Rehabilitation of Patients with Hip Joint Arthroplasty (Late Post-surgery Period - Hospital Rehabilitation).

BACKGROUND: Hip joint replacement (endoprosthesis, alloplasty) has become one of the most frequent surgery interventions of the 20th century. AIM: To conduct rehabilitation therapy in the late post-surgery period of hospital rehabilitation (45 days after surgery), to track patients' progress and measure the results. MATERIALS AND METHODS: One hundred and fifty-two patients with hip joint endoprosthesis were included in the study. All underwent surgery and rehabilitation at the Department of Clinical Rehabilitation of the Physical and Rehabilitation Medicine Clinic at Doctor G. Stranski University Hospital, Pleven. Kinesitherapy included therapeutic massage, isometric exercises for gluteal and hip muscles, isotonic exercises for the hip and the knee joint, breathing exercises, analytical gymnastics, exercises for balance and posture stability; gait control, exercises with gym equipment; occupational exercises included all activities of daily living (ADL) that were practiced at home; treatment with performed physical factors included applying magnetic field, interferential current therapy, electrostimulation of the m. quadriceps femoris and the gluteal muscles. RESULTS: The scores from the pain visual analog scale (VAS), the muscle strength test and the test for the movement volume of the hip joint were obtained at the beginning and at the end of the rehabilitation process and stored in an individual file for each patient. CONCLUSION: The results of the present study suggest that the complex rehabilitation program (kinesitherapy, performed physical factors and occupational therapy) can result in a considerably faster recovery and ensures that patients reach optimal functional results.

Radial shock wave therapy for plantar fasciitis: a one year follow-up study.

UNLABELLED: The vast majority of published papers on the efficacy of extracorporeal shockwave therapy (ESWT) have come up with rather controversial results in patients with plantar fasciitis. The AIM of the present study was to investigate the effect of radial shock wave therapy in patients with chronic proximal plantar fasciitis. MATERIAL AND METHODS: Twenty-one patients were included in the study (mean age 51.29 +/- 2.02 yrs, mean duration of symptoms 10.14 +/- 1.11 mos). Radial shock wave therapy was administered in five sessions. Total number of shocks per session was 2500 at a pressure of 2.5 bars. Visual analog scale (VAS) and a modification of the clinical rating system of the American Orthopedic Foot and Ankle Society (AOFAS) were used for outcome measurement. The patients were assessed before treatment and followed up 3, 6, and 12 months after end of treatment. RESULTS: Statistically significant improvement in pain and functional capacity was found after completion of treatment in comparison with baseline; the improvement was preserved throughout a one-year follow-up. VAS mean score for pain showed changes in pain while walking the first few steps in the morning from 6.28 +/- 0.4 before therapy to 2.85 +/- 0.48 after treatment and to 1.52 +/- 0.31 at 3 months, to 1.09 +/- 0.25 at 6 months, and to 0.52 +/- 0.14 at 12 months of follow up (p <0.001). Similar dynamics was observed in pain intensity during daily activities, at rest, in the evening and upon compression. The AFOAS score showed a statistically significant reduction in pain--from 11.90 +/- 2.35 at baseline to 31.90 +/- 1.48 after the end of interventions (p < 0.001), and to 39.52 +/- 0.47 at one year of follow-up (p < 0.001). The mean values of the evaluation reflecting activity limitations and support requirements increased from 3.85 +/- 0.42 to 7.85 +/- 0.46 after treatment and to 9.71 +/- 0.19 at one year of follow up (p < 0.001). Similar dynamics was seen in the maximum walking distance and walking surfaces. Gait abnormalities changed from 3.43 +/- 0.50 at baseline to 6.28 +/- 0.59 after treatment (p < 0.001). CONCLUSION: Based on the results of this study we could conclude that radial shock wave therapy is a safe non-invasive method of treatment. Our preliminary findings indicate that it could be an effective treatment of choice for patients with chronic plantar fasciitis that is recalcitrant to other conservative treatment modalities.

Radial shock wave therapy in patients with lateral epicondylitis.

