Effect of Telerehabilitation-Based Exercise and Education on Pain, Function, Strength, Proprioception, and Psychosocial Parameters in Patients With Knee Osteoarthritis: A Randomized Controlled Clinical Trial.

OBJECTIVE: In middle-aged individuals with early-stage knee osteoarthritis, follow-up with remote rehabilitation methods may provide effective clinical outcomes. The present study aimed to investigate the effect of telerehabilitation on pain, function, performance, strength, proprioception, and psychosocial parameters in patients with knee osteoarthritis. DESIGN: A randomized controlled study was conducted with 54 participants with knee osteoarthritis. All patients were randomized into two groups: the home-based telerehabilitation group ( n = 29) and the home-based paper group ( n = 28). The home exercise program and training were provided with an instruction manual to paper group. The same home exercise and education prescriptions were given to individuals in telerehabilitation group via an online platform. Pain, function, quality of life, physical performance, muscle strength, and proprioception were evaluated at baseline and after 8 wks of intervention. In addition, satisfaction and usability were evaluated at week 8. RESULTS: Telerehabilitation group demonstrated better improvement in terms of pain, function, quality of life index score, and left extremity proprioception ( P < 0.05). Telerehabilitation group was not superior to paper group in terms of muscle strength and performance tests (except the Five Times Sit to Stand Test) ( P > 0.05). CONCLUSIONS: The home-based telerehabilitation program was superior to the home-based paper group program for pain, function, quality of life, and proprioception in patients with knee osteoarthritis.

The effectiveness of cruciate-retaining versus posterior-stabilized designs on extensor mechanism function and knee function in patients after simultaneous bilateral total knee arthroplasty: A two-year retrospective follow-up study.

INTRODUCTION: The importance of the posterior-cruciate ligament in knee functionality is known; however, the effect of preserving the posterior-cruciate ligament in total knee arthroplasty (TKA) on extensor mechanism function and knee function is not clear. We aimed to compare extensor mechanism function and knee function between patients operated with the cruciate-retaining and posterior-stabilized designs for simultaneous bilateral TKA. HYPOTHESIS: Patients operated with the cruciate-retaining design would produce better outcomes than those operated with the posterior-stabilized design. MATERIALS AND METHODS: A total of 104 patients were divided into two groups as the cruciate-retaining (n=52) and posterior-stabilized (n=52) groups. The groups were compared for extensor mechanism function (chair-rise test) and knee function (Hospital for Special Surgery [HSS] knee score). The follow-up points were six weeks, three months, six months, one year and two years. RESULTS: No statistically significant effect on chair-rise performance of the group-by-time interaction (χ2 [5, n=104]=5.32, p=.37) or of group (χ2 [1, n=104]=1.69, p=.19). In the HSS knee score, the group-by-time interaction was statistically significant (F [5.510]=6.24, p<.001). A statistically significant difference of 7.4 points in favor of the posterior-stabilized group was found at six weeks (p=.002). No statistically significant differences were found between the groups at the other follow-up points. DISCUSSION: The cruciate-retaining and posterior-stabilized designs have similar outcomes with regard to extensor mechanism function and knee function in the long-term period in patients who underwent simultaneous bilateral TKA. In the short-term period, the posterior-stabilized design shows better knee function than the cruciate-retaining design. LEVEL OF EVIDENCE: III; a retrospective study.

Fear of movement and other associated factors in older patients with total knee arthroplasty.

