Abstract
Introduction
Rapid increase of aged population has been one of major issue affecting national health care plan in Japan. In 2006, Japanese Orthopaedic Association proposed the clinical entity of musculoskeletal ambulation disorder symptom complex (MADS) to define the elderly population with high risk of fall and ambulatory disability caused by musculoskeletal disorders. Osteoarthritis of the knee is one of major cause of MADS. The number of patients with MADS underwent total knee arthroplasty (TKA) had been increased in Japan, and also expected to increase worldwide in the near future. The effectiveness of TKA for the patient with MADS has not been well evaluated. In the present study, we analyzed the early post-operative functional recovery after TKA using 2 simple performance tests to diagnose MADS.
Material & Method
Fifty patients with varus type osteoarthritic knees implanted with posterior-stabilized (PS) TKAs were subjected to this study. There were 44 female and 6 male patients. The mean age of the patients was 71.6 years (range, 59 to 84 years). Patients were subjected to 2 functional performance tests which were essential tests for MADS diagnosis. Firstly, 3 meter timed up and go test (TUG) was used to evaluate ambulation. Secondary one leg standing time with open eyes was measured to assess balancing ability. 2 tests were performed pre-operatively, 2 weeks after surgery and at discharge (23.8 days po). MADS was defined to be diagnosed if TUG and one leg standing time was not less than 11 seconds and/or less than 15 seconds respectively. Each parameter was compared among at above mentioned three time points -using a repeated measured analysis of variance (p<0.05).
Results
The number of the patients with MADS were 37, 44 and 38 in 50 patient pre-operatively, 2 weeks after surgery and at hospital discharge respectively. Mean TUG was 12.9, 16.9 and 14.0 sec. respectively [fig 1]. TUG significantly increased during 2 weeks after TKA, followed by significant decrease at discharge. There were no significant improvements in ambulation during hospital stay. Mean one leg standing time with operated and non-operated side leg at three time points were 11.0, 12.4, 17.9 sec, and 18.4, 17.9, 24.2 sec. each respectively [fig 2]. There were no significant improvements during initial 2 weeks after surgery. Significant increase of one leg standing time was found after 2 weeks, and balancing ability was found to be improved during hospital stay.
Discussion & Conclusion
Although both parameters assessing ambulatory and balancing function were found to be improved post-operative 2 weeks, still as much as 76% of patients were suffered from MADS at hospital discharge in our patient population. These results indicate that the patient after TKA has still exposed to high risk of fall and ambulatory dysfunction at discharge. We should reconsider the appropriate rehabilitation protocol especially for the elderly patient with MADS to meet with patient expectation and enhance early post-operative care.