INTRODUCTION: Lateral epicondylitis, or "tennis elbow", is a relatively common disorder. Various therapeutic modalities have been tried in an attempt to manage the disorder but neither the conservative methods nor the surgical options have proved to be beneficial so far. During the past decade in the USA and European countries and the past several years in Bulgaria, the shock wave therapy (focused and radial) has been introduced as a method of choice in the treatment of chronic tendynopathies. The AIM of the present study was to make quantitative assessment of the effect of radial shockwave therapy in patients with lateral epicondylitis. PATIENTS AND METHODS: The study included 16 patients with lateral epicondylitis (9 males, 7 females, mean age 47.2 +/- 2.3 yrs) of mean duration of 15.06 +/- 4.06 months. We used the BTL-5000 radial shockwave therapy equipment and performed 5 procedures (one per week). The total number of shocks was 2500, the pressure was 2 Bars: 1500 shocks of 5 Hz frequency followed by 500 shocks of 10 Hz frequency were applied locally on the lateral epicondyle and 500 shocks of 2 Bar pressure and 5 Hz frequency were applied along the muscles near the insertion. The patients were evaluated 5 times: before treatment, immediately after the end of treatment and at 3, 6 and 12 months of follow-up. Pain was assessed at rest, on palpation and by the Thomsen test using a visual analogue scale (VAS). The patient-rated tennis elbow evaluation (PRTEE) questionnaire was used to assess the patients' pain, functional condition and limitations in performing specific activities, as well as for the overall self evaluation. RESULTS: We found significant difference (p < 0.05) between the mean pain scores (at rest, on palpation and by Thomsen test) before treatment and these scores obtained immediately after treatment, the decrease sustained at 3, 6 and 12 months. VAS showed decrease from 3.75 +/- 0.49 before therapy to 2.44 +/- 0.39 after treatment, to 1.94 +/- 0.46 at 3 months and to 0.69 +/- 0.38 at one year at rest, from 7.44 +/- 0.38 before therapy to 4.69 +/- 0.51 after treatment, to 3.56 +/- 0.40 at 3 months and 1.46 +/- 0.56 at one year at palpation, and from 5.87 +/- 0.46 before therapy to 3.5 +/- 0.29 after it, to 2.5 +/- 0.40 at 3 months and 1 +/- 0.38 at one year in the Thomsen test. The pain, function and the total score as assessed on the patient-rated scale (PRTEE) also showed statistically significant improvement (p < 0.05) after completion of therapy and over the whole follow-up. Total score decreased from 56.75 +/- 2.34 before therapy to 39.38 +/- 3.96 after treatment, to 27.53 +/- 3.7 at 3 months and to 13.69 +/- 4.48 at one year. CONCLUSION: Based on the results of this preliminary study we could recommend the radial shock wave therapy in the treatment of lateral epicondylitis of more than 6 months' duration if the condition is recalcitrant to other conservative methods of treatment.

Exercise training modes in rehabilitation of patients with chronic heart failure.

Modern cardiac rehabilitation (CR) in chronic heart failure (CHF) is a multidisciplinary process with the patient being the centre of the focus. Various CR models (inpatient, outpatient and home based) have been used the last two decades in the pursuit of higher effectiveness and better results. The aim of this review is to present different exercise training modes applied in rehabilitating patients with CHF and to highlight their clinical value, advantages and disadvantages and practical implication.

Fractures of the femoral neck treated with hemiarthroplasty. A comparative study.

INTRODUCTION: Hemiarthroplasty is the treatment of choice in the management of displaced intracapsular fractures of the proximal femur in old patients with low functional demands. AIM: To assess the effectiveness of cementless Austin-Moore and the cemented Thompson prostheses used in the treatment of displaced intracapsular fractures of the proximal femur. PATIENTS AND METHODS: We studied retrospectively 376 patients with fresh, displaced, nonpathological femur neck fractures. They were treated with either a cementless Austin-Moore prosthesis or a cemented Thompson prosthesis. Criteria for the choice of the prosthesis were the fracture site on the neck of the femur and the bone quality. The follow-up period was 3 to 8 years and the number of reviewed patients was 122. RESULTS: The Thompson prosthesis group showed slightly better results. Acetabular erosion rate was significantly lower in the uncemented group while loosening rate here was significantly higher. CONCLUSION: Advantages and disadvantages were identified in both groups although we believe that none of the approaches proved definitively superior to the other.

