Comparison of the effectiveness of late-phase clinic-based and home-based progressive resistance training in female patients with total knee arthroplasty.

BACKGROUND: Early rehabilitation after total knee arthroplasty (TKA) is crucial in functional outcomes. However, considering improvements in the first six months, there may be benefits to continuing rehabilitation beyond three months postoperatively to achieve maximum functionality and strength. OBJECTIVE: The aim was to compare: (a) effectiveness of late-phase clinic-based and home-based progressive resistance training (PRT) in female patients with TKA; and (b) crude cost of both interventions and explore feasibility. METHODS: Thirty-two patients were assigned to clinic-based PRT (n = 16) and home-based PRT (n = 16) groups. A training program was performed at the clinic or at home for eight weeks. Pain, quadriceps and hip abductor strength, patient-reported and performance-based outcomes, knee range of motion (ROM), joint awareness, quality of life (QoL) were assessed at baseline (three months postoperatively) and after 8-week intervention (five months postoperatively). Feasibility and crude cost were examined. RESULTS: Exercise adherence was 100% in clinic-based PRT and 90.6% in the home-based PRT group. Both interventions improved quadriceps and hip abductor muscle strength, performance-based and patient-reported outcomes, knee ROM, and joint awareness without side effects (p < .05). Clinic-based PRT showed better results in: activity pain (p = .004, ES = -0.888); knee flexion (p = .002, ES = 0.875) and extension ROM (p = .004, ES = -1.081); chair sit-to-stand test (p = .013, ES = 0.935); joint awareness (p = .008, ES = 0.927); and QoL than home-based PRT (p < .05). CONCLUSION: Late-phase clinical-based and home-based PRT interventions may be beneficial in improving muscle strength and functionality in patients with TKA. Late-phase PRT is feasible, cost-effective, and recommended for rehabilitation after TKA.

The dark side of the animal experiments.

The use of animals in research has increasingly continued, although there are serious concerns about appropriate methodology, moral issues and translation to clinical practice. The aim of the present article is to review the insufficiency of statements in ethical approvals to obtain animal welfare in real life practices and to draw attention to the need for an additional evidence-based audit system. In many countries, local Animal Ethics Committees are established to ensure that animals are treated in accordance with 3Rs (Replace, Reduce, Refine) principles. Although the ethical approval certificate which is taken before the start of research is considered as the proof of animal welfare, footages released from all over the world reveal the maltreatment. However, due to the scientific resource provided by animal models, it does not seem possible to expect animal experiments to be terminated in the near future. Addition of previously suggested welfare section to methods of study or including the ethical approval certificate does not seem to be sufficient practices to guarantee the animal welfare, since they are not based on audited evidence. The welfare certificate, in which the welfare is supervised by independent auditors, would serve as a proof of both the wellbeing of subjects and consequently the scientific reliability of data. Application of review and publication priority for the animal researches which have the welfare certificate in addition to the ethical approval would encourage the researchers to obtain this certificate. The achievement of worldwide consensus about content, requirements, and application methods of the welfare certificate should be in the scope of scientists in the near future to reach the more humane and more qualified animal experiments.

A comparison of balance and fall risk in patients with unilateral and bilateral total knee arthroplasty.

BACKGROUND: Static or dynamic postural control cannot be fully restored in patients with knee osteoarthritis, even after total knee arthroplasty (TKA), which may contribute to an increased risk of falls in the elderly. OBJECTIVE: To evaluate balance and the fall risk before and after TKA in patients with bilateral knee osteoarthritis. Secondary outcomes were patient-reported and performance-based activity limitations. METHODS: A total of 45 patients were separated into two groups as unilateral TKA (UTKA, n= 24) and bilateral TKA (BTKA, n= 21) groups. All the patients received standard postoperative physical therapy for 3 months. Balance and fall risk (Biodex Balance System SD), patient-reported and performance-based functionality (WOMAC, 30-second chair-stand test, 9-step stair climbing test and 40-meter fast-paced walk test) and Short Form-12 (SF-12) were evaluated at preoperatively, and at 3 months postoperatively. RESULTS: There was no difference between the groups in postoperative fall risk and balance (p> 0.05). The BTKA group obtained better results in the sit-to-stand test and SF-12 physical dimension (p< 0.05). CONCLUSIONS: UTKA and BTKA interventions and the standard postoperative rehabilitation were seen to improve balance and quality of life, and reduce the fall risk, patient-reported and performance-based activity limitations. However, despite improvements in balance, the risk of falling persists.

Evaluation of overactive bladder and nocturia as a risk factor for hip fracture in climacteric women: a matched pair case control study.

The aim of this study was to investigate whether overactive bladder (OAB) influences hip fractures in climacteric women by comparing the frequency of OAB and nocturia symptoms in patients with hip fractures and their age-matched controls in pre-fracture period. A total of 30 climacteric patients with a history of hip fracture were compared to a control group of 51 women in terms of OAB, nocturia and nocturia-QoL. A questionnaire composed of structured questions and Turkish validated versions of the specific questionnaires for OAB, OAB-Quality of Life (OAB-q) and nocturia-QoL was directed to the two groups. We did not detect statistically relevant differences between the groups for the presence or severity of OAB and OAB-q (p > .05). However, Nocturia-QoL was worse in the group with hip fracture (p = .022). Overactive bladder has no contribution to the overall risk of hip fracture, whereas, the severity of nocturia seems to play a role as a risk factor in the formation of hip fracture. Impact statement What is already known on this subject: Hip fracture is associated with high morbidity, mortality and the cost. Prevention of hip fracture is a high priority for the patients, physicians and the public health. Several studies and consensus opinions have investigated the risk factors for the hip fractures. What the results of this study add: Although urinary symptoms were not evaluated in previous studies as a risk factor, desire of urination makes people stand up and move to their toilet, and may put them in a hurry if it is sudden and uncontrollable one. Therefore, we hypothesised that overactive bladder (OAB) and nocturia may be a risk factor in the formation of hip fractures. Our study showed that Nocturia Quality of Life is worse in patients with the hip fracture. Therefore, overactive bladder may not have a role on the overall risk of hip fracture, but the severity of nocturia seems as a risk factor in the fracture process. What the implications are of these findings for clinical practice and/or further research: The getting up from the bed would probably be harder than getting up from a chair in elderly, and life style modifications such as illumination bedroom and organisation of living place may be helpful to minimise the risks.

Obliteration of Intercondylar Notch Mimicking Flexion-Extension Gap Imbalance in a Cruciate Retaining Total Knee Arthroplasty.

Following total knee arthroplasty (TKA), the most frequent cause of extension deficit and limitation of range of motion in early postoperative period is related to improper tensioning of soft tissues and failure to balance extension and flexion gaps. If a cruciate retaining (CR) prosthesis is the planned implant, then attention should be given to balancing the posterior cruciate ligament (PCL), and any factor that alters this balance may also cause deterioration of knee balance in postoperative period. Here, we report on an unusual case referred from another hospital because of continuous pain and restriction of knee motion in early postoperative period following CR-designed TKA that was initially thought to be due to flexion-extension imbalance. However, during the revision procedure, extruded cement to the intercondylar notch was found to be both mechanically blocking terminal extension and limiting flexion by possible mechanism of irritation of the synovial nerve endings around the stretched anterior fibers of PCL during flexion. This case was successfully treated by removal of extruded cement from intercondylar notch to decompress PCL, polyethylene exchange, and secondary patellar resurfacing.