[Evaluation of the systematic functional rehabilitation on rheumatoid arthritis patients following total knee arthroplasty].

Abstract

Objective: To evaluate the effects of functional rehabilitation on rheumatoid arthritis patients after the total knee arthroplasty (TKA). Methods: Two hundred rheumatoid arthritis patients (259 knees) were enrolled in this study at Arthritis Clinic and Research Center, Peking University People's Hospital from January 2012 to December 2017. All patients received the primary total knee arthroplasty, followed by a systematic functional rehabilitation. The same procedure of rehabilitation was followed, which consisted of patients' education, resistance training, passive and active range of motion exercise, balance exercise, gait training and daily-activity training. According to the degree of postoperative residual flexion contracture, these patients were divided into three groups: the severe (≥30°), moderate(15°-30°), and mild (≤15°). The outcomes of functional rehabilitation were evaluated among different groups and compared with those before the rehabilitation, which included the active range of motion (AROM), the flexion and extension angle of the knee, pain on the visual analogue scale (VAS). The complications and their impacts on the process of rehabilitation were also studied. Independent t test was applied to compare the data before and after the rehabilitaton. Results: There were 17 males (20 knees) and 183 females (239 knees) in this group, aged (57±13) years with a disease course of (16±10) years. There were significant improvements after the functional rehabilitation, including the flexion angle, the extension angle, AROM and pain VAS (76°±12° vs 112°±9°, 12.9°±10.2° vs 2.4°±4.6°, 63°±15° vs 110°±10° and 3.7±1.2 vs 2.0±0.4, respectively; t=39.0, 15.1, 41.3, 21.2, all P<0.01). The residual flexion contracture after the surgery in 259 knees were all improved, among which 195 knees (75.3%) reached a complete correction. Compared with the mild flexion contracture, the moderate and severe group had a lower complete correction rate (80.2% vs 45.9%, χ(2)=20.15, P<0.05). Total of 141 patients (70.5%) suffered from anemia two days after the surgery. By offering the anti-anemia treatment during the systematic rehabilitation, all cases of anemia were healed. The length of hospital stay was longer in the patients with moderate and severe anemia when compared with that in mild anemia ((13±5) days vs (11±5) days, t=2.2, P=0.028). Conclusion: The systematic functional rehabilitation is an effective treatment for rheumatoid arthritis patients after TKA, which can not only help release the pain after surgery, but also assist patients to achieve a better function of the knee.