Total Diz Artroplastisinde Prehabilitasyon: 12 Haftalık Preoperatif Egzersiz Programının Postoperatif Sonuçlar Üzerine Etkisi

Öz

Amaç: Bu çalışmada, total diz artroplastisi (TDA) öncesinde preoperatif egzersiz eğitimi uygulanan gonartroz hastalarının erken postoperatif klinik, fonksiyonel ve radyolojik sonuçlarının prospektif olarak değerlendirilmesi amaçlandı.
Materyal ve metod: Mayıs 2022 ile Temmuz 2023 tarihleri arasında, primer osteoartrit tanısı olan, varus diz deformitesi bulunan ve 50 yaş ve üzerindeki toplam 50 hasta çalışmaya dahil edildi. Hastalar rastgele iki gruba ayrıldı. Müdahale grubundaki hastalar cerrahi öncesinde Amerikan Kalça ve Diz Cerrahları Birliği tarafından önerilen 12 haftalık egzersiz programını tamamladı. Kontrol grubundaki hastalara ise başlangıç değerlendirmesinin ardından uygun zamanda cerrahi uygulandı. Tüm hastalara çimentolu, posterior çapraz bağ koruyucu total diz protezi uygulandı. Hastalar preoperatif dönemde ve postoperatif ikinci haftada American Knee Society Score (AKSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) ve Tampa Kinezyofobi Ölçeği (TSK) ile değerlendirildi. Ayrıca radyolojik değerlendirme, Total Diz Artroplastisi Radyolojik Değerlendirme Kriterleri’ne göre yapıldı. Bulgular: Çalışmaya dahil edilen hastaların 7’si (%13,7) erkek, 43’ü (%86,3) kadın olup ortalama yaş 64,90±7,29 yıl idi. Egzersiz grubunda ortalama preoperatif VAS ağrı skoru 8,16 iken kontrol grubunda 7,96 olarak saptandı; postoperatif dönemde bu değerler sırasıyla 3,4 ve 4,2’ye geriledi. Her iki grupta da ağrı düzeylerinde anlamlı azalma gözlendi. Bununla birlikte, VAS skorlarındaki azalma egzersiz grubunda kontrol grubuna kıyasla anlamlı derecede daha fazlaydı (sırasıyla 4,76±1,53 ve 3,72±1,59; p=0,023). Fleksiyon ve ekstansiyon hareket açıklıkları her iki grupta anlamlı şekilde arttı; ancak fleksiyon kazanımı egzersiz grubunda anlamlı derecede daha yüksekti (p=0,001). Ortalama preoperatif varus açısı egzersiz grubunda 11,52±4,65°, kontrol grubunda 13±4,5° iken; postoperatif ortalama valgus açıları sırasıyla 2,62±1,82° ve 2,61±2,08° olarak ölçüldü. Postoperatif radyolojik dizilim parametreleri açısından gruplar arasında anlamlı fark saptanmadı. Ortalama TSK skoru egzersiz grubunda 40,16±3,44’ten 30,96±4,14’e, kontrol grubunda ise 39,12±3,01’den 33,08±2,94’e düştü. TSK skorlarındaki iyileşme egzersiz grubunda anlamlı derecede daha fazlaydı (p=0,042).
Sonuç: TDA sonrası fonksiyonel kapasite ve bağımsızlığın artırılmasında rehabilitasyon süreci kritik öneme sahiptir. Osteoartrite bağlı dejeneratif dizlerde uygulanan preoperatif egzersiz programları postoperatif iyileşmeye olumlu katkı sağlamaktadır. Preoperatif rehabilitasyon postoperatif ağrıyı azaltmakta, diz fonksiyonlarını iyileştirmekte, kinezyofobiyi azaltmakta ve hastaların postoperatif sürece yönelik farkındalığını artırmaktadır. Bununla birlikte, erken rehabilitasyonun kısa dönem radyolojik dizilim sonuçları üzerinde belirgin bir etkisi bulunmamaktadır.

Anahtar Kelimeler

• Total diz artroplastisi
• Preoperatif rehabilitasyon
• Egzersiz tedavisi
• Fonksiyonel sonuçlar
• Erken postoperatif dönem

Etik Beyan

Ethical approval was obtained from the Harran University Clinical Research Ethics Committee prior to the study (approval no: HRÜ/22.09.36, session no: 09, date: May 9, 2022).

Prehabilitation in Total Knee Arthroplasty: The Impact of a 12-Week Preoperative Exercise Program on Postoperative Outcomes

Öz

Background: In this study, the early postoperative clinical, functional, and radiological outcomes of patients with gonarthrosis who underwent preoperative exercise training prior to total knee arthroplasty (TKA) were prospectively evaluated.
Materials and Methods: Between May 2022 and July 2023, a total of 50 patients aged 50 years and older, diagnosed with primary osteoarthritis and presenting with varus knee deformity, were included in the study. Patients were randomly assigned into two groups. The intervention group completed a 12-week exercise program recommended by the American Association of Hip and Knee Surgeons prior to surgery. The control group underwent surgery at an appropriate time following baseline assessment. All patients received cemented posterior cruciate ligament-retaining total knee prostheses. Patients were evaluated preoperatively and at the second postoperative week using the American Knee Society Score (AKSS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Tampa Scale of Kinesiophobia (TSK). In addition, radiological evaluation was performed according to the Radiological Evaluation Criteria for Total Knee Arthroplasty.
Results: Seven patients (13.7%) were male and 43 (86.3%) were female, with a mean age of 64.90±7.29 years. The mean preoperative VAS pain score was 8.16 in the exercise group and 7.96 in the control group; postoperatively, these values decreased to 3.40 and 4.24, respectively. A significant reduction in pain levels was observed in both groups. However, the reduction in VAS scores was significantly greater in the exercise group compared with the control group (4.76±1.53 vs. 3.72±1.59, respectively; p=0.023). Range of motion in flexion and extension improved significantly in both groups, with significantly greater flexion gains observed in the exercise group (p=0.001). The mean preoperative varus angle was 11.52±4.65° in the exercise group and 13±4.5° in the control group, while the mean postoperative valgus angles were 2.62±1.82° and 2.61±2.08°, respectively. No significant differences were observed between the groups regarding postoperative radiological alignment parameters. The mean TSK score decreased from 40.16±3.44 to 30.96±4.14 in the exercise group and from 39.12±3.01 to 33.08±2.94 in the control group. The improvement in TSK scores was significantly greater in the exercise group (p=0.042). Conclusions: The rehabilitation process is critical for improving functional capacity and independence after TKA. Preoperative exercise programs applied in degenerative knees due to osteoarthritis contribute positively to postoperative recovery. Preoperative rehabilitation reduces postoperative pain, improves knee function, decreases kinesiophobia, and enhances patients’ awareness of the postoperative process. However, early rehabilitation does not appear to influence short-term radiological alignment outcomes.

Anahtar Kelimeler

• Total knee arthroplasty
• Preoperative rehabilitation
• Exercise therapy
• Functional outcomes
• Early postoperative period

Etik Beyan

Ethical approval was obtained from the Harran University Clinical Research Ethics Committee prior to the study (approval no: HRÜ/22.09.36, session no: 09, date: May 9, 2022).

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