Correlation Between Lower Limb Skeletal Muscle Mass And Knee Functional Rehabilitation After Total Knee Arthroplasty

Objective: The patients who underwent total knee arthroplasty(TKA)for the first time were selected as the research objects to investigate the functional mobility and early functional exercise performance after TKA,and to evaluate the subjective functional rehabilitation of patients after TKA.The relationship between lower limb skeletal muscle mass(LSM)in patients with knee osteoarthritis(KOA)and functional rehabilitation after TKA;the influencing factors of LSM were analyzed to provide new ideas and intervention strategies for promoting knee functional rehabilitation nursing after TKA.Methods:1.Investigation and research on the current situation of knee functional rehabilitation and functional mobility after TKAUsing self-compiled general questionnaires and Western Ontario and Mc Master Universities Osteoarthritis Index(subscale Physical Function,WOMAC-PF),the initial admission to the Orthopedics Department of a tertiary hospital in Chongqing patients with lateral total knee arthroplasty were evaluated for postoperative subjective knee functional rehabilitation,the status of early functional exercise implementation after TKA was investigated,and the influencing factors of patients’ functional mobility and their differences were analyzed.2.Prospective follow-up study on the effect of LSM on knee functional rehabilitation after TKAConvenience sampling method was used to prospectively recruit 111 KOA patients who received unilateral TKA for the first time in the Orthopedics Department of a third-class hospital in Chongqing.The preoperative general data,LSM,lower limb muscle strength and lower limb function evaluation were collected,and the height unified correction LSM was used as the lower limb skeletal muscle mass index(LSMI).Subjective and objective evaluation of knee function was performed at the time points of the 1,3 and 6 months,and the objective evaluation result of the knee joint function score(hospital for special knee scores,HSS)6 months after TKA was used as the main outcome index.The effect of LSM on functional rehabilitation of patients after TKA was analyzed by univariate and multivariate Logistic regression.Using the WOMAC evaluation at 6 months after TKA as the secondary outcome index,the effects of LSM on subjective functional recovery and functional activity ability of patients after TKA were analyzed by univariate and multiple linear regression.3.Influencing factors of LSM in patients with TKAConvenience sampling method was used to select 144 KOA patients who were going to receive TKA for the first time in the Orthopedics Department of a tertiary hospital in Chongqing as the research subjects,including age,gender,body index,disease history,nutritional risk screening,laboratory indicators of nutrition and infection,Bone mineral density and other independent variables,LSM as dependent variable,and factors with statistically significant differences in univariate analysis as independent variables,multiple linear regression analysis was performed to explore the influencing factors of LSM in patients undergoing knee arthroplasty.Results:1.Investigation and research on the current situation of knee functional rehabilitation and functional mobility after TKA1.1 87% of the 110 post-TKA patients surveyed in this group can easily stand and walk 3months after the operation,which is the most satisfactory activity for the patients;35.6% of the patients at 6 months after the operation indicated that the level of walking endurance can be improved.Up to half an hour,while sitting-standing unassisted transfer,going up and down stairs,squatting,doing relatively heavy housework and other self-reported difficulties,asymmetrical weight bearing on both lower limbs and long-distance walking are not easy to complete;41.8% of the patients expected to be able to squat,and kneeling is an almost impossible activity.1.2 A total of 97(88.2%)patients underwent early functional exercise after TKA.There was a significant difference in the WOMAC-PF score of functional rehabilitation between the exercise group and the non-exercise group(19 vs 37,Z=-2.214,P=0.027).With the WOMAC-PF score as the dependent variable,the nonparametric statistical test results of univariate analysis showed that age,pain,home environment,early functional exercise and postoperative time were related to the patient’s self-function rehabilitation evaluation(P<0.05);the results of multiple linear regression analysis showed that pain(B=12.261,P<0.001)was positively correlated with WOMAC-PF,and early functional exercise(B=-18.751,P=0.003)and postoperative month duration(B=-5.960,P=0.023)were associated with WOMAC-PF negatively correlated.Knee function tended to be stable in the second half of TKA,and there was no significant difference in joint function between 6 months and 12 months after TKA(P=0.811>0.05).1.3 The content of early functional exercise was limited to knee range of motion and lower limb muscle strength,and only 13(13.4%)performed other functional training.Six months after TKA,patient