BACKGROUND: Kinesiophobia is an important risk factor for functional activities of patients in the early stage following total knee arthroplasty (TKA). AIMS: This study aimed to investigate the relationship between fear of movement and associated factors in older patients in the late stage after TKA. METHODS: The study included 45 older patients (mean age:70.11 ± 0.90 years) with knee osteoarthritis who underwent TKA. Kinesiophobia was assessed with the Tampa Scale of Kinesiophobia (TSK). Pain and strength in the quadriceps femoris (QF) muscle were assessed by the Visual Analog Scale and hand-held dynamometer, respectively. Functional level was determined using the 30-s sit-to-stand test (STS) and 10-m walking test. RESULTS: There were correlations between TSK and QF muscle strength (r = -0.538, p < 0.001), activity pain level (r = 0.489, p = 0.001), and 30-s STS (r = -0.306, p = 0.041). There were no correlations between TSK and age (r = 0.207, p = 0.172) and 10-m walking test (r = 0.112, p = 0.465). CONCLUSIONS: Increased pain and decreased QF muscle strength and functional level on STS were related with fear of movement in TKA patients. It was concluded that kinesiophobia of older patients with TKA must be considered during the assessment and rehabilitation program in the late stage after TKA.

The effect of pelvic floor muscle training on urinary incontinence in patients with stroke: a systematic review and meta-analysis.

BACKGROUND: No other systematic review presented the effectiveness of pelvic floor muscle training (PFMT) in individual with stroke. AIMS: The purpose of this systematic review and meta-analysis was to demonstrate the effectiveness of PFMT for urinary incontinence in patients with stroke. METHODS: "Web of Science (WoS), Cochrane Library, PubMed and Scopus" databases were searched. "Revised Cochrane risk-of-bias tool randomized trials (RoB 2)" and "PEDro" were used to assess the risk of bias and methodological quality of the studies. Narrative synthesis and meta-analysis were conducted to present the results. RESULTS: A total of 8 articles were included in the review. Seven articles were classified as "good" level evidence. Four articles were considered to have "high risk" of bias for the overall score. Regarding two homogenous studies, PFMT-based rehabilitation was not superior standard urinary incontinence therapy on SF-36-Social Function score at 12-week follow-up (ES 0.47, 95% CI - 0.16-0.96). Data pooling of two studies did not provide an additional advantage of pelvic muscle training on 3 days voiding diary (night, total day) score at 12-week follow-up (ES 28, 95% CI - 0.61-0.48; ES 0.30, 95% CI - 0.23-0.95). On the other hand, low-quality evidence demonstrated that pelvic muscle training yielded better results on daytime voiding (ES 0.28, 95% CI 0.04-1.16). CONCLUSIONS: The results demonstrated that PFMT had positive effects in terms of daytime urination frequency and incontinence. Although some studies have reported positive effects on symptoms, function, strength, and endurance, the generalizability of these results is controversial. Further studies should assess the quality-of-life and function with urinary incontinence and stroke-specific tools.

Turkish Translation, Cultural Adaptation, Reliability, and Validity of the Exercise-Induced Leg Pain Questionnaire.

CONTEXT: Exercise-induced leg pain (EILP) is a chronic condition that generally arises in elite and recreational athletes' lower quarter of the legs. OBJECTIVES: The study aimed to translate and culturally adapt the EILP questionnaire into Turkish (T-EILP) and evaluate its reliability and validity. DESIGN: A cross-sectional study. METHODS: Established guidelines were preferred for translation and adaptation. T-EILP was filled twice with a 1-week interval. In the first assessment, patients were also evaluated with Short Form-36 and Visual Analog Scale, both for preexercise and postexercise. Test-retest reliability and internal consistency of the T-EILP were measured with the intraclass correlation coefficient and Cronbach α coefficient, respectively. The construct validity was demonstrated with the Pearson correlation coefficient (r). Further, the minimum detectable change and standard error of measurement with 95% confidence were calculated. RESULTS: A total of 121 participants (23.0 [3.59] y) were included in the study. The test-retest reliability was excellent and internal consistency was acceptable (intraclass correlation coefficient = .821, α = .808). T-EILP was highly correlated with the physical function subscore of the Short Form-36 (r = .509, P < .01). There was a moderate correlation between T-EILP with the bodily pain subscore of the Short Form-36 and Visual Analog Scale (postexercise; r1 = .436, r2 = -.355, P < .01). The standard error of measurement and minimum detectable change with 95% confidence were 3.54 and 9.81, respectively. CONCLUSION: T-EILP is a reliable and valid tool in Turkish-speaking participants. The minimum detectable change with 95% confidence of the T-EILP provides an essential reference for monitoring EILP.

