Unveiling Timetable for Physical Therapy after Single-Level Lumbar Surgery for Degenerative Disc Disease: Insights from a Systematic Review and Meta-Analysis.

Background: Postoperative physical therapy emerges as a pivotal element of the rehabilitation process, aimed at enhancing functional recovery, managing pain, and mitigating the risk of further complications. The debate concerning the optimal timing of physical therapy intervention post-surgery remains unresolved; in particular, whether to initiate physical therapy immediately or to wait weeks is of particular interest. The aim of this study is to review the available literature regarding the optimal timing of physical therapy initiation and the outcomes obtained. Methods: This review was carried out in accordance with the Preferential Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. This search was carried out in February 2024. Only peer-reviewed articles were considered for inclusion. Results: Fourteen studies were included. The primary outcomes assessed in the included studies were the following: 12-week and 12-month low back pain, return to work, function and disability, psychological status, patient satisfaction, and complications associated with early physical therapy. A meta-analysis was performed concerning low back pain after lumbar discectomy at 12 weeks and 12 months and complications after early physical therapy after lumbar discectomy and lumbar interbody fusion. A significant difference was found between early and standard physical therapy in terms of low back pain at 12-18 months (p = 0.0062); no significant differences were found in terms of complications, both for discectomy and arthrodesis. Conclusions: This review indicates that employing early rehabilitation strategies for intervertebral disc disease could enhance results in terms of pain and disability without an enhanced risk of complications.

Drain versus no drain after total ankle arthroplasty: are there any differences in complications rate?

INTRODUCTION: While the efficacy of closed suction drains has been extensively studied in hip, knee, and shoulder surgery, it lacks scientific evidence in the foot and ankle domain, especially after total ankle arthroplasty (TAA). Thus, this study aims to compare the incidence of postoperative complications with and without the application of a closed suction drain following TAA. MATERIALS AND METHODS: A retrospective monocentric chart review of all patients who had undergone TAA with an anterior approach from January 2020 to March 2023 was performed. Data were analyzed to assess the effect of drain usage on postoperative complications. RESULTS: A total of 110 patients were enrolled, 59 in the drain group and 51 without a drain. The mean age at surgery was 58.4 (range 28-81) years. No statistical differences were found between the two groups in the total complication rate (19.6% in no-drain group versus 20.3% in drain group, p = 0.227). CONCLUSION: This study showed no effect of applying a closed suction drain after TAA in the incidence of postoperative complications. Since the use of a drain did not negatively affect the outcome, nor did it provide a significant benefit, it can be asserted that there is no evidence to support the routine use of closed suction drains in TAA.