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Masaryk University Faculty of Medicine REHABILITATION IN Masaryk University Faculty of Medicine REHABILITATION IN PATIENTS AFTER TOTAL KNEE ARTHROPLASTY Bachelor´s Thesis Physiotherapy Bachelor’s Thesis Supervisor: Author: Mgr. Veronika Mrkvicová Josh Tilrem Brno, 2018 Name and Surname of the Author: Josh Tilrem Title of Bachelor’s thesis: Rehabilitation in patients after total knee arthroplasty Název bakalářské práce: Rehabilitace u pacientů po totální endoprotéze kolenního kloubu Department: Department of Rehabilitation and Physiotherapy MF MU Supervisor: Mgr. Veronika Mrkvicová Year of the Bachelor’s thesis defence: 2018 Summary: This Bachelor’s thesis is composed of two parts. The first part deals with the subject of total knee arthroplasty. The aim of this part is to describe the indication, surgical procedure and treatment, both in acute and long-term phase. The first part also contains the approach and management of the physical therapist and how to utilize proper rehabilitation. The second part is a case study and the aim is to describe the practical procedure of a specific rehabilitation after total knee arthroplasty. This include examination at admittance, discharge and rehabilitation provided by the author. Souhrn: Tato bakalářská práce je složená ze dvou částí. Prní část pojednává o tématu totální endoprotézy kolenního kloubu. Cílem této části je popsat indikace, chirurgický přístup a léčbu, jak v akutní, tak chronické fázi. První část také zahrnuje fyzioterapetické postupy a provádění léčebné rehabilitace. Druhá část obsahuje kazuistiku a jejím cílem je přiblížit praktické postupy speciální rehabilitace po totální endoprotéze kolenního kloubu. To zahrnuje vstupní a výstupní vyšetření a rehabilitaci prováděnou autorem. Keywords: Total knee arthroplasty, rehabilitation, physiotherapy Klíčová slova: Totální endoprotéza kolenního kloubu, rehabilitace, fyzioterapie I agree that this bachelor thesis will be archived in the Masaryk University of Brno library and will be quoted according to citations norms. I declare that this bachelor thesis was written independently, under the supervision of Mgr. Veronika Mrkvicová, and that I stated all the literary and technical resources in the bibliography list. 30th of March, Brno Josh Tilrem _______________ Acknowledgements: I would like to thank Mgr. Veronika Mrkvicová for her supervision, great leadership, professionality, advice and patience. I also would like to thank MUDr. Jarmila Siegelová for her guidance and Mr. D.V. for his excellent cooperation. Contents 1 REVIEW OF THEORETICAL KNOWLEDGE ....................................................... 8 1.1 GENERAL PART OF THE THESIS ................................................................................... 8 1.1.1 Definition of total knee arthroplasty ...................................................................................... 8 1.1.2. Functional anatomy of the lower limb ................................................................................... 8 1.1.2.1 Bones .................................................................................................................................. 8 1.1.2.2 Ligaments ........................................................................................................................... 9 1.1.2.3 Joints ................................................................................................................................ 12 1.1.2.4 Muscles ............................................................................................................................ 14 1.1.3 Indications for TKA ............................................................................................................. 16 1.1.3.1 Injury ................................................................................................................................ 16 1.1.3.2 Osteoarthritis ...................................................................................................................... 17 1.1.3.3 Rheumatoid arthritis ......................................................................................................... 20 1.1.4 The surgical procedure of TKA ........................................................................................... 22 1.1.4.1 Background ........................................................................................................................ 22 1.1.4.2 Preparation ......................................................................................................................... 23 1.1.4.3 Technique ........................................................................................................................... 24 1.1.4.4 Postoperative care .............................................................................................................. 25 1.1.4.5 Contraindications ............................................................................................................... 25 1.1.4.6 Technical considerations .................................................................................................... 26 1.1.4.7 Procedural planning ........................................................................................................... 27 1.1.4.8 Risks and complications .................................................................................................... 28 1.2 SPECIALIZED PART OF THE THESIS ............................................................................... 30 1.2.1 Rehabilitation in acute phase after TKA ................................................................................... 30 1.2.1.1 Positioning ........................................................................................................................... 30 1.2.1.2 Respiratory physiotherapy ................................................................................................. 30 1.2.2 Therapeutic exercise after TKA ................................................................................................ 31 1.2.3 Physical therapy modalities after TKA ..................................................................................... 31 1.2.4 Occupational therapy after TKA ............................................................................................... 33 1.2.5 Manual techniques after TKA ................................................................................................... 33 1.2.5.1 Scar tissue mobilisation ..................................................................................................... 33 1.2.5.2 Patellar mobilisation .......................................................................................................... 34 1.2.6 Psychological and social aspects after TKA ............................................................................. 34 2 CASUISTIC .................................................................................................................................. 36 2.1 BASIC DATA ........................................................................................................................... 36 2.1.1 Case history ............................................................................................................................... 37 2.2 EXAMINATION ..................................................................................................................... 39 2.2.1 Kinesiological examination of the patient ................................................................................ 39 2.2.2 Manual muscle test ................................................................................................................... 43 2.2.3 Muscle shortening test .............................................................................................................. 44 2.3 SHORT-TERM REHABILITATION PROGRAM ........................................................... 45 2.3.1 Realization of rehabilitation ...................................................................................................... 46 2.4 KINESIOLOGICAL EXAMINATION OF THE PATIENT AT THE COMPLETION OF COMPREHENSIVE REHABILITATION ............................................ 49 2.5 LONG-TERM REHABILITATION PROGRAM ............................................................. 54 2.6 CONCLUSION ........................................................................................................................... 55 3 REFERENCES............................................................................................................................ 56 List of Acronyms: TKA total knee arthroplasty ROM range of motion PROM passive range of motion ACL anterior cruciate ligament PCL posterior cruciate ligament CCD caput-collum-diaphyseal AROM active range of motion ECG electrocardiography PT physiotherapist 1 REVIEW OF THEORETICAL KNOWLEDGE 1.1 GENERAL PART OF THE THESIS 1.1.1 Definition of total knee arthroplasty Total knee arthroplasty is a surgical procedure of the knee joint where damaged parts are replaced by artificial parts [WILLIAM C.S, 2017]. 1.1.2. Functional anatomy of the lower limb 1.1.2.1 Bones The two hip bones os sacrum and ossa coxae are connected through articulatio sacroiliaca and symphysis pubica. This result in a stable ring structure which enable transferring of the bodyweight to the lower limb. Ossa coxae is composed of three parts, os ilium, os ischium and os pubis. All these three parts contributes to the formation of acetabulum in which the proximal part of the femur bone is connected
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