The test-retest reliability and concurrent validity of the 3-m backward walk test and 50-ft walk test in community-dwelling older adults.

BACKGROUND: Three-meter backward walk test (3MBWT) and 50-ft walk test (50FWT) are frequent physical performance tests in clinical practice. AIMS: The aim of the study was to determine the test-retest reliability and concurrent validity of the 3MBWT and 50FWT in community-dwelling older adults. METHODS: A cross-sectional study was carried out with 65 participants. 3MBWT, 50FWT, Timed Up and Go Test (TUG), and Five Times Sit to Stand Test (FTST) were evaluated in the first assessment. The test-retest reliability was evaluated by performing two repetitions of the 3MBWT and 50FWT with 1-h interval. The test-retest reliability and validity were assessed by the intraclass correlation coefficient (ICC) and the Spearman correlation coefficient, respectively. RESULTS: The mean age of the participants was 68.9±3.7 years. The ICC score of 3MBWT and 50FWT were 0.940 and 0.820, respectively. The test-retest reliability of both tests was excellent (> 0.80). Both the test and retest assessment of the 3MBWT were strongly correlated with TUG (rtest = 0.649, rretest = 0.645, p < 0.01). 50FWT (test) was not significantly correlated with FTST (r = 0.215, p > 0.05). 50FWT (retest) were weakly correlated with FTST (r = 0.260, p < 0.05). Both the test and retest assessments of the 50FWT was strongly correlated with TUG (rtest = 0.550, rretest = 0.596, p < 0.01). CONCLUSIONS: The 3MBWT and 50FWT are valid and reliable performance tests in community-dwelling older adults. MDC value of both tests provides an essential contribution to clinical practice.

The reliability and validity of the Turkish version of the graded chronic pain scale in patients with chronic low back pain.

PURPOSE: To translate and cross-culturally adapt the Turkish version of the Graded Chronic Pain Scale-Revised (GCPS-R) and to evaluate its reliability and validity. METHODS: The prospective and cross-sectional study was performed with 102 low back pain patients (67 women, 35 men). Patients were asked to complete the GCPS-R twice, one week apart. Visual Analog Scale (VAS), Roland Morris Disability Questionnaire (RMDQ), Short Form-36 (SF-36), Fear Avoidance Beliefs Questionnaire (FABQ) were filled only in the first evaluation. Test-retest reliability was analyzed with intraclass correlation coefficient (ICC). Internal consistency was measured using Cronbach's α. The minimal detectable change (MDC95) was calculated based on the standard error of measurement (SEM95). The construct validity was analyzed using the Pearson correlation coefficient. Exploratory factor analysis was calculated to explore the factor structure of GCPS-R. RESULTS: The mean age of the patients was 45.2 ± 13.1 years. The internal consistency was acceptable, and test-retest reliability was excellent (α = 0.933, ICC = 0.972). SEM95 and MDC95 for the total score were 2.07 and 5.73, respectively. VAS measured for both rest and activity were strongly correlated with GCPS-R (r > 0.50). The correlation between the total score of GCPS-R and RMDQ was excellent (r = 0.677, p < 0.001). SF-36's; physical function, role physical, bodily pain and social function subscores were strongly correlated with GCPS-R (r > 0.50). There was moderate correlation between GCPS-R and the physical activity subscore of the FABQ (r = 0.494, p < 0.001). GCPS-R had a single factor structure as expected. CONCLUSION: The Turkish version of GCPS-R is a valid and reliable questionnaire in patients with chronic low back pain. Level of Evidence II (Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding).

Cross-cultural adaptation, reliability, and validity of the Turkish version of the SymptoMScreen.

