Total knee replacement (TKR) surgery has been performed in increasing number of patients in recent years. Postoperative complications often occur despite the improvement of the technique for performing this surgical intervention. All of the above confirms the need for the development and implementation of modern rehabilitation programs for patients after TKR. Aim. To substantiate scientifically the feasibility of the combined use of cryotherapy and electrical stimulation in patients after TKR. Material and methods. We examined 90 patients who were admitted 3 months after TKR and were randomized into 3 groups. In the first group – 30 subjects received electrical stimulation of the quadriceps muscles and carried out therapeutic exercises for a course of 10 procedures. In the second group – 30 subjects received electrical stimulation of the quadriceps muscles and air cryotherapy, performed therapeutic exercises for a course of 10 procedures. In the third group – 30 people were given physical therapy classes only. Results. From the standpoint of the ICF, it has been proven that the physical factors application in the complex treatment of the above patients’ category contributes to the improvement of “b 710 – the function of joint mobility”. This is confirmed by the operated joint function improvement according to the KSS scale, microcirculation state enhancement, and the decrease in pain syndrome according to the VAS. The mobility level advance was revealed when evaluating the effectiveness of the proposed rehabilitation programs in the domain “d 450-walking” based on the ICF. When assessing the domain “d 5-self-service”, the HAQ questionnaire data indicate an increase in the ability to perform most activities in everyday life. However, more statistically significant results were obtained in patients after a course of quadriceps electrical stimulation, air cryotherapy and therapeutic exercises.
total knee replacement, air cryotherapy, electrical stimulation, rehabilitation
1. Cykunov M.B. Programma reabilitacii pri povrezhdeniyah hryaschevyh i kapsul'no-svyazochnyh struktur kolennogo sustava. Metodicheskie rekomendacii. Vestnik vosstanovitel'noy mediciny. 2014; 3(61): 110-114.
2. Wang X., Hunter D.J., Vesentini G., Pozzobon D., Ferreira M.L. Technology-assisted rehabilitation following total knee or hip replacement for people with osteoarthritis: a systematic review and meta-analysis. BMC Musculoskeletal Disorders. 2019; 1(20): 506 p. https://doi.org/10.1186/s12891-019-2900-x
3. Abdel M.P., Oussedik S., Parratte S., Lustig S., Haddad F.S. Coronal alignment in total knee replacement: historical review, contemporary analysis, and future direction. Bone and Joint Journal. 2014; 96-B(7): 857-862. https://doi.org/10.1302/0301-620X.96B7.33946
4. Kul'chickaya D.B., Konchugova T.V., Salamadina M.O. Nemedikamentoznye metody lecheniya bol'nyh gonartrozom. Vestnik vosstanovitel'noy mediciny. 2019; 2(90): 40-43.
5. Kul'chickaya D.B., Konchugova T.V., Minenkov A.A., Kolbaya L.I. Tehnologii vosstanovitel'noy mediciny v korrekcii mikrocirkulyatornyh narusheniy u bol'nyh gonartrozom. Voprosy kurortologii, fizioterapii i lechebnoy fizicheskoy kul'tury. 2012; 89(1): 14-16.
6. Alqualo-Costa R., Thomé G.R., Perracini M.R., Liebano R.E. Low-level laser therapy and interferential current in patients with knee osteoarthritis: a randomized controlled trial protocol. Pain Management. 2018; 8(3): 157-166. https://doi.org/10.2217/pmt-2017-0057
7. Hegedűs B., Viharos L., Gervain M., Gálfi M. The effect of low-level laser in knee osteoarthritis: a double-blind, randomized, placebo-controlled trial. Photomedicine and Laser Surgery. 2009; 27(4): 577-584.
8. Langella L.G., Casalechi H.L., Tomazoni S.S. et. al. Photobiomodulation therapy (PBMT) on acute pain and inflammation in patients who under- went total hip arthroplasty-a randomized, triple-blind, placebo-controlled clinical trial. Lasers in Medical Science. 2018; 33(9): 1933-1940. https://doi.org/10.1007/s10103-018-2558-x
9. Zhang Q., Zhang J.H., Tong P. Application of transcutaneous electrical nerve stimulation to multimodal analgesia after total knee arthroplasty. Zhongguo Gu Shang. 2014; 27(4): 283-286.
10. Şavkin R., Büker N., Güngör H.R. The effects of preoperative neuromuscular electrical stimulation on the postoperative quadriceps muscle strength and functional status in patients with fast-track total knee arthroplasty. Acta Orthopaedica Belgica. 2021; 87(4): 735-744. https://doi.org/10.52628/87.4.19
11. Bistolfi A., Zanovello J., Ferracini R., Allisiardi F., Lioce E., Magistroni E., Berchialla P., Da Rold I., Massazza G. Evaluation of the Effectiveness of Neuromuscular Electrical Stimulation After Total Knee Arthroplasty: A Meta-Analysis. American Journal of Physical Medicine & Rehabilitation. 2018; 97(2): 123-130.
12. Mistry J.B., Elmallah R.D., Bhave A. et al. Rehabilitative Guidelines after Total Knee Arthroplasty: A Review. The Journal of Knee Surgery. 2016; 29(3): 201-17. https://doi.org/10.1055/s-0036-1579670
13. Fatoye F., Wright J.M., Yeowell G., Gebrye T. Clinical and cost-effectiveness of physiotherapy interventions following total hip replacement: a systematic review and meta-analysis. Rheumatology International. 2020; 40(9): 1385-1398.
14. Belyaev A.F., Kantur T.A., Hmeleva E.V. Reabilitaciya pacientov posle endoprotezirovaniya tazobedrennyh sustavov. Vestnik vosstanovitel'noy mediciny. 2018; 4(86): 2-6.
15. Razumov A.N., Grigor'eva V.D., Dashina T.A. Vozdushnaya krioterapiya v vosstanovitel'nom lechenii bol'nyh osteoartrozom i zabolevaniyami myagkih tkaney. Posobie dlya vrachey. Voprosy kurortologii, fizioterapii i lechebnoy fizicheskoy kul'tury. 2010; (4): 51-53.