complained of limitations in completing activities such as going up and down the stairs,getting on and off the bus,getting in and out of the bathtub,and doing more heavy housework.2.Prospective follow-up study on the effect of LSM on knee functional rehabilitation after TKA2.1 LSMI was negatively correlated with knee pain in KOA patients(r=-0.223,P=0.025),and affected the walking endurance of TKA patients six minutes before surgery,that is,lower limb function performance(r=0.209,P=0.037).2.2 Objectively evaluate joint function with the HSS evaluation score 6 months after TKA as the main outcome index.2.2.1 Divide the patients into two groups: HSS<85 is divided into general group(78.508±4.930),HSS≥85 is divided into excellent group(90.892±3.992),55(53.9%)of 102 patients postoperative knee function rehabilitation effect achieved excellent,and the objective joint function rehabilitation evaluation score of the excellent group was significantly higher than that of the general group [t=-14.016,P<0.001].2.2.2 Univariate analysis of the objective evaluation indexes of joint function of the two groups of patients at 6 months after TKA showed that the results were age,education level,BMI,preoperative HSS,LSMI,lower extremity muscle strength,and postoperative pain were significantly different(P<0.05);the LSMI of patients in the excellent joint functional rehabilitation group was higher than that in the general group(2.50±0.27 vs 2.18±0.33,F=3.723,t=-5.400,P<0.001).2.2.3 Multivariate logistic regression analysis results table for independent variable screening by stepwise regression,under the premise of early functional exercise,age and postoperative pain were independent risk factors for the excellent function rehabilitation affect of patients 6 months after TKA(P<0.05);LSM was a protective factor(P<0.05).<0.05).2.3 Taking the WOMAC evaluation score 6 months after TKA as the secondary outcome index,the postoperative rehabilitation of patients was subjectively evaluated.2.3.1 Univariate analysis of patients’ age,gender,educational level,disease pain history,preoperative HSS,LSMI,lower limb muscle strength,postoperative first landing time,postoperative hospitalization days,caregivers and postoperative pain subjective subjective to patients after TKA rehabilitation evaluation,that is,the overall score of WOMAC showed a difference(P<0.05).Further multiple linear regression analysis was performed,and the results showed that the overall WOMAC after TKA,that is,the influencing factors of patients’ self-joint rehabilitation evaluation,were postoperative pain,age,and LSMI in order(P<0.05).2.3.2 Using WOMAC-PF as the dependent variable,univariate and stepwise multiple linear regression analysis were used respectively.The results showed that the patient’s age,type of comorbidity,LSMI,lower extremity muscle strength,and postoperative pain were the factors that affect the patient’s self-assessment of functional rehabilitation,that is the main factor of difference functional mobility.3.Influencing factors of LSM in patients with TKAUnivariate analysis showed that gender,BMI,smoking,Hb,ESR,vitamin D and bone mineral density(BMD)were associated with LSM(P<0.05);stepwise multiple linear regression analysis showed that male LSMI was higher than female(β=0.526,P<0.001),BMI was a protective factor for LSM(β=0.410,P<0.001),while BMD was positively correlated with LSM(β=-0.269,P<0.001).Conclusions:1.Early functional exercise can improve the function of knee in patients after TKA,and improve the daily functional activity level of patients.However,even on the premise of adhering to the early functional exercise,after reaching a stable period of knee function rehabilitation for 6 months after TKA,the patient complained that the completion of up and down stairs,squatting,kneeling,long-distance walking,etc.required more participation of the lower limb musculoskeletal system.There are problems in activities,suggesting that there may be other objective factors that affect the functional rehabilitation of knee.2.LSMI is a confounding factor for knee pain and lower limb functional performance in KOA patients.Knowing the patient’s LSM before surgery is helpful to judge the functional status of the patient’s lower limb and improve the quality of perioperative nursing decision-making.3.LSMI is an objective protective factor for achieving excellent function rehabilitation outcome at 6 months after TKA.Clinical rehabilitation nursing should pay attention to the influence of preoperative LSM on postoperative rehabilitation of TKA patients.4.LSMI is an influencing factor of postoperative self-rehabilitation evaluation of knee function and the level of functional mobility.Nurses should predict the effect of joint function rehabilitation according to the results of patients’ LSM evaluation when implementing preoperative health education and set up patients’ self-function reasonably rehabilitation target expectations.5.Gender,BMI and BMD can be used as nursing predictors of preoperative LSM in patients with TKA,which can be considered by clinical nurses when formulating targeted rehabilitation nursing programs.