PURPOSE: The study aimed to translate and cross-culturally adapt the SymptoMScreen into Turkish and evaluate its reliability and validity. METHODS: One hundred nine MS patients were included in the study. SymptoMScreen was translated into Turkish according to the standardized guidelines and cross-culturally adapted. For construct validity, SymptoMScreen was compared with the Expanded Disability Status Scale (EDSS), Multiple Sclerosis-Related Symptom Checklist (MS-RS), and Beck Depression Scale (BDS) by Spearman's correlation coefficient. Thirty patients refilled SymptoMScreen one week later, and the test-retest reliability was analyzed by the Intraclass Correlation Coefficient (ICC). Internal consistency was evaluated with Cronbach's alpha coefficient. The standard error of measurement (SEM95) and the minimum detectable change (MDC95) were calculated. RESULTS: Test-retest reliability and internal consistency of the SymptoMScreen were excellent (ICC = 0.925, α = 0.914). SEM95 and MDC95 were 3.28 and 9.29, respectively. There was a strong correlation between the SymptoMScreen with the MS-RS and EDSS (r1= 0.908, p < 0.00; r2= 0.511, p < 0.001). Besides, the SymptoMScreen was moderately correlated with BDS (r = 0.584, p < 0.001). CONCLUSION: The Turkish version of the SymptoMScreen is a reliable and valid questionnaire for multiple sclerosis patients.

The test-retest reliability and concurrent validity of the five times sit to stand test and step test in older adults with total hip arthroplasty.

PURPOSE: The aim of the study was to determine the test-retest reliability and concurrent validity of the five times sit to stand test (FTST) and step test (ST) in older adults with total hip arthroplasty (THA). METHODS: A cross-sectional and prospective study was carried out with 32 unilateral total hip arthroplasty patients. FTST, ST, and Timed Up & Go Test were evaluated at the first evaluation session. The test-retest reliability was evaluated by performing two repetitions of the FTST and ST. Besides, the functional status of the patients was evaluated with the Harris Hip Score (HHS). The test-retest reliability of the FTST and ST were assessed by the intraclass correlation coefficient (ICC). In the concurrent validity analysis, the Pearson correlation coefficient was analyzed. In addition, the standard error of measurement (SEM95) and minimal detectable change (MDC95) values of the FTST and ST were also calculated. RESULTS: The mean age of the participants was 75.4 ±â€¯10.3 years. The ICC score of FTST, ST (right) and ST (left) were 0.987, 0.908 and 0.846, respectively. SEM95 and MDC95 values of the FTST were 1.05 and 2.91, respectively. FTST was correlated with both the HHS and TUG (r1 = -0.522, r2 = 0.730, p < 0.01). SEM95 and MDC95 values of the ST (right) were 0.37 and 1.02, respectively. SEM95 and MDC95 values of the ST (left) were 0.55 and 1.52, respectively. Also, ST (right) was only correlated with TUG (r = -0.654, p < 0.01). ST (right) were correlated with both the HHS and TUG (r1 = 0.503, r2 = -0.806, p < 0.01). The degree of correlations was strong. CONCLUSION: The FTST and ST are valid and reliable performance tests in older adults with primary unilateral THA.

Evaluation of functional characteristics in patients with knee osteoarthritis / Avaliação das características funcionais em pacientes com osteoartrite do joelho

ABSTRACT Objective: This study evaluated the physical and functional characteristics of Turkish patients with knee osteoarthritis and how this disease affects their physical and functional status. Methods: This study included 320 patients, who were evaluated to assess body mass index (BMI) and Hospital for Special Surgery (HSS) score in terms of age, sex and functional characteristics. Results: Mean patient age was 66.92±8.89 years and mean BMI was 31.02±5.20 kg/m2. Mean patient HSS score was 58.70±11.08. According to their sit-to-stand test results, 33% of the patients (n=104) were found to be independent. There was a significant relationship between BMI and functional activity score (p<0.05). Conclusions: The majority of the patients in our study were female and obese, and had low functionality levels. Function in patients with OA is restricted as a result of excess weight, so preventive measures can help Turkish patients with OA maintain their ideal weight. Furthermore, patient education can be help this population acquire the habit of regular exercise in order to reduce pain and improve their physical activity and quality of life. Level of Evidence IV, Case Series.

