therapy, low frequency pulsed magnetic field and interferential currents. Patients were evaluated with two health-related quality of life questionnaires- The Womac (Western Ontario and Mc Master Universities Index of Osteoarthrosis) and modified SF 36 (Short-Form Health Survey) prior to surgery and 1, 3 and 6 months after. Patients' functional state was additionally estimated by measuring BMI, knee diameter, ROM, muscle strength of the quadriceps and hamstrings. SPSS software was used for the statistical analyses.

Results Both questionnaires WOMAC and SF-36 showed significantly better outcome results for all the patients 6 months after the surgery considering pain, stiffness, mobility and active participation of daily living activities and self care (p=0.000001), while the covariance analyses showed significant differences between OA and RA patients for almost every score analyzed. OA patients amended more due to the physical function, vitality, active participation in daily living activities and general health postoperatively (p<0.001). Although there was no significant difference for pain presence postoperatively between two categories of patients, RA patients achieved larger improvement due to pain reduction because of the worse preoperative results (p=0.001). Better preoperative functional status guaranteed superior postoperative results. BMI was not a clinically important predictor of outcome.

Conclusions Early rehabilitation and physical therapy program after TKR significantly improved pain reduction, functional state and quality of life in patients with OA and RA. All TKR patients need to be included in the physical therapy and rehabilitation program during the early postoperative period in order to achieve ROM necessary for everyday activities, functional, economic and enduring gait.

References

  1. Singh JA, Lewallen DG. Better functional and similar pain outcomes in osteoarthritis compared to rheumatoid arthritis after primary total knee arthroplasty: a cohort study. Arthritis Care Res (Hoboken). 2013 Dec;65(12):1936-41.

  2. Judge A, Arden NK, Cooper C, Kassim Javaid M, Carr AJ, Field RE, Dieppe PA. Predictors of outcomes of total knee replacement surgery. Rheumatology (Oxford). 2012 Oct;51(10):1804-13.

  3. Escobar A, Quintana JM, Bilbao A, Arostegui I, Lafuente I, Vidaurreta I. Responsiveness and clinically important differences for the WOMAC and SF-36 after total knee replacement. Osteoarthritis Cartilage. 2007 Mar;15(3):273-80.

Disclosure of Interest None declared

DOI 10.1136/annrheumdis-2014-eular.4638

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