Substantiated use of robotic mechanotherapy integrated with the analysis system in patients after knee arthroplasty

Authors:

Khoziainova Stella Samvelovna – Lecturer of the Department of Physical and Rehabilitation Medicine, Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation, 6 Akademika Lebedeva St., 194044 Saint Petersburg, Russian Federation; assistant of the Department of Physical and Rehabilitation Medicine of the North-Western State Medical University named after I.I. Mechnikov, 47 Piskarevskiy Avenue, 195067 St. Petersburg, Russian Federation; assistant of the Department of Physical and Rehabilitation Medicine, Albrecht Federal Scientific and Educational Centre of Medical and Social Expertise and Rehabilitation, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; e-mail: stella.khozyainova@gmail.com; https://orcid.org/0000-0002-7231-6018.

Kustova Oksana Vyacheslavovna – PhD in Medical sciences (Cand. Med. Sci.), associate professor, head of the Center for Physical and Rehabilitation Medicine, Albrecht Federal Scientific and Educational Centre of Medical and Social Expertise and Rehabilitation, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; associate professor of the Department of Physical and Rehabilitation Medicine, I.I. Mechnikov North-Western State Medical University, 47 Piskarevskiy Avenue, 195067 St. Petersburg, Russian Federation; e-mail: o.v.kustova.med@mail.ru; https://orcid.org/0009-0007-1408-7492.

Ponomarenko Gennadiy Nikolaevich – Corresponding Member of the Russian Academy of Sciences, Honored Scientist of the Russian Federation, Grand PhD in Medical sciences (Dr. Med. Sci), Professor, Director General of the Albrecht Federal Scientific and Educational Centre of Medical and Social Expertise and Rehabilitation, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; Head of the Department of Physical and Rehabilitation Medicine, North-Western State Medical University named after I.I. Mechnikov, 47 Piskarevskiy Avenue, 195067 St. Petersburg, Russian Federation; e-mail: ponomarenko_g@mail.ru; https://orcid.org/0000-0001-7853-4473.

Abuseva Gulnara Ryakitovna – senior Lecturer of the Department of Physical and Rehabilitation Medicine, Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation, 6 Akademika Lebedeva St., 194044 St. Petersburg, Russian Federation; assistant of the Department of Physical and Rehabilitation Medicine, I.I. Mechnikov North-Western State Medical University of the Ministry of Health of the Russian Federation, 47 Piskarevskiy Avenue, 195067 St. Petersburg, Russian Federation; e-mail: bomar-oz@ya.ru; https://orcid.org/0000-0002-9525-6361.

Annotation:

Introduction. The study of modern approaches to rehabilitation of patients after total knee replacement has allowed us to identify key aspects of recovery in the early stages after surgery: effective pain relief, restoration of joint mobility and the patient’s return to daily activity.
Correction of walking biomechanics disorders deserves special attention, since lameness not only reduces the patient’s quality of life, but also leads to overload of neighboring joints, causing the development of secondary pathologies.
The introduction of scientifically based rehabilitation programs in the first postoperative days plays a crucial role in improving the functions of the operated joint and is an urgent task of physical rehabilitation medicine.

Aim. Evaluation of the effectiveness of an integrated approach to rehabilitation of patients after total knee replacement in the early stages after surgery, including the use of modern robotic systems for continuous passive movement (CPM therapy), the h/p/cosmos rehabilitation complex to restore natural gait, an individually selected set of physical therapy exercises and physiotherapy methods.

Materials and methods. A modern methodology was employed, combining the use of robotic systems for CPM therapy, physiotherapeutic factors, as well as therapeutic exercises and the rehabilitation complex h/p/cosmos, aimed at restoring the functional capabilities of the patient and normalizing the gait pattern.
In this study, the effectiveness of comprehensive solutions for the rehabilitative treatment of patients following total knee arthroplasty in the early stages of the postoperative period was assessed.

Results. The analysis of baseline data revealed that prior to the initiation of therapy, all patients experienced restrictions in the movement of the knee joint (with a flexion angle of 123.51±2.44 degrees) and suffered from pain ranging from moderate to severe (from 4 to 7 points on the visual analogue scale). These factors had a significant impact on their daily activities. According to the results of assessments using the WOMAC, Lequesne, and Harris scales, the majority of participants showed a significant decrease in their level of functioning.
After completing the medical rehabilitation course, significant improvements were noted across all studied indicators. The range of motion in the joints increased on average to 95.58±1.27 degrees. The intensity of pain decreased to a mild level (1-2 points on the visual analogue scale), which had little impact on daily activities. Although moderate limitations in functioning persisted, positive dynamics were observed across all the scales used.

Discussion. Changes in goniometry parameters before and after the rehabilitation course demonstrated a significant improvement in the amplitude of knee joint flexion in patients in both groups. However, according to the WOMAC scale and the algofunctional Leken index, which assesses the intensity of pain, the maximum walking distance and daily activity of the patient, there is a statistically significant improvement in the main group.

Conclusion. The achieved results confirm the high effectiveness of the proposed comprehensive approach. The combination of robotic mechanotherapy, therapeutic exercises, and physiotherapeutic interventions allows for a significant acceleration of joint mobility recovery, minimizes the duration of the rehabilitation process, effectively reduces pain syndrome, and enhances patients’ quality of life in a shorter time frame. This methodology facilitates the rapid attainment of a full range of motion in the operated joint, which is critical for successful rehabilitation.

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