RESUMO Objetivo: Este estudo avaliou as características físicas e funcionais dos pacientes turcos com osteoartrite e como essa doença afeta seu estado físico e funcional. Métodos: O estudo incluiu 320 pacientes que foram avaliados quanto ao índice de massa corporal (IMC) e quanto ao escore Hospital for Special Surgery (HSS), em termos de idade, sexo e características funcionais. Resultados: A média de idade dos pacientes foi 66,92 ± 8,89 anos e a média do IMC foi 31,02 ± 5,20 kg/m2. A média do escore HSS dos pacientes foi 58,70 ± 11,08. De acordo com os resultados do teste sentar/levantar, observou-se que 33% dos pacientes (n = 104) eram independentes. Houve relação significativa entre IMC e escore de atividade funcional (p < 0,05). Conclusões: A maioria dos pacientes em nosso estudo era do sexo feminino e obesos e tinham níveis baixos de funcionalidade. A função dos pacientes com OA foi restrita em decorrência do excesso de peso, de modo que as medidas preventivas podem auxiliar os pacientes turcos a manter o peso ideal. Além disso, a educação dos pacientes pode ajudar essa população a adquirir o hábito de exercícios regulares para reduzir a dor e melhorar a atividade física e a qualidade de vida. Nível de Evidência IV, Série de Casos.

[Does preoperative body weight affect early postoperative functional activities in patients with total hip arthroplasty?] / Total kalça artroplastili hastalarda ameliyat öncesi vücut agirligi ameliyat sonrasi erken dönem fonksiyonel aktiviteleri etkiler mi?

OBJECTIVES: This study aims to compare early postoperative functional activities of obese or non-obese patients who underwent total hip arthroplasty (THA). PATIENTS AND METHODS: The study included 45 patients (17 males, 28 females; mean age 64.6±8.6 years; range 45 to 78 years) who were operated due to coxarthrosis. Patients were assigned to two groups as obese (body mass index [BMI] >30 kg/m2, n=21) and non-obese (BMI <30 kg/m2, n=24) based on their preoperative BMI. Obese and non-obese patients' functional movements (lie-to-sit, sit-to-stand, ambulation, stair climbing) were assessed with Iowa Level of Assistance Scale while ambulation velocity was assessed with Iowa Ambulation Velocity Scale preoperatively, on postoperative second and sixth days and at discharge. RESULTS: While there was significant difference between non-obese patients' intragroup functional movement levels preoperatively and at discharge (p<0.05), there were no difference in the same intragroup values of obese patients (p>0.05). There was no significant difference between obese and non-obese patients in terms of functional movements and ambulation velocities on postoperative second and sixth days and at discharge (p>0.05). CONCLUSION: According to our study findings, obesity has no effect in early postoperative period on functional activities in patients who underwent THA.

EVALUATION OF FUNCTIONAL CHARACTERISTICS IN PATIENTS WITH KNEE OSTEOARTHRITIS.

OBJECTIVE: This study evaluated the physical and functional characteristics of Turkish patients with knee osteoarthritis and how this disease affects their physical and functional status. METHODS: This study included 320 patients, who were evaluated to assess body mass index (BMI) and Hospital for Special Surgery (HSS) score in terms of age, sex and functional characteristics. RESULTS: Mean patient age was 66.92±8.89 years and mean BMI was 31.02±5.20 kg/m2. Mean patient HSS score was 58.70±11.08. According to their sit-to-stand test results, 33% of the patients (n=104) were found to be independent. There was a significant relationship between BMI and functional activity score (p<0.05). CONCLUSIONS: The majority of the patients in our study were female and obese, and had low functionality levels. Function in patients with OA is restricted as a result of excess weight, so preventive measures can help Turkish patients with OA maintain their ideal weight. Furthermore, patient education can be help this population acquire the habit of regular exercise in order to reduce pain and improve their physical activity and quality of life. Level of Evidence IV, Case Series.

