The estimated blood loss was calculated using the Nadler formula. The secondary outcome measures evaluated were the laboratory data (C-reactive protein, creatinine kinase, hemoglobin level: preoperatively and on postoperative days 1, 4, 7, and 14 D-dimer: preoperatively and on postoperative days 7 and 21), the estimated blood loss, the ROM of the knee (preoperatively and on postoperative days 7, 14, 21, 28 and 3 months, and 1–2 year), and thigh swelling (two points thigh circumference at the superior border of the patella and 5-cm proximal from the superior border of the patella: preoperatively and on postoperative days 7, 14, and 21), the WOMAC Index (preoperatively and 3 months and 1–2 year postoperatively), 20 and adverse complications, including wound complications, surgical site infection, peroneal nerve palsy, and deep venous thrombosis, during this study. The operating surgeon, ward nursing staff, and data collectors, excluding patients and physiotherapists, remained blinded for the whole duration of the trial.īoth groups performed flexion and extension of the knee joint on the affected side (30-min training by a physiotherapist in each day, combined with permitted self-training), but with different starting time (1 or 7 days after TKA). Patients in Day 7 group did not have any active and passive ROM exercises until postoperative day 6. The rehabilitation program consisted of walking with a walker starting at day 1 after TKA and walking with a T-shaped cane and climbing and descending stairs starting at day 7 after TKA. All patients underwent the physiotherapist assisted passive and active hospital-based rehabilitation program that only differed in the starting time of ROM exercise until 3 months postoperatively. A staff member who did not participate in this study performed the envelope selection. (1) patients who started the postoperative ROM exercises on postoperative day 1 (Day 1 group: n = 55) and (2) patients who started the postoperative ROM exercises on postoperative day 7 (Day 7 group: n = 54). In this study, we aimed to examine different initiation timings of postoperative ROM exercises after TKA and to compare the results in terms of postoperative pain, swelling, and ROM improvement to determine the optimal time of initiating ROM exercises following TKA.īefore admission, the patients were randomly divided into 2 groups using the envelope method. However, there has been no report that denied the propriety of ROM exercise during the early postoperative stage. In particular, it has been reported that local inflammation and swelling may occur in an early stage after TKA 15, 16, 17 therefore, we speculated and hypothesized that ROM exercises beginning in the early postoperative stage are disadvantageous in restoring the ROM and relieving pain postoperatively, for eliciting local inflammation and swelling. 11Īlthough ROM exercise is known to be a means of increasing the ROM after TKA 1, 12 and starting early rehabilitation within 24 h have benefits for the early recovery, 13, 14 the optimal time of initiating only ROM exercise has not been discussed in the literature it still remains to be unclear and varies per institution. 3, 4 It has also been reported that the postoperative ROM is influenced by nerve block, changes in ligament balance in the knee joint, accurate implant positioning and by the implant design adopted 4, 5, 6, 7, 8, 9, 10 and the improved ROM after TKA affect the patient function and satisfaction. 1, 2 The ROM after TKA is reported to be strongly influenced by the preoperative ROM. 1 However, postoperative limitations in the range of motion (ROM) may occur occasionally and restrict a patient’s ADL. Total knee arthroplasty (TKA) is an effective procedure for alleviating pain and improving activities of daily living (ADL) in patients with end-stage osteoarthritis of the knee.
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