Are exercise interventions beneficial for people with hip and knee osteoarthritis? - A Cochrane Review summary with commentary.

The aim of this commentary is to discuss in a rehabilitation perspective the recently published Cochrane Review "Exercise interventions and patient beliefs for people with hip, knee or hip and knee osteoarthritis: a mixed methods review" by Hurley M. et al., 2018,1 under the direct supervision of Cochrane Musculoskeletal Group. This Cochrane Corner is produced in agreement with Journal of Musculoskeletal Science and Practice by Cochrane Rehabilitation.

Effectiveness of High Intensity Laser Therapy for Reduction of Pain in Knee Osteoarthritis.

Introduction. Osteoarthritis is the most common type of arthritis. It is the main cause of chronic musculoskeletal pain and disability among the elderly population. Aim. This is a pilot, randomized clinical study about the effect of high intensity laser therapy in patients with osteoarthritis of the knee (OA of the knee). Material and Method. 72 patients (aged between 39 and 83 years) with (clinically and radiographically proved) OA of the knee were included in the study. They were randomized in two groups: therapeutic (test) one (n = 37, 65,11 ± 1,40 (mean ± SD) years old; patients were treated with HILT) and control group (n = 35, 64,71 ± 1,98; patients receive sham laser). Both groups had seven sessions of treatment. VAS and dolorimetry were used for assessment of pain before and after the therapy. Pedobarometric analysis (static and dynamic) was used to assess comparatively the contact surface area and maximum pressure under the heel. Results. Pain levels measured by VAS and dolorimetry decreased significantly in the therapeutic group after seven days of treatment (p< 0,001). Conclusion. The results after seven days of treatment show more intensive and cumulative effect after the application of high intensity laser therapy in comparison to sham laser. This is the reason why HILT can be a method of choice in the treatment of gonarthrosis.

The holistic approach to rehabilitation of patients after total hip joint replacement.

AIM: The objective of the present study was to present the principles of a program used jointly by the Clinic of Orthopaedics and Traumatology and the Clinic of Physical Medicine and Early Rehabilitation at St. George University Hospital, Plovdiv for rehabilitation of patients with total hip replacement surgery. MATERIALS AND METHODS: We reviewed 486 cases of endoprostheses implanted by two surgical teams in the Clinic of Orthopaedics and Traumatology over a period of 6 years. We lay the stress on the fact that early mobilization of patients (3 to 5 days after operation) results in better functional results. We particularly emphasize the necessity of using a comprehensive approach that can have an effect on the psychoemotional status and the motivation of patients. RESULTS: The treatment results we evaluated by taking into account not only all functional parameters of restoring the range of hip joint motion but also the psychoemotional aspects of the recovery of patients after surgery. We took into consideration the range of motion of both the operated and the unoperated hip joints, the muscle strength, the walking distance, the type of gait, and the subjective evaluation of the patients (satisfied, not very satisfied, unsatisfied of operation). Particular attention was paid to the psychoemotional status of patients stimulating the positive feedback and their willingness to put in serious efforts toward improvement of their quality of life. CONCLUSION: The new approach to rehabilitation of patients with total hip replacement focuses not only on the collaboration between orthopedists, traumatologists and physical therapeutists, but also on the integral effect both on the physical state of patients and on their psychoemotional status with the aim of improving their quality of life.

Diagnostic value of the muscle fiber conduction velocity for evaluation of muscle hypotrophy.