OBJETIVO: Este estudo avaliou as características físicas e funcionais dos pacientes turcos com osteoartrite e como essa doença afeta seu estado físico e funcional. MÉTODOS: O estudo incluiu 320 pacientes que foram avaliados quanto ao índice de massa corporal (IMC) e quanto ao escore Hospital for Special Surgery (HSS), em termos de idade, sexo e características funcionais. RESULTADOS: A média de idade dos pacientes foi 66,92 ± 8,89 anos e a média do IMC foi 31,02 ± 5,20 kg/m2. A média do escore HSS dos pacientes foi 58,70 ± 11,08. De acordo com os resultados do teste sentar/levantar, observou-se que 33% dos pacientes (n = 104) eram independentes. Houve relação significativa entre IMC e escore de atividade funcional (p < 0,05). CONCLUSÕES: A maioria dos pacientes em nosso estudo era do sexo feminino e obesos e tinham níveis baixos de funcionalidade. A função dos pacientes com OA foi restrita em decorrência do excesso de peso, de modo que as medidas preventivas podem auxiliar os pacientes turcos a manter o peso ideal. Além disso, a educação dos pacientes pode ajudar essa população a adquirir o hábito de exercícios regulares para reduzir a dor e melhorar a atividade física e a qualidade de vida. Nível de Evidência IV, Série de Casos.

Does a weight-training exercise programme given to patients four or more years after total knee arthroplasty improve mobility: A randomized controlled trial.

AIM: To investigate the effects of the home exercise therapy performed after at least four years postoperatively on skeletal muscle strength and functionality in patients with total knee arthroplasty (TKA). METHODS: Sixty patients (age; 69.66±7.53, weight; 81.56±14.43 kg, 10 male, 50 female) followed up four or more years were randomly divided into two groups. An 8-week exercise program was designed for bilateral TKA patients. While the patients in one group were assigned to weighted exercise group, the patients in the other group were assigned to non-weighted exercise group. The primary outcome was the isometric muscle strength of quadriceps femoris (QF) and hamstring muscles assessed by Hand-Held Dynamometer. The secondary outcomes were the pain level, 30s sit-to-stand test, 10 m walk test, range of motion, and the knee function score of the Hospital for Special Surgery. The assessments were performed before and after the treatment. RESULTS: After treatment, significant differences were found in all evaluation parameters (except rest pain and range of motion) in favour of the weighted group. QF muscle strength changes (kg); weighted group: 1.99±1.70, non-weighted group: 0.51±1.14 (p=0.000), 30s sit-to-stand test changes (repetitions); weighted group: 3.66±2.23, non-weighted group: 1.70±1.95 (p=0.000), 10 m walk test changes (seconds); weighted group: -2.60±1.30, non-weighted group: -0.83±3.51 (p=0.000). CONCLUSION: Home exercise programs applied to TKA patients after at least four years postoperatively was effective in increasing muscle strength, decreasing severity of pain, and improving functional activities. The improvements were significantly greater in weighted compared with the non-weighted exercise group.

Effects of two different continuous passive motion protocols on the functional activities of total knee arthroplasty inpatients.

OBJECTIVE: The aim of this study was to compare the effects of two different continuous passive motion (CPM) application protocols (low- and high-angle) on the early phase functional activities of total knee arthroplasty inpatients. METHODS: The study included 170 patients who underwent primary TKA. While 84 of the TKA patients underwent low-angle CPM application, 86 of the patients underwent high-angle CPM application. The patients' functional activities were compared using the Iowa Level of Assistance Scale (ILAS), gait speeds using the Iowa Ambulation Velocity Scale (IAVS), knee scores using the Hospital for Special Surgery (HSS) Knee Score, and the duration of hospital stays with the Visual Analog Scale (VAS) preoperatively and on postoperative Day 2, Day 6, and at discharge. RESULTS: It was found that patients in the high-angle group had lower pain levels than did the patients in the low-angle group postsurgery (p<0.05). Patients in the high-angle group achieved their functional activities more independently on postoperative Day 2, Day 6, and at discharge than did the patients in the low-angle group (p<0.05). However, gait speed of patients in the former group was lower than that of the patients in the latter group (p<0.05). CONCLUSION: Although low-angle CPM application produced better results in terms of gait speed following TKA, the high-angle CPM application was superior in terms of independence levels of functional activities in the early postsurgery period. This result suggests that the appropriate use of rehabilitation methods such as CPM applications may guide clinicians to increase patients' level of independence.

