Changes of Dynamic Parameters in Joints of the Lower Extremity before Endoprosthesis Replacement of the Knee Joint of Patients with Rheumatoid Arthritis

S.I. Gerasymenko, M.V. Polulyakh, I.V. Roy, A.S. Gerasymenko, T.V. Zamorskyi, V.M. Gromadskyi, E.M. Avtomeenko

Abstract


Rheumatoid damage of joints develops rapidly and aggressively, which leads not only to significant destruction of joints, as well as of surrounding tissues as the result of autoimmune reaction. After 5–8 years more than 50 % of patients lose working performance and 10–12 % people need a care-giver. Damage of knee joints is observed approximately in 70 % of cases of rheumatoid arthritis. Restoration of movements in knee joint on the late stages of the di­sease is possible only by means of surgery treatment. An important factor for efficiency of surgery treatment is rehabilitation of patients in the early postoperative period. Materials and methods. The study has been conducted in Institute of traumatology and orthopedics of NAMN of Ukraine. One hundred and thirteen patients with rheumatoid arthritis with damage of the knee joint have been surgically treated (total endoprosthesis replacement of the knee joint), with 27 patients operated on both knee joints, which sums up to total of 140 surgeries. The age of patients fluctuated from 18 to 77 years old and averaged 45,1 ± 1,1 years old. Results. Healthy person’s line of action of body weight passes through the centers of joints. Line of action of body weight falls through the center of the head, passes in one centimeter in front of the fourth lumbar vertebra, through the center of a coxofemoral joint, in front of the knee joint and lies down on the support area 4–5 cm to the front from the line of internal anklebones. This posture allows for the lowest energy losses. The method of mathematical statistics was used to calculate average parameters and evaluate clinical condition of patients before and after endoprosthesis replacement of knee joints. Based on these data, a complex of rehabilitation actions has been developed. The analysis of results of studies of patients’ walking after the treatment shows that patients’ walking becomes more dynamic: on the dinamogramme there appear the maximum load of forward and back pushes and the minimum of the inter-push period. Insignificant reduction of general time support has been discovered, compared to the period before the treatment, but walking still remained pathological due to a number of compensatory movements in the process of walking. Therefore there appear certain deformations in different parts of the support reactions graph. Conclusions. The developed program of rehabilitation of patients with rheumatoid arthritis with prosthetics of the knee joint allows carry out preparation of the musculoskeletal system for surgical treatment and restore the power of muscles, as well as the movement in joints in the postoperative period. The complex of actions which consists of remedial gymnastics, massage, mio­stimulation of muscles of the lower extremities and magnetoquantum therapy in preoperative and early postoperative periods promotes to improvement of dynamic indices of walking after endoprosthesis replacement of the knee joint of patients with rheumatoid arthritis. As the result of application of the method, a significant increase in load of back and front part of foot, reduction of time of foot support, as well as approach of walking to a dynamic type have been confirmed.


Keywords


rheumatoid arthritis; knee joint; endoprosthesis; biomechanics; rehabilitation

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DOI: https://doi.org/10.22141/1608-1706.5.16.2015.79791

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