| Background of the studyImproper or inadequate exercise of rehabilitation on the early stage after total knee arthroplasty (TKA) may lead to troubles, such as limited range of motion (ROM) of knee, joint stiffness, muscle atrophy, which lead to inconvenience in the patients'activity and daily life postoperatively. In addition, with the development of modern society, patients require of more and more in functional rehabilitation of knee.ObjectiveTo observe the clinical efficacy of functional rehabilitation of knee joint by massage combining with conventional rehabilitation methods on the early stage after TKA, so as to provide better rehabilitation to the patients who underwent TKA.MethodsClinical materialsIn the Third Affiliated Hospital of Guangzhou University of Chinese Traditional Medicine (Orthopedics Hospital),60 patients with osteoarthritis (OA) who accept TKA for first time were enrolled as the research objects. The patients were grouped randomly into two groups:Group A, in which the patents were treated with massage combining with conventional rehabilitation methods; and Group B, in which the patents were treated with conventional rehabilitation methods only. There were 30 cases in Group A, and 30 knees underwent TKA, including 4 males and 26 females; age 52 years-85 years, mean 69.1 years; duration of OA lasting 5 years-20 years with an average of 12.6 years; double knee affected in 13 cases,9 cases of right knee, left knee joint in 8 cases. 30 knees underwent TKA, of which 16 are left knees and 14 are right knees. A total of 30 patients was in Group B, of which 7 males and 23 females; age of 54 years-83 years, mean age 69.3 years; duration of OA lasting 6 years-22 years, average 11.9 years; double knee affected in 15 cases,8 cases of right knee, left knee in 7 cases; 30 knees underwent TKA, of which 17 are left knees and 13 are right knees. The ages, genders, disease durations, the distribution of left and right knees of the two groups are not statistically different.TreatmentGroup A:the following rehabilitation treatment began at the first day after the operation, and the treatment divides in two parts. Part One, conventional rehabilitation:①keeping foot higher than hip;②Ankle pump movement;③functional exercises with weight bearing;④isometric knee extensor muscle exercises;⑤straight legs raise movement;⑥extremely extense and flex knee training;⑦knee extensor and flexor training in seat and anti-resistance knee extensor and flexor training;⑧management of stairs;⑨quadriceps muscle strength and popliteal rope muscle enhanced training;⑩enhance vastus medialis oblique muscle exercise;(11)guide patients independently completed daily life movement; (12)coordination training. Part Two, Chinese massage:①knead gently ankle and crus gastrocnemius;②flex and extend ankle in minor range;③rub popliteal fossa, crus gastrocnemius and ankle;④focalizing press on the following points:Sanyinjiao, Zusanli, Fenglong, Taichong, Chengshan, Chengjin; rub quadriceps muscle;⑤rub quadriceps muscle with major strength;⑥stroke smooth,kneading,pushing medially the knee joint;⑦extremely flex and extend knee joints and maintain for a certain time;⑧rotate knee joint gently;⑨pinch, knead and rollingly press quadriceps with major strength;⑩rotate knee joint with suitable strength in major range.Group B:Treatment is performed in the same way as the first part of Group A, without performing Chinese massage.Indicators for measurement The following indicators were measured before and after treatment:1. HSS score; 2. ROM of knee; 3. visual analog scale of pain (VAS); 4. quadriceps and popliteal rope muscle strength; 5. length of hospital stay.Results1. HSS scores of the two groups were not statistically significantly different in 3 days after operation (P>0.05), whereas there was statistically significant difference in postoperative 1 week,2 weeks and 1 month, and HSS score of Group A was higher than that of Group B.2. ROM of knee of the two groups of had no statistically significant difference after postoperative 3 days (P>0.05), however, they were significantly different in statistics in 1 week after the operation, ROM of Group A being larger than that of Group B (P<0.01), and so did in 2 week and 1 month after surgery (P<0.05).3. The numbers of VAS of Group A were lower than those of Group B, there being statistically significant differences in the VAS in both groups in postoperative 3 days,1 week,2 weeks and 1 month (P<0.01).4. Quadriceps and popliteal rope muscle strength of Group A were stronger than those of Group B, and there was a statistically significant difference between them in postoperative 3 days (P<0.01), so did in postoperative 1 week, 2 weeks and 1 month (P<0.05).5. The average length of hospital stay of Group A was shorter than that of Group B, and there was statistically significant difference between them (P<0.01).6. One month after the operation, the excellent and good rate of the therapeutical effect concerning HSS score was significantly different in statistics between the two groups (P<0.05), and Group A being better than Group B.ConclusionApplication of conventional rehabilitation therapy plus Chinese massage in the early stage after TKA for functional rehabilitation of operated knees is more therapeutically effective than only-application of conventional rehabilitation therapy.
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