Cross-cultural adaptation, reliability and validity of the Turkish version of the Hospital for Special Surgery (HSS) Knee Score.

OBJECTIVE: The purpose of this study was to adapt the English version of the Hospital for Special Surgery (HSS) knee score for use in a Turkish population and to evaluate its validity, reliability and cultural adaptation. METHODS: Standard forward-back translation of the HSS knee score was performed and the Turkish version was applied in 73 patients. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Mini-Mental State Examination and sit-to-stand test were also performed and analyzed. Internal consistency reliability was tested using Cronbach's alpha. The intraclass correlation coefficient (ICC) was used to calculate the test-retest reliability at one-week intervals. Validity was assessed by calculating the Pearson correlation between the HSS, WOMAC and sit-to-stand test scores. RESULTS: The ICC ranged from 0.98 to 0.99 with high internal consistency (Cronbach's alpha: 0.87). The WOMAC score correlated with total HSS score (r: -0.80, p<0.001) and sit-to-stand score (r: 0.12, p: 0.312). CONCLUSION: The Turkish version of the HSS knee score is reliable and valid in evaluating the total knee arthroplasty in Turkish patients.

[Investigation of body weight ratios on joint structures at different knee flexion angles in patients with unilateral knee arthroplasty]. / Tek tarafli total diz artroplastili hastalarda farkli diz fleksiyon açilarinda ekstremiteler arasindaki vücut agirlik oranlarinin incelenmesi.

OBJECTIVES: The study aims to determine body weight ratios between extremities in patients with unilateral total knee arthroplasty (TKA) at 12 months postoperatively at the static-standing position at 30, 60 and 90 degrees of knee flexion. PATIENTS AND METHODS: The study included 52 female patients (mean age 65.6±10.6 years; range 40 to 83 years) who underwent unilateral primary TKA. The force-platform was used to calculate the body-weight ratios of the patients. Body weight ratios on the operated and non-operated limbs of the unilateral TKA patients were examined at standing-static position at 30, 60 and 90 degrees of knee flexion on the force-platform according to their age and body mass index (BMI). The pain levels of the patients were evaluated using the visual analog scale. RESULTS: It was found that unilateral TKA patients placed their body weight on the non-operated limb more at the standing-static position, and 30, 60 and 90 degrees of knee flexion at 12 months postoperatively (p<0.05). It was also found that as the knee flexion degree increased with age, so did TKA patients place their body weight on the nonoperated limb more (p<0.05), and that BMI had no effect on the load distribution difference over the two extremities (p>0.05). CONCLUSION: During the postoperative period, load asymmetry between the two extremities in patients with unilateral TKA remains the same due to advancing age. This accelerates the osteoarthritis process on the non-operated knee. It is concluded that the age factor should be taken into account while planning physiotherapy and rehabilitation programs for unilateral TKA patients and knee exercise programs aiming to place load over the operated limb should be arranged.

Physical performance parameters during standing up in patients with unilateral and bilateral total knee arthroplasty.