AIM: To find an objective method of evaluation of the thigh muscle hypothrophy in gonarthrosis. MATERIAL AND METHODS: The subjects of the study were 24 patients with gonarthrosis (mean age 58.4 +/- 2.6 years). Of these 8 (33%) were males and 16 (67%) females. The following methods of examination were used: computed tomography (CT) of the thigh musculature--linear measurement and area of the cross-section of the vastus medialis muscle; electromyography--muscle fiber conduction velocity; and measurement of thigh girth. RESULTS: Significant reduction of the cross-section area and linear measurement of the vastus medialis muscle and significant delay of the muscle fiber conduction velocity was found in the symptomatic side compared with the asymptomatic side. No correlation was found between the tape measure of the thigh and cross-section area of the muscle. A significant correlation was found between the cross-section area of the muscle and the fast fiber conduction velocity as well as between the linear measurement of the vastus medialis muscle cross-section and fast fiber conduction velocity. CONCLUSION: The correlation between the macromorphological changes of the vastus medialis muscle assessed by computed tomography and the functional changes detected by electromyography allows the conclusion that the muscle fiber conduction velocity can be used as an objective method of evaluation of muscle atrophy in degenerative joint diseases.

A case of encephalomyelopolyneuropathy in vitamin B12 deficiency.

UNLABELLED: A case of a 44-years-old patient with unusual clinical presentation of encephalomyelopolyneuropathy in vitamin B12 deficiency is presented. The disease manifested itself with gastrointestinal bleeding, which necessitated emergency hospitalisation in surgical clinic. Clinical examinations revealed atrophic gastritis, pernicious anemia, neurological and mental complications. The diagnosis was made according to the following criteria: physical examination--smooth tongue, atrophic gastritis, mild hepatosplenomegaly; laboratory findings--pernicious anemia, low vitamin B12 serum levels; neurological examination--syndrome of combined damage of the posterior and lateral columns of the spinal cord; magnetic resonance imaging--typical hyperintense areas on T2-weighted images in the posterior columns in the cervical regions of the spinal cord; transcranial magnetic stimulation--prolonged central motor conduction time of the motor evoked potentials bilaterally; psychological examination--cognitive decline. After treatment with vitamin B12 an improvement of the hematological findings, neurological deficit and cognitive impairments was found. CONCLUSION: Neurological complications could be an early manifestation of vitamin B12 deficiency. In diagnostic aspect similar complaints require examination of the serum levels of vitamin B12. The delay in diagnosis and inadequate therapy bear the risk of incomplete recovery of the neurological deficit. The current problem of "cognitive decline" necessitates routine examination of the serum levels of vitamin Bl2 in all patients with initial cognitive impairments and their prompt and approapriate treatment.

Effect of radial shock wave therapy on muscle spasticity in children with cerebral palsy.

Extracorporeal shock wave therapy is a treatment of choice in patients with musculoskeletal disorders. The aim of this study was to investigate the effect of radial shock wave therapy (RSWT) on muscle spasticity of plantar flexor muscles in children with cerebral palsy. This was an open, controlled, observational study with one placebo treatment session, followed 4 weeks later by one active treatment session. Procedures and measurements were performed on inpatients of the Physical and Rehabilitation department of the Medical University Hospital, Plovdiv, Bulgaria. Twenty-five children, mean age 4.84±3.11 years, with spastic diplegia and hemiplegia participated in the study. They received a single session of RSWT to the plantar flexors of the foot. The following clinical methods were used for outcome assessment before, after, and 2 and 4 weeks later: passive range of motion, Modified Ashworth Scale. Baropodometric measurements were performed before and after the placebo and active session. After placebo application, no changes measured by clinical or instrumental methods were found. After RSWT, a significant increase in passive range of motion was observed: 47.00±2.29° versus 33.25±2.20° (P<0.001), which persisted at the second (46.87±2.08°, P<0.001) and fourth week (44.12±1.93°, P<0.001) after treatment. The Modified Ashworth Scale score decreased from 2.77 to 2.00 points (P<0.001), which persisted at the second (mean 2.05±0.07 points, P<0.001) and fourth week (2.15±0.76 points, P<0.001) after treatment. Baropodometric measurement showed a significant increase in the contact plantar surface area of the affected foot (from 81.32±6.14 to 101.58±5.41 cm, P<0.001) and in heel pressure (from 50.47±6.61 to 75.17±3.42 N/cm, P<0.001). There is a significant reduction in the spasticity of plantar flexor muscles in children with cerebral palsy after a single session of RSWT and this improvement remains at the 4-week follow-up.