OBJECTIVE: The aim of this study was to compare quadriceps femoris muscle performance parameters of patients who underwent unilateral and bilateral total knee arthroplasty (TKA). METHODS: The study included 80 patients. Thirty-five underwent unilateral primary TKA (35 females; mean age: 67.11 ± 3.97 years) and 45 underwent bilateral primary TKA (2 males, 43 females; mean age: 67.12 ± 7.32 years). Patients were evaluated in terms of performance parameters including stand-up time, rising index, standing postural sway velocity, and symmetries of body weight distribution on the extremities while standing up using a Balance Master® balance and performance instrument in the postoperative 6th and 12th month. RESULTS: No significant difference was determined in body weight symmetry ratios between the operated and non-operated extremity in unilateral TKA patients in the 6th and 12th month sit-to-stand test (p>0.05) whereas there was a significant difference in bilateral TKA patients (p<0.05). There was no significant difference between unilateral and bilateral TKA patients in terms of time needed for standing up, rising index and gravity sway velocity at the postoperative 6th month and 12th month (p>0.05). Bilateral TKA patients stood up in a shorter time than unilateral TKA patients (p<0.05) although the degree of body sway was higher after standing up (p<0.05). CONCLUSION: Bilateral TKA patients should be encouraged to focus on exercises with non-dominant limbs and to use them more while physiotherapy and rehabilitation programs including physical performance activities are planned.

A comparison of static and dynamic balance in patients with unilateral and bilateral total knee arthroplasty.

OBJECTIVES: Unilateral and bilateral total knee arthroplasty (TKA) patients were compared with respect to static and dynamic balance in the postoperative sixth and 12th months. PATIENTS AND METHODS: Eighty TKA patients 35 unilateral, 45 bilateral were assessed for static and dynamic balance using the balance master test device in sixth and 12th months after surgery. Patients were also measured with respect to Hospital for Special Surgery knee score and range of motions. Differences between groups were statistically evaluated using independent t-tests. Within-group time differences were statistically examined using paired t-tests. Correlation between the measurements was evaluated by the Pearson,s analysis. RESULTS: Sensory interaction balance and unilateral stance test of static balance assessment were similar in unilateral and bilateral TKA (p>0.05). Patients with bilateral TKA had statistically significantly better performance at the limits of stability of dynamic balance evaluations (p<0.05). There was no significant difference between rhythmic weight shift tests in the sixth and 12th months after surgery (p>0.05). CONCLUSION: In our study we concluded that while dynamic balance parameters in the daily activities of patients with bilateral TKA were expected to be better than patients with unilateral TKA, there was no significant difference between static balance parameters between the two groups.

[Comparison of early postoperative functional activity levels of patients undergoing unilateral and bilateral total knee arthroplasty]. / Tek tarafli ve iki tarafli total diz artroplastili hastalarin ameliyat sonrasi erken dönem fonksiyonel hareketlerinin karsilastirilmasi.

OBJECTIVES: We compared early postoperative functional activities of patients undergoing unilateral and bilateral total knee arthroplasty (TKA). METHODS: A total of 241 patients underwent bilateral (n=130; 12 men, 118 women; mean age 67.5+/-7.6 years) or unilateral (n=111; 7 men, 104 women; mean age 66.3+/-9.0 years) primary TKA for gonarthrosis. All the patients had indications for bilateral TKA and received the same rehabilitation program postoperatively. Functional activities and walking speed of the patients were assessed with the Iowa Level of Assistance Scale and Ambulation Velocity Scale, respectively, before surgery and on the second and sixth postoperative days and during discharge. In addition, knee range of motion and HSS (Hospital for Special Surgery) knee scores were measured. RESULTS: There were no significant differences between the two groups preoperatively (p>0.05). Compared to baseline, functional activity levels during discharge showed significant improvement in both groups (p<0.05), whereas improvement in walking speed was significant only in the unilateral TKA group (p<0.05). Comparison of postoperative functional activity levels favored unilateral over bilateral TKA in all instances (p<0.05). The two groups did not differ significantly with respect to postoperative walking speed, HSS knee scores, range of motion of the knee, and mean hospital stay (p>0.05). Complications included knee hematoma (n=2) and deep vein thrombosis (n=1) in the unilateral TKA group, and knee hematoma (n=1) in the bilateral TKA group. CONCLUSION: Postoperative physiotherapy programs should consider decreases in functional activities of patients undergoing